Rajiv Gandhi University of Health Sciences, Karnataka s2

Rajiv Gandhi University of Health Sciences, Karnataka

SYNOPSIS

FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 Name of the Candidate MS. POONAM SHARMA

2. Name of the Institution Diana College of Nursing No. 68, Chokkanahalli, Jakkur Post, Bangalore – 64

3. Course of Study and Subject Master of Science in Nursing

Medical Surgical Nursing.

4. Date of Admission to Course 10.06.2009

ASSESS THE EFFECTIVENESS OF 5. Title of the Topic VIDEO ASSISTED TEACHING ON KNOWLEDGE AND ATTITUDE REGARDING ORGAN DONATION AMONG STAFF NURSES IN SELECTED HOSPITAL, BANGALORE. 6. Brief resume of the intended work:

Introduction

“Don’t take your organs to heaven God knows they are needed here” Life is a dynamic process. It starts from birth and ends into death. In between, comes different stages of life with different diseases and problems. The medical advancement and technology has begun to save lives and the most miraculous achievement of modern medicine is organ transplantation which has the power to save the lives of the client.

Each organ of the body has its own important purpose to keep us well, but whenever it doesn’t work properly or stop working because of number of different reasons like shock, trauma etc., it is known as organ failure. The new form of organ failure was recognized in late 1970s, that of sequential failure of lungs, liver and kidneys usually followed by death and known as Multisystem organ failure. The paradoxes of MODS are evident in three epidemiological findings that have emerged since the syndrome was first written about in the late 1960s. (1)

The field of organ transplantation has evolved from the early beginning of experimental kidney transplantation to the current practice of multiple organ transplantation. The gift of organ and tissue by donation are a vital part of transplantation. Without the gracious decision of the donor or donor family to give the “gift of life” by donation, there would be no post transplantation miracle. (2)

“Don’t think of organ donations as giving up part of yourself, to keep a total stranger alive. It’s really a total stranger giving up almost all of themselves to keep part of you alive.”

According to inform Anatomical Gift Act of 2000, the success rate of organ donation has been raised to 80%. Even though organ donation has been developed, the people have numerous social, cultural and ethical misbelieves regarding organ donation. People consider organ donation as a life threatening and dangerous to the person. (3) The Transplantation of Human Act was enacted in 1994. Till now only about 1457 kidneys, 35 hearts and 40 liver transplantations have been done. At any point of time there is a huge waiting list for kidney, heart and liver transplantation. Also the number of people requiring life saving transplants continues to rise faster than the number of available donors. Approximately 300 new transplant candidates are added to the waiting list each month adding to the critical shortage of organs. (4)

The Need for Organ Donation despite the number of transplants, there are still not enough donor organs to fill the needs of those who require them. As of October 19, 2005, more than 89,790 people were on the waiting list for a suitable donor organ. More than 12,700 people wait five or more years to get a matching organ. Experts with Donate Life, a government- sponsored educational organization, estimated that 17 people die every day because they are unable to get a donor organ in time. (5)

A study conducted to assess knowledge, attitude, and proficiency in relation to organ donation among staff members of intensive care units (ICUs) in donor hospitals. A total of 1168 structured questionnaires were distributed to the health care professionals in the ICUs. Doctors were more positive toward organ donation than the nursing staff. Only 49% of the ICU health care professionals were willing to donate their own organs after death. 70% of the doctors were willing to donate own organs after death compared to 45% of the nurses. The survey demonstrated significant lack of experience in organ donation. Data showed a considerable need for more education and training, especially on how to inform and support the donor relatives and how to identify potential donors. (6)

The increase demand of organ transplantation and shortage of donor organs increase the need of the participation of public and health care providers in organ transplantation activity. And the first step in the donation process is awareness about the organ donation. Hence educational programme are in great demand especially for health care providers who in turn can motivate the public in donating organs.

6.1. Need for the study

“You have the power to change someone’s world by being a donor, it’s about living, and it’s about life……….Make the decision, share your life”

Organ donation is the removal of the organ or tissues of the human body from a person who has recently died, or from a living donor, for the purpose of transplanting whereas the organ donor is a person whose fatal injury related in brain death but who was otherwise healthy and infection free. Experts say that the organs from one donor can save or help as many as 50 people. The successful implementation of organ donation needs the positive attitude and proper knowledge towards cadaveric organ donation.

