Riverside College

Bacolod City

Knowledge of Selected Nurses and Clinical Instructors

Towards Pap Smear In Relation To Cervical Cancer

In Partial Fulfillment

of the Requirements for Master in Nursing

Submitted to:

The Faculty of Graduate Studies

Submitted by:

Joanna Sandy P. Villaester, RN

April 12, 2010

 CHAPTER I

INTRODUCTION

Background of the Study

Cervical cancer or the cancer of the cervix was found to be highly prevalent in

developing countries such as the Philippines where 80% of the total case had been reported

(Babao-Guballa, 2007). Approximately ten Filipino women die each day due to this type of

cancer (Facts and Estimates by the Philippine Cancer Society, Inc., 2005) which is second to

breast cancer as the leading cause of death among Filipino women (DOH, 2003).

99.7% of the total cases show that Human Papilloma Virus or HPV was held responsible

for the occurrence of the said cancer. The World Health Organization estimates 630 million

people have HPV and there are up to 40 million cases of abnormal cervical cells and pre-cancers,

which are conditions that may lead to cervical cancer.

Most of the time, this virus is transmitted by sexual contact where it is estimated that

many people get HPV within two to three years after becoming sexually active (CECAP, 2007);

but skin-to-skin transmission is also possible.

The high prevalence rate of cervical cancer is due to the fact that HPV is highly

contagious since acquisition of this virus is possible with just a single event of exposure. The

fatality of cervical cancer is also due to the fact that the virus rarely causes symptoms especially

on its early stages which explain the late presentation of the disease (DOH, 2008).

Early detection of the precursor lesions of the invasive disease can lead to a reduction in

the number of cervical cancer cases and, thus, widespread screening of women is a must.

Cytological screening programs had proven to be effective in reducing the cervical cancer
incidence and deaths in develop nations. One widely used screening test in the early detection of

precancerous lesions and cervical cancer cells is the Papanicolaou test or the Pap smear test.

The high incidence and high mortality past attempts to fight the disease had been

inadequate and limited in scope and duration (CECAP, 2007).

Despite the effectivity of screening programs such as Pap smear in preventing the

cervical cancer, high incidence and high mortality of cervical cancer has continued because

attitudes and beliefs towards the test are negative. Medical workers in Uganda who are

responsible for screening women are not keen on getting their selves screened.

Negative practices and beliefs towards Pap smear can be possibly corrected through

proper education and understanding that this method can significantly reduces the occurrence of

cervical cancer.

The need to significantly reduce and understand the prevalence of cervical cancer in

some way will be satisfied by this study wherein the level of knowledge of clinical instructors

and staff nurses of Riverside Medical Center, Inc. regarding Pap smear will be determined.

Statement of the Problem

This study deals with the level of knowledge in Pap smear and its importance in the early

detection and treatment of cervical cancer among staff nurses and clinical instructors of

Riverside Medical Center, Inc.

Research Objectives

1. What is the profile of the staff nurses in Riverside Medical Center, Inc. in terms of:

a. Sex

b. Age

c. Length of work experience

2. What is the profile of the clinical instructors in Riverside College, Inc. in terms of:

a. Sex

b. Age

c. Length of work experience

3. What is the level of knowledge in Pap smear among staff nurses in Riverside Medical

Center, Inc. in terms of its:

a. History and background

b. Preparation

c. Its importance in the early detection and treatment of the cervical cancer

4. What is the level of knowledge in Pap smear among clinical instructors in Riverside

College, Inc. in terms of its:

a. History and background

b. Preparation
 c. Its importance in the early detection and treatment of the cervical cancer

5. What information campaign program may be formulated to increase the level of

knowledge of staff nurses and clinic al instructors on Pap smear?

