Cancer is the second largest killer of disease around the world due to the growth of population, aging, life style changes etc. in India the estimated number of new cancer cases per year is 7 lakhs and 3.5 lakhs people die of cancer each year (WHO, 2010). The management of cancer is variable depend on a number of factors including the type, location and amount of disease and the health status of the patient.
Most of the cancer patient, after getting discharge from the hospital also, will suffer with a symptom of pain, vomiting, diarrhea, loss of appetite etc due to the effect of chemotherapy, radiation therapy and progress of disease. Patient and family members were not aware about management of problems and symptoms at home.
Nurses play a crucial role to deliver the discharge education using standard protocol in order to achieve the uniformity of care and effective patient outcome including quality of life
A self instructional discharge protocol for cancer client is a set of pre determined instructions that articulate situation in which the nurse makes education based on the specified criteria.
The objectives of the study were
To assess the need of self instructional discharge protocol for cancer patients among nurses in the experimental and control group
To assess and compare the post test level of knowledge and practice regarding self instructional discharge protocol for cancer patients among nurses in the experimental and control group.
To correlate the post test level of knowledge with post test level of practice in the experimental and control group.
To associate the posttest level of knowledge and practice regarding self instructional discharge protocol with selected demographic variables of the nurses in the experimental and control group.
The study was based on the assumptions that
1. Nurses may have some knowledge and practice on self instructional discharge protocol for cancer patients.
2. Providing information on self instructional discharge protocol for cancer patients may enhance knowledge and practice among nurses.
3. Adequate information regarding self instructional discharge protocol provided by the nurses to the cancer patients may promote their quality of life.
The null hypotheses formulated were
NH 1: There is no significant difference in the post test level of knowledge and practice
regarding self instructional discharge protocol for cancer clients among nurses in
the experimental and control group at p<0.05 level
NH2: There is no significant relationship between the post test level of knowledge with
practice regarding self instructional discharge protocol for cancer clients among
nurses in the experimental and control group at p<0.05 level.
NH3 : There is no significant association between the post test level of knowledge and
practice regarding self instructional discharge protocol with selected demographic
variables of the nurses in the experimental and control group.
The review of literature, professional experience and expert’s guidance from the field of medical and surgical nursing provided a strong foundation for the study. It also strengthened the ideas for conceptual framework, aided to design the methodology and develop the tool for the data collection.
In view of explaining and relating various aspects of the study, the investigator had adopted an Integrated Hildegard E Peplau’s Interpersonal Relationships Model and Robert R. Carkhuff’s Helping and Human Relationships Theory.
The researcher adopted a quasi experimental post test only design to assess the effectiveness of self instructional discharge protocol for cancer patients on knowledge and practice among nurses. 60 nurses were selected using non probability convenient sampling technique.
The tool for data collection had 4 sections. Part A: Personal data sheet to collect information on 5 demographic variables to assess the background of the nurses. Part B: Need assessment comprising of questions to assess the need of the staff nurses on self instructional discharge protocol for cancer clients. Part C: Structured knowledge questionnaire comprising of 30 questions to assess the knowledge of the staff nurses on self instructional discharge protocol. Intervention tool: self instructional discharge protocol for cancer patients. It comprises of 9 parts:
i personal hygiene instruction ii)pain management iii) safe use of medication iv)Dietary management v) care of wound vi) Rest and activity vii) Management instruction for selected adverse effect of chemotherapy and radiation therapy ix) follow up x)Family responsibility
Part E: Post practice was assessed using observational checklist for the Self instructional discharge protocol for cancer patients.
The medical, surgical and nursing experts validated the tool. The pilot study was conducted at VS Hospital chetpet, Chennai and it was found practicable and feasible to proceed with main the study.
The ethical aspect of research was maintained throughout the study by obtaining ethical committee clearance from the ICCR, formal permission from the authorities and written consent from the nurses who participated in the study. A brief introduction of self and explanation on the purpose of the study was given.
The investigator selected 60 nurses from the Medical and Surgical onclogy department of Cancer Institute Adyar, who fulfill the sample selection criteria using the Non probability convenience sampling technique. The study was conducted for a period of 4 weeks. A brief introduction of self and explanation on the purpose of the study was given. After obtaining written consent from the nurses, data collection was commenced. The investigator selected 60 nurses who fulfilled the sample selection criteria using the non probability convenience sampling technique from the medical and surgical oncology department of Cancer Institute, Adyar. At first, demographic detail was elicited using structured profile, and then the need assessment was done by using the positive worded questionnaire. The scale consisted of positive worded statements which were used to select the nurses based on the need.
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After the need assessment, to prevent bias, the investigator selected the experimental group (n=30) from the annexe hospital and control group (n=30) from the main hospital of Cancer Institute. The participants were assigned an identification number to maintain confidentiality. The nurses in the control group were gathered in the well ventilated room and questionnaire was administered on the day one to assess their knowledge regarding discharge instruction .It took 30 minutes to the nurses to answer the question. No intervention was given for the nurses in the control group. Following this the nurses in the experimental group were gathered together in the well ventilated room in the annexe block which had comfortable seating arrangements and the self instructional discharge protocol for cancer patients was administered.
Following this, both the groups were observed for 7 days, to record their practice using observational checklist. It took 10-20 minutes to record one observation for each nurse. After the seventh day, structured post test knowledge questionnaire was administered to the experimental group. On ethical grounds, the investigator administered self instructional discharge protocol for cancer clients for the control group. With that the study was concluded.
Major findings of the study
The data was analyzed using descriptive and inferential statistics.