The number of people needing a transplant continues to rise faster than the number of donors. About 3,700 transplant candidates are added to the national waiting list each month. Each day, about 77 people receive organ transplants. However, 18 people die each day waiting for transplants that can't take place because of the shortage of donated organs. There are now more than 92,000 people on the waiting list. (7)

According to WHO, kidney transplants are carried out in 91 countries. It was estimated that organ trafficking accounts for 5-10% of the kidney transplants performed annually throughout the world in March 2007. In the United States in 2008, a total of 6,229 patients died because of the shortage of organ donors. Of these, 4,217 were awaiting kidneys; 1,447 needed livers; 54 pancreas; 368 hearts; 227 lungs, and 25 were waiting for intestines. Of these, 612 deaths were in New York State. (8, 9, 10)

The Total Cadaver Transplants activities for various solid organs from Jan 1995 to Jun 2001 in India are Kidney 379, Heart 34, Liver 12, Pancreas 02, Lungs 01 (total 428). Public attitude Survey to organ donation showed 72% of the population were willing to donate eyes and carry a 'Donor Card', however less than 50% were willing to consider solid organ donation. 74% of Hindus, 72% Christians, 58% Muslims were willing to consider organ donation; however the concept of brain death was new to most of the people. An audit of 159 brain death patients showed that 30 or 19% of the relatives donated of the organs of their loved ones. (11)

The studies show that 2.2 million people who die under circumstances that make them medically eligible to be either organ donor or tissue donor. This process of donation is technical one. Therefore, it is important for nurses not to forget family bereavement support. So there is need for additional awareness and education of areas of the organ donation process. (12)

A study conducted on the assessment of nurses' knowledge and educational needs towards organ donation within one adult general intensive care unit. The survey consists of 31 registered nurses who completed a confidential questionnaire. Study concluded that the sample lacked confidence in approaching relatives for donation consent, deficits in brain stem death testing and donor criteria. It was also apparent that a significant number of nurses could not identify which tissues can be donated and the contraindications for tissue donation. A majority of the sample stated their knowledge of donation issues would improve if an educational programme were developed on organ donation. (13)

Transplant is the only area in all of health care that can’t exist without the participation of the public and the health professionals. A study conducted on attitudes of hospital staff involved in organ donation. In a community hospital with 7–8 multi-organ extraction procedures each year 199 staff members were surveyed. Although only 7 % of the responding staff would personally refuse to donate an organ, 23 % would not give consent to organ donation from a close relative. 47 % of those prepared to be donors had signed a donor card. Donors informed their family more frequently (88 %) about their personal attitude towards organ donation than non-donors (60 %), or undecided personnel (43.8 %). The findings showed that much work needs to be done to encourage medical staff involved in organ donation to set an example to the community. (14)

Hence the investigator keeping the above view in mind felt to undertake this study among staff nurses who have a key function in asking for potential organ donors. Also as a part of health care providers, nurses are expected to come forward to motivate themselves and other public for organ donation. Moreover with the evidence of literatures, lack of knowledge regarding organ donation among nurses invites planned teaching programme to be conducted. In addition to this the personal experience also motivated the investigator to organise a planned teaching programme assisted by video teaching among staff nurses which may help to enhance the knowledge regarding organ donation.

6.2. Review of literature

The review of literature entails systemic identification, selection, critical analysis and reporting of existing information in relation to the problem of interest.

The purpose of review of literature is to obtain comprehensive knowledge and in depth information about nurses knowledge and attitude on organ donation. Thus literature review will help in developing a broad conceptual context into which research problem will fit. (15)

The review of literature is presented under the following subheadings: 1. Literature related to Organ donation. 2. Literature related to knowledge regarding organ donation. 3. Literature related to attitude regarding organ donation. 4. Literature related to knowledge and attitude regarding organ donation. 5. Literature related to effectiveness of planned teaching programme regarding organ donation.

1. Literature related to Organ donation.

A study conducted on the role of marginal donors in liver transplantation. 243 patients were implanted. From the 243 transplantations 40 recipients (16%) received marginal graft, 203 (84%) received non-marginal graft. Study concluded that there is no significant difference in morbidity and mortality of patients receiving marginal or non-marginal graft. Use of marginal grafts should be avoided in Hepatitis C virus positive recipients. (16)

A study conducted on Effect of "collaborative requesting" on consent rate for organ donation. 201 relatives of patients meeting criteria for brain stem death. 101 relatives were randomised to routine requesting and 100 to collaborative requesting. All were analysed on an intention to treat basis. In the routine requesting group, 62 relatives consented to organ donation. In the collaborative requesting group, 57 relatives consented. Study concluded that there is no increase in consent rates for organ donation when collaborative requesting is used in place of routine requesting by the patient's clinician. (17)

A study conducted on the variables that influenced brain-dead donor family groups to refuse donation. Interview method was used as a tool. This tool analyzed three phases. The first phase allowed the coordinator to evaluate the communication quality with the family group during a brain-death notification. The second phase assessed how families understood this notification, and the third phase identified the family grief sequence. Among the 186 interviews, 37.63% (n = 70) concluded as family refusals. Study concludes that Brain-death notification produced a deep sadness among family groups. There was a lack of knowledge regarding donation of tissues and organs. It was impossible to quantify the time needed by families to understand and accept brain death and to identify the grief sequence in order to avoid family refusals. (18) 2. Literature related to knowledge regarding organ donation.