Conceptual Framework

PROFILE: INFORMATION
STAFF NURSES 1. AGE EXTENT OF CAMPAIGN
2. GENDER KNOWLEDGE PROGRAM TO
3. LENGTH OF WORK TOWARDS IMPROVE THE
CLINICAL LEVEL OF
INSTRUCTORS EXPERIENCE PAP SMEAR
KNOWLEDGE

Hypothesis

There is no significant difference between the clinical instructors’ and staff nurses’ level

of knowledge towards Pap smear, when it is classified into:

a. History and background

b. Preparation of the test

c. Its importance in the early detection and treatment of cervical cancer

Significance of the Study

The results of this study will be beneficial to the following:

The Health Sector of the Local Government. This study will be beneficial in the

evaluation of the effectiveness of their information dissemination with regards to the importance

of regular Pap smear and its role in the early detection of cervical cancer. The outcome of this

study will determine the necessity for a more intense information spread.
 The Riverside College Administration. This study will be beneficial by serving as an

evaluation tool whether their clinical instructors are providing correct information regarding Pap

smear and its importance in the early detection and treatment of cervical cancer. In the event that

this study proves adequacy on the part of the clinical instructors, then there will be an assurance

of correct health teachings provided by the student nurses’ to female clients of the reproductive

age. However, if inadequacy will be proven, then this study will serve as a proof for the need for

further seminars on Pap smear.

The Officers of the Riverside Medical Center Inc. This study will be beneficial in

ensuring that their staff nurses are providing the right information regarding Pap smear and its

importance in the early detection and treatment of cervical cancer to female clients of the

reproductive age. In the event that this study will prove correctness and sufficiency of the staff

nurses’ knowledge, then there will be an expected decline in the number of admission of clients

with cervical malignancy on the late stages. However, in case that this study will prove

inadequacy on the part of the staff nurses, then this will guide the prevention and early treatment

of cervical cancer. This study will also be beneficial to other researchers as this will be a guide

for their further inquiries.

Definition of Terms

The following terms are used in this study and are defined operationally:

Knowledge. In this study it refers to the extent of understanding of nurses on Pap smear

and its importance in the early detection and treatment of cervical cancer. The level of

knowledge will be categorized into three, namely: (1) Excellent – with 85% correct answers and
above; (2) Adequate – with 60% correct answers to 84%; and (3) Inadequate – with less than

60% correct answers.

Staff Nurses. In this study, it refers to all nurses with actual contact or exposure to female

clients of the reproductive age and is one of the respondents in this study.

Clinical Instructors. In this study, it refers to all clinical instructors who are handling

student nurses with actual exposures to female clients of the reproductive age, and is one of the

respondents in this study.

Dr. Pablo O. Torre Memorial Hospital. In this study, it refers to the work place of the

staff nurses where they provide female clients of the reproductive age information regarding Pap

smear and its importance in the early detection and treatment of cervical cancer.

Riverside College, Inc. In this study, it refers to the place where clinical instructors

educate student nurses regarding Pap smear and its importance in the early detection and

treatment of cervical cancer.

Sex. In this study, this refers to the biological preference of an individual categorized

either as male or female and is one of the variables in this study.

Age. In this study, age is divided into two sub groups: (1) young adult – those nurses as

well as clinical instructors whose age is between 20-29 years old; and (2) middle adult – those

respondents whose age is 30 years old and above. This is also one of the variables in this study.

Length of Work Experience. In this study, it refers to the length of service both

respondents had rendered in practicing their respective profession with actual contact with

female clients of the reproductive age in terms of years. This is sub categorized into: (a) Short –
refers to length of service less than five years; and (b) Long – refers to length of service more

than five years.

Scope and Limitations of the Study

This study aims to determine the familiarity with Pap smear of the selected clinical

instructors and staff nurses. The study also aims to ascertain how the sex, age and length of work

experience affects the knowledge level of the respondents regarding Pap smear and its

importance in the early detection and treatment of cervical cancer. The knowledge level of the

respondents will be access in terms of familiarity with: (a) History and Background of the Pap

smear, (b) Preparation of the test and (c) Importance in the early detection and treatment of

cervical cancer.

This study will be conducted on April 2010. The respondents of the study will be the 30

selected clinical instructors and 30 selected staff nurses. The target clinical instructors are those,

employed at Riverside College, Inc., who are handling student nurses with actual exposures to

female clients of the reproductive age for the second semester of academic year 2009-2010. The

target staff nurses are those currently employed at Riverside Medical Center, Inc. who are taking

care of female clients of the reproductive age from the month of November to March 2010.

