Miss. Valentina j sergay st. Johns college of nursing

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

ANNEXURE-2

PERFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1.	NAME OF THE CANDIDATE AND ADDRESS (IN BLOCK LETTER)	MISS.VALENTINA J SERGAY ST.JOHNS COLLEGE OF NURSING
2.	NAME OF THE INSTITUTION	ST.JOHNS COLLEGE OF NURSING , BANGALORE
3.	COURSE OF THE STUDY SUBJECT	MASTER OF SCIENCE (NURSING) MEDICAL- SURGICAL NURSING
4.	DATE OF ADMISSION TO THE COURSE	MAY 02,2013
5.	TITLE OF THE TOPIC	EFFECTIVENESS OF AN INFORMATION BOOKLET ON KNOWLEDGE OF PATIENT REGARDING MANAGEMENT OF TRANSURETHRAL RESECTION OF PROSTRATE (TURP) IN A SELECTED HOSPITAL, BANGALORE.

6. BRIEF RESUME OF INTENDED WORK

6.1 NEED FOR THE STUDY

Benign Prostate Hyperplasia (BPH) is the most common urological problem of ageing men, manifested as severe obstruction in urinary flow with discomfort and pain.BPH complex disease from etiology and pathological point view.¹ A recent AUA guideline (2003) suggest an increase in the incidence of BPH worldwide and predicts by the age of 60 years,more than 50% of men will have microscopic evidence of the disease and by the age of 85 yrs as many as 90% of men affected.² In India, BPH has the incidence rate of 60% for those above 60yrs old.

Transurethral resection of the prostrate (TURP) surgery is to remove all or part of prostate gland to treat an enlarged prostrate.³ From 20^th century onwards , the premier treatment for symptomatic benign prostatic hypertrophy (BPH) was transurethral resection of the prostate (TURP) .TURP was the first successful, minimally invasive surgical procedure of the modern era.

The criteria for performing TURP surgery are now more stringent than before. In general ,TURP surgery is reserved for patients with symptomatic BPH who have acute, recurrent, or chronic urinary retention; in whom medical management and less invasive prostatic surgical procedures failed; who have prostrates of an un usual size or shape (eg;a marked enlarged median lobe, significant intravesical prostatic encroachment); who have azotemia or renal insufficiency due to prostatic obstruction; or who have the most severe symptoms of prostatism.⁴

Benign prostatic hyperplasia (BPH) is a common urological disorder. Open prostatectomy, a relatively high –morbidity and expensive procedure was gradually replaced by transurethral resection of the prostate (TURP) as the standard surgical treatment of small to medium sized BPH.¹ High success rates, lower costs and shorter recovery times after TURP were among the factors contributing to the gradual replacement of open prostatectomy.

TURP is the classic treatment for urinary symptoms due to prostate (prostatism) or BPH, Prostatic tissue is removed and so the physical bulk of the prostate is reduced. Obstruction is reduced and urinary symptoms considerably improved. The operation is performed through the penis and usually there are no cuts or surgical incisions. The procedure is tolerated reasonably well, although associated with retrograde ejaculation. It is the gold standard treatment for BPH with many years of history to support its use.⁶

St. John’s Medical College Hospital is a tertiary care center with a bed strength of 1100. Every month about 20 TURP surgeries are done. The investigator while interacting with patients in urological ward found that, patients had difficulties related to frequent hospitalization, verbalization of patients regarding altered family roles and responsibility and fear of future. Every patient who undergo TURP experiences some doubt, but the magnitude may be different for each patient and also the way they tackle the situation.The investigator also observed that there is no teaching/pamphlet given to patient before or after TURP. This greatly motivated the investigator to do an interventional study to improve the knowledge of patients undergoing TURP and thus reduce complications.
6.2 REVIEW OF LITERATURE

A thorough literature review focusing on prior researches related to topic of study knowledge base. It helps to develop an insight in to the area of investigation and direct the researcher to develop a plan. The review of literate involves location, reaching an evaluation report of research as well as reports on causal observation and opinion that are related to individual planned research.⁷

The investigator organized the review under the following headings;

1. LITERATURE REALATED TO TRANSURETHRAL RESECTION OF PROSTRATE (TURP)

2. LITERATURE REALATED TO KNOWLEDGE OF MANGEMENT ON TURP

LITERATURE REALATED TO TRANS URETHRAL RESECTION OF PROSTRATE

A study on complications of transurethral resection of prostrate (TURP) and incidence management and prevention at three Germen centers was done in 100 patients. Findings showed that through the technological improvements there is a reduction of perioperative complications but TURP still represents the gold standard for managing BPH with less complication rates.⁷

A cohort study on incidence and prevalence of lower urinary tract symptoms suggestive of benign prostatic in primary care-Benign prostatic hyperplasia (BPH) is the most common benign tumor in men. By age 50 years, up to 50% of men may have histologically distinguished BPH with reported prevalence increasing to 90% by age 90. Histology indicating the presence of BPH includes proliferation of prostatic tissue around the urethra. Despite the high prevalence of histologic diagnosis, symptoms of the disorder do not affect all men presenting with BPH.⁸