The overall post test mean of knowledge in experimental group was 22.30 with S.D of 4.31 and the overall post test mean score of knowledge in control group was 15.03 with S.D of 3.44. The mean differed knowledge score was 7.27. This showed that after the administration self instructional discharge protocol, there was a highly significant difference in the knowledge level of nurses with a ‘t’ value of 7.220 at p<0.01 in experimental and control group.
The overall post test mean of practice in experimental group was 11.80 with S.D of 1.79 and the overall post test mean of practice in control group was 8.17 with S.D of 2.03. The mean differed practice was 3.63. This showed that after the administration of self instructional discharge protocol, there was a highly significant improvement in the practice level of nurses with a ‘t’ value of 7.344 at p<0.01 in experimental group.
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The post test level of knowledge of nurses in the experimental group showed that the mean score was 22.30 with SD of 4.31 in experimental group and the post test level of practice shows mean score of 11.80 with SD of 1.79. The calculated Karl Pearson ‘r’ value was 0.473, which showed moderate correlation between the post test level of knowledge and practice of the nurses in the experimental group at p<0.01.
The post test level of knowledge of nurses in control group showed that the mean score was 15.03 with SD of 3.44 and the post test level of practice showed mean score of 8.17 with SD of 2.03. The calculated Karl Pearson ‘r’ value was -0.011, which showed negative correlation between the post test level of knowledge and practice of the nurses in the control group at p<0.05.
There was no significant association between the post level of knowledge and practice regarding self instructional discharge protocol with the selected demographic variables of the nurses at p < 0.05 in experimental and control group.
CONCLUSION
The present study assessed the effectiveness of self instructional discharge protocol for cancer patients on knowledge and practice among nurses. On the basis of the above study findings, it can be said that by enhancing the nurse’s knowledge we can ensure sound practice and this should be a major concern in the present day health scenario. Hence, self instructional discharge protocol for cancer patients can be utilized by the nurses to provide effective care to cancer patients at the time of discharge.
IMPLICATIONS
Nursing Education
Nursing education is the foundation on which the nursing practice is built upon. Sound knowledge creates and ensures delivery of sound practice. Hence the protocol should be included in nurse’s education curriculum as well as in continuing refresher nursing education program.
Skill development is an essential component of professional life. The present study emphasizes on enhancement of knowledge and practice on discharge protocol for cancer patients.
Education has a positive impact on retention of knowledge, attitude and practice in all staff. There is a need to develop a system of continuing education to reduce the incidence of errors during discharge instruction.
In service education, refresher course and training programs on discharge instruction should be systematically planned and regularly conducted for staff nurses to keep them updated.
Nursing Practice
Nurses play a vital role in giving safe and effective nursing care to the clients. By enhancing the nurse’s knowledge regarding self instructional discharge protocol for cancer clients, we shall ensure a safe and sound practice.
Self instructional discharge protocol for cancer patients helps nurses to provide uniform and wholesome package of discharge instruction for cancer patients. This helps to boost the image of the nurses as an indispensable member of the health care team with their own scientific body of knowledge and scope of practice. The discharge protocol instruction should be useful for all cancer patients
Nursing Administration
Nurse as an administrator plays an important role in educating the professionals and in policy making. Nurse administrators should facilitate and encourage nurses to update their knowledge and practice on discharge instruction strategies by organizing in service education program.
Nurse Managers are in a position to prepare policies, protocols and enhance its use in the hospitals. Nurse managers can strengthen interdisciplinary and multidisciplinary collaboration with researchers.
Nursing leaders in the hospitals and accrediting bodies can implement policies to make sure that nurses in India practice uniform protocols and guidelines.
Nurse Managers are in a position to prepare policies, protocols and enhance its use in the hospitals. They can facilitate the conduction of in-service educations, periodic conferences, workshops and seminars on various aspects of discharge instruction for cancer clients which will enable the staff nurses to update their knowledge on recent advancements .
Nursing Research
The essence of research is to build up a body of knowledge in nursing. The findings of the present study serve as basis for other professionals and the student nurses to conduct further studies and to find out the effectiveness of various methods of providing education.
In India, the research studies related to assessment of knowledge and practice of staff nurses on discharge protocol was very few. Student researchers can be motivated to conduct studies in this area.
The nurse researchers should encourage the staff nurses to implement the research findings in their daily care and bring out more techniques to promote health of the clients.
The findings of the study can be disseminated to nurse practitioners and student nurses through internet, journals, literature etc.
The findings of the study will help the professional nurses and nursing students to gain knowledge on discharge protocol for cancer clients.
The generalization of the study results can be made by further replication of the study in various settings and larger population.
Develop stronger evidence base for nursing practice by conducting multisite studies.
RECOMMENDATIONS
The researcher encourages the use of discharge protocol for cancer patients in Cancer Institute Adayar and V S hospital Chennai.
The researcher recommends the utilization of discharge protocol for cancer patients by the student nurses of Omayal Achi College of Nursing and its affiliated hospitals.
Similar study can be replicated on a larger sample to increase validity and generalizability of findings.
A study comparing the staff nurse’s utilization and patient’s utilization of the protocol on discharge instruction of cancer clients can be done using mixed methodology.
A true experimental study can be conducted to assess the effectiveness of the discharge protocol for cancer patients.
An explorative study can be done at various settings to identify factors influencing the nurse’s practice on discharge protocol.
A study can be conducted to evaluate the quality of nursing care after implementation of discharge protocol
LIMITATIONS
The study was limited to nurses who are working in the medical and surgical oncology unit.
Researcher found difficulty in getting Indian reviews related to self instructional discharge protocol for cancer patients.
The researcher found it very strenuous to get permission from the hospital, to conduct the study
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