Data will be gathered through the use of self-administered questionnaire that will be used

to access the level of knowledge of the respondents. The self-administered questionnaire will

include information from three topics, namely: (a) History and Background of the Pap smear, (b)

Preparation of the test and (c) Importance in the early detection and treatment of cervical cancer.

The instruments will undergo a series of validation and revisions as recommended by results of

the pre-test.
 The descriptive research design will focus on knowledge as dependent variables. The

independent variables are sex, age, and length of work experience.

The level of knowledge will be categorized into: (1) Excellent – with 85% correct

answers and above; (2) Adequate – with 60% correct answers to 84%; and (3) Inadequate – with

less than 60% correct answers.

 CHAPTER II

REVIEW OF RELATED LITERATURE

Cervical cancer is the second most common cancer among women, the first being breast

cancer. Worldwide, every two minutes, a woman dies of cervical cancer. In 2005, at least 10

Filipino women died from cervical cancer which is caused by the Human Papillomavirus or

HPV. (2005 Facts and Estimates by the Philippine Cancer Society, Inc.) The World Health

Organization estimates 630 million people have HPV and there are up to 40 million cases of

abnormal cervical cells and pre-cancers, which are conditions that may lead to cervical cancer. In

the Philippines, according to the 2005 Philippine Cancer Facts and Estimates, 7,277 new cases

and 3,807 deaths due to cervical cancer were estimated to have occurred. This meant that there

were approximately 10 Filipino women dying each day due to cervical cancer. This is mainly

due to late detection and lack of awareness of the disease among Filipino women.

CHAPTER III

METHODOLOGY

Research Design

Purpose of the study and Research Design

The purpose of this study is to determine the knowledge level towards Pap smear and its

importance in the early detection and treatment of cervical cancer among staff nurses of

Riverside Medical Center, Inc. and clinical instructors of Riverside College, Inc.
 The cross-sectional survey design will be employed in this investigation. The

independent variables in this study are age, sex, and length of work experience while the

dependent variables are the knowledge level of the respondents.

Method

Sample

The respondents of this study will be the clinical instructors of Riverside College, Inc.

and staff nurses of Riverside Medical Center, Inc.

The Purposive Sampling Technique will be employed in the selection of the respondents

wherein the respondents were chosen specially by the researchers. The level of personal variable

is determined as follows:

The sex of the respondents is either male or female.

Respondent’s age will be grouped into: (1) young adult – those nurses as well as clinical

instructors whose age is between 20-29 years old; and (2) middle adult – those respondents

whose age is 30 years old and above.

As to the length of work experience, this is sub categorized into: (a) Short – refers to

length of service less than five years; and (b) Long – refers to length of service more than five

years.

Instrumentation

Data collection will be done using self-administered questionnaires that will be pre-tested

to determine its validity. Some questions that will be included in the questionnaire will be
negatively stated, so the answers will be reversed to get the appropriate weights of the

respondent’s response.

Evaluation of Knowledge. This will be a self-administered questionnaire that intends to

gather information on the respondent’s knowledge level regarding the Pap smear and its

importance in the early detection and treatment of cervical cancer. This test will be divided into

three categories namely: (1) History and background, (2) Preparation, and (3) Importance in the

early detection and treatment of the cervical cancer. The participants were asked to check the

corresponding box which they think was appropriate. Each statement was provided with the

following responses:

Response Points

Yes 2

No 1

For negatively stated questions, the weight of the response is as follows:

Response Points

Yes 1

No 2

To interpret the scores, the following scale and corresponding description was used:

Scale Description
85% and above correct answers Excellent
60% to 84 % correct answers Adequate
below 60% correct answers Inadequate

Data Analysis Procedure

 The data obtained in this investigation was subjected to the following descriptive

statistical treatment:

Mean. The obtained mean scores will serve as the respondent’s general response.

The following scale of mean was used for the knowledge level:

Scale Description

1.85 - 2.00 High

1.60 - 1.84 Adequate

1.00 - 1.59 Inadequate

Cross Tabulation. To determine the frequency of scores garnered by each respondent

when grouped according to selected categories.