A study was done to assess the effectiveness of patient education on quality of life in BPH patients in a South Indian teaching hospital results that, the patient education is effective in improvement of knowledge about the disease, symptoms, management of the disease and quality of life of BPH patients.⁹

LITERATURE RELATED TO KNOWLEDGE ASSOCIATED TO MANGEMENT ON TURP

A study was done to assess effectiveness of planned teaching programmed regarding home care management of TURP on BPH patients who are above the age of 50 years at wards in the Kastubra Hospital, Manipal. The major findings was that, most of patients (40.00%) were in the age group of 61-65 years and the total mean post-test mean score of knowledge (31.73) was significantly higher than that of pre –test (19.90) .The study revealed that knowledge level on BPH management among BPH patients is inadequate.¹⁰

A quasi experimental control group study conducted on a population consisting of patients who are under going for TURP surgery as control and experimental group.The study shows a significant difference in variances and outcome as a result of TURP clinical care intervention. The conclusion identifies their successful implementation of integrated clinical care intervention help health professional, manager and administrator to meet one of their biggest challenges in making optimal use of limited resources while delivering high quality and timely care.¹¹

A study to measure the effect of specific preoperative information on post-operative anxiety and satisfaction of Chinese male having TURP. The researchers allocated all patients (n-30) who undergoing TURP in a general hospital in Hong Kong during a 3 months period. The experimental group (n-15) receives a specific information pamphlet and a general pre-operative counseling video and post-operative care suggestion. Experimental subject reported significantly lower anxiety levels post-operatively than controls.The conclusion findings support the importance of providing patients with specific written pre-operative information about the surgery and its effect to minimize their post-operative anxiety level and improve their satisfaction with the care provider. ¹²

An experimental study was conducted to test the hypothesis that the intra-operative use of a sacral wedge would decrease the incidence of post operative back pain in patients undergoing TURP of the prostate in lithotomic position. A total of 236 patients who are undergoing was recruited to the study and allocated to the control and intervention group by block randomization resulting a 52% of participants reported having a history of back pain and point prevalence on admission to hospital was 27%. 28% of participants experienced back pain on day 2 post operatively and this decreased to 14% on day 4. Conclusion is contrast to other studies we found no evidence to support the use of a sacral wedge intra operatively to reduce the incidence of post operative back pain. ¹³

A pilot study was designed to compare self concept alteration in a group of patients undergoing bi-lateral orchidectomy for treatment of advanced prostate cancer with a group undergoing TURP. The result provide both group also were diagnosed with cancer but no significant difference between the pre and post-operative self concept scores. ¹⁴

A quasi experimental study was done to determine the alteration of the continence after TURP and result shows that, at follow up after 43 months in 99 patients. The patients reported that after TURP urinary incontinence came as a complication. Conclusion is that the majority of the patients recorded urinary incontinence after TURP appears about 12.1%.¹⁵

A study was conducted to explore the concern of man with urinary incontinence in the early weeks of recovery after TURP in early stage of B.P.H. As a resulting a discharge they revealed many knowledge gaps about catheter care, post operative care incontinence and erectile dysfunction. Participants also perceive a lack of health care professional support .These information depicts severely affected quality of life and healthy post operative rehabilitation after TURP. ¹⁶

A quasi experimental study was done to assess the necessity of routine outpatient review following TURP for B.P.H patients. There are 102 patients with histologically proven that the follow up after TURP is helpful to prevent complication . ¹⁷

A comparative study was done own care map management postoperative prostatectomy care at home among 198 patients who underwent TURP and discharged on post-operative day 1, received the care map method of health care delivery at home. They were compared with 85 patients who were discharged on post-operative day 2 or 3 and received standard hospital based post-operative care and results derived that the care map method of health care delivery at home is more effective .¹⁸

A study conducted on the load on family and primary health care in the first six weeks after trans urethral resection of the prostate.55(80%)were satisfied with information given before the operation and 46(68%)were satisfied with information given in relation to discharge. Among patients discharged after TURP there is considerable number of treatment related symptoms in the first few weeks effect the family as well as health services. The study has resulted in better oral and written information in relation to discharge.¹⁹

A review on written and verbal information for patients being discharged from

acute hospital setting to home recommends that the use of both interventions are

significant to assure the stable care to the patients and appears to improve knowledge and satisfaction.²⁰

6.3 PROBLEM STATEMENT

A study to assess the effectiveness of an information booklet on knowledge of patients

regarding management of Transurethral Resection of Prostrate (TURP)in a selected Hospital

Bangalore.

6.4 OBJECTIVES OF THE STUDY

1.To assess the knowledge of control group regarding management of TURP.

2.To assess the knowledge of experimental group regarding management of TURP.

3. To compare the effect of information booklet on management of TURP between experimental and control group.

4. To determine the association of knowledge and selected baseline data.

6.5 OPERATIONAL DEFINITION

Effectiveness

The degree to which something is successful in producing a described result.

Oxford dictionary

In this study effectiveness refers to outcome in terms of change in knowledge achieved through information booklet.

Information booklet

Little book, pamphlet

-Oxford dictionary

In this study it refers to educational material which provides information regarding

BPH, TURP& management in terms of fluid intake, antibiotics, activity, bowels and bleeding.

Knowledge

Information or awareness gained through experience or education

-Oxford dictionary

In thus study knowledge refers to awareness of the patients of how the management after TURP, as measured by scores obtained using a structured questionnaire.

Baseline Variables

In the study base line variables refers to the age, previous history of BPH, educational qualification & occupation.

6.6 ASSUMPTIONS

1) Patients may have some knowledge regarding management of TURP.

2) Providing appropriate information may help to better compliance

6.7 DELIMITATION

The study is limited to adult patients who is undergoing TURP procedure in urology unit of SJMCH Bangalore.

6.8 PROJECTED OUTCOME

Based on the findings from the study , the information booklet will improve the knowledge of the TURP patients regarding management. This will help to reduce complications after TURP .This information booklet can be used for patient teaching in the urology wards.

6.9 HYPOTHESIS

H1: There is a significant difference in the knowledge scores of the patient regarding

management of TURP between experimental group and control group at 0.05 level of

significance.
H2: There is a significant association between knowledge of patients with selected baseline

variable at 0.05 level of significance.

7.1 MATERIAL AND METHODS

7.1 SOURCE OF DATA

7.1.1 RESEARCH APPROACH

Quantitative Research Approach will be adopted for this study.

7.1.2 RESEARCH DESIGN

The research design to be adopted for this study will be post-test only control group design.

7.1.3 SETTING

The study will be conducted in urology ward of St. Johns Medical College Hospital

(SJMCH), Bangalore .SJMCH is a1100 bedded multi –specialty, tertiary care Hospital which cactus the health needs of people from different parts of the country.

7.1.4 POPULATION

In this study, the target population is the clients who are undergoing TURP surgery of above 40 years old at urology ward of SJMCH, Bangalore during the time of data collection.

7.2 METHODS OF DATA COLLECTION

7.2.1 SAMPLING PROCEDURE

Purposive sampling technique will be used to select the samples.

7.2.2 SAMPLE SIZE

Sample size will be 42.

7.2.3 INCLUSION CRITERIA FOR SELECTION OF SUBJECTS

1) Age above 40 yrs

7.2.4 EXCLUSION CRITERIA FOR SELECTION OF SUBJECTS

1) Clients who are not mentally alert.

2) Patients who have any additional surgery along with TURP

7.2.5 INSTRUMENTS INTENDED TO BE USED

Section A: A structured questionnaire to assess the baseline variables of age, educational qualification, occupation, previous history of BPH and any other source of data.

Section B: A structured knowledge questionnaire will be used to assess the knowledge of management of TURP among control group.

Section C: Information booklet on management of TURP in the aspect of fluid intake, antibiotic, activity, bowel pattern, bleeding and follow up will be given to experimental group.

Section D:A structured knowledge questionnaire will be used to assess the posttest knowledge of experimental group.

7.2.6 DATA COLLECTION METHOD

Permission will be obtained from the Administrative authorities to conduct the study. The subject who are willing to participate in the study will be identified based on the inclusion and exclusion criteria.The purpose of the study will be explained to them and informed consent will be obtained from the subject. The baseline variables of the patient will be obtained by a structured questionnaire. After assessing baseline variables, a structured knowledge questionnaire will be used to assess the knowledge of control group before discharge and each section will take around 10 to 15 minutes. An information booklet will be given to experimental group one day prior to the surgery and posttest knowledge will be assessed by using the structured knowledge questionnaire on the day of discharge. This section will take around 10-15 minutes to complete.

.7.2.6 DATA ANALYSIS PLAN

Based on the observation of the study, data collected will be analyzed and interpreted by using descriptive and inferential statistics.

• 
  Descriptive Statistics
  

Frequency, Percentage distribution, means and Standard Deviation will be used to assess the knowledge of patients regarding management of TURP.

• 
  Inferential Statistics
  

Chi Square will be used to determine the association.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? SO, PLEASE DESCRIBE BRIEFLY.

In this study, the intervention is the information provided by the information booklet to one group of the clients. No investigations will be done on the subjects.Permission will be obtained from the Administrative authorities and Ethical Clearance Board of SJMCH and the head of the Urology Department.

7.4 HAS ETHICAL BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3?

The investigator will obtain administrative permission and approval from the research committee of the St. Johns College of Nursing prior to conducting the study.

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