A study conducted on the Knowledge regarding organ donation: identifying and overcoming barriers to organ donation. 455 undergraduate students, 26 MBA students, and 465 people from the surrounding community responded to 21 true/false questions regarding factual knowledge about organ donation. Study showed that the mean number of correct answers was 74.6%. Four questions with very large error rates suggest possible 'barriers to donation'. Study concluded that the knowledge of organ donation was related to whether subjects carried or requested an organ donor card, their attitude towards organ donation and their willingness to donate their own organs or the organs of a deceased loved one. (19)

A study conducted on the level of awareness about transplantation, brain death and cadaveric organ donation in hospital staff in India. 166 paramedical (nurses, technologists, medical physicists) and 100 nonmedical (administrative, clerical, engineering, social scientists, and miscellaneous) staff chooses for sample. A questionnaire was distributed in a group of randomly selected hospital staff. Study concluded that 97% had well to excellent awareness about transplantation, 17.3% of the hospital staff thought that brain death was a reversible process, and 59.4% had misconceptions about the retrieval of cadaveric organs. A significant positive correlation (r = 0.147, P = 0.01) was observed between the awareness of transplantation, brain death, and organ donation. A significant association was also observed between the workplace (operating room and intensive care unit vs. other donation areas) and awareness of transplantation (P = 0.048), and brain death and organ. (P = 0.030). (20)

A study conducted on the awareness and knowledge on eye donation among university students. Four hundred (400) students studying first year Medicine, Dentistry, Laboratory Technology, Pharmacy, Biomedicine and Bioengineering degree courses in the University of Malaya were taken as a sample. Study concluded that the majority of the students (344, 86%) in this study were aware about eye donation; the awareness was higher in biomedical (77.1%) and medical students (76.7%) compared to the others (55.9%-70.7%). (21)

3. Literature related to attitude regarding organ donation.

A study conducted on Organ and Tissue Donation attitude among Intensive Care Unit Nurses. A 31-item questionnaire was distributed to 418 nurses in 24 intensive care units (ICUs). Study concluded that three hundred sixteen (75.6%) expressed favourable attitudes regarding cadaveric donation. The major reason for their consent was humanity, and the major reason for their disagreement was “body respect.” Of the 418 nurses, 105 (25.1%) stated positive attitudes toward living kidney donation. (22)

A study conducted on the attitude of health professionals toward cadaveric tissue donation. An anonymous survey composed of 23 questions was given to health professionals from 2 university hospitals with donation experience. Among 600 distributed questionnaires 514 completely answered surveys was collected. Study concluded that 93% and 92% accepted the opportunity to receive an organ or tissue transplantation, respectively. The acceptance of a tissue varied according to the type: cardiovascular, 93%; ocular, 94%; skin, 89%; and musculoskeletal, 87%. Participant acceptance of a relative's tissue donation was 74%, refusal was 22%, and with doubts was 4%. (23)

A study conducted on the attitude towards organ donation of operating room nurses and their experiences of participating in the procurement of organs for transplant. In-depth qualitative interviews done with 14 operating room nurses. Study concluded that process of organ procurement is highly stressful and raises many concerns for operating room nurses. Experiences of nurses participating in surgical removal of organs for transplantation resulted in personal feelings of distress and negative attitudes to the issue of organ donation. (24)

A study conducted on the Nursing and Medical students' attitudes towards organ and corneal donation. A sample of 72 nursing and medical degree students from a British University completed a 61-item self-administered quantitative questionnaire. The study concluded that all but one of the respondents had an overall positive attitude towards organ donation; a significant relationship was found to exist between the extent of this positive attitude held by each student and their personal willingness to donate organs. In total, 74% of the student nurses had already signed a donor card, compared to only 43% of the medical students, and the difference in the two groups' personal commitment towards donation was significant (P = 0.005). (25)

4. Literature related to knowledge and attitude regarding organ donation.

A study conducted on the knowledge and attitudes of rural critical care nurses regarding organ donation. Self-reported knowledge and attitudes were measured for 46 critical care nurses using the Organ Donor Attitude Questionnaire and compared with respondents' demographic characteristics. Study concluded that Knowledge scores were found to be average (74% correct). Attitude scores reflected a strongly positive attitude toward organ donation. Increased knowledge of organ donation was not found to be related to a positive attitude. However, both attitude and knowledge were found to be positively correlated with previous experience in caring for either organ donors or recipients. Results were compared with data collected in an urban setting and found to be similar. Results of this study indicate that exposure to patients affected by organ procurement increased knowledge and improved attitudes of the nurses who provided care. (26)

A study conducted on the knowledge, perceptions and attitudes of practicing critical care nurses towards caring for 'brain stem dead' cadaver organ donors and their families. Data were collected through self-completion questionnaires from 103 critical care nurses. This was instrumental in forming a semi-structured interview schedule whereby seven respondents were interviewed. The findings of the study suggest that nurses are very favorable towards organ donation and this correlated with their knowledge of brain stem death (P < 0.024). Nurses with between 6 and 10 years critical care experience had a significantly higher knowledge base (P < 0.05) than those of less or greater experience. Study concluded that all nurses need to have a better understanding of their role in organ donation, no matter what nursing discipline they practice. (27)

A study conducted on the nurse’s knowledge, awareness and acceptance of tissue-organ donation. A prospective, descriptive and semi-analytic study was designed. Data were collected using 25 structured and semi-structured questionnaires. The respond rate for participation was 65.6%. Study concluded that Of the nurses, 87.7% had positive thoughts about the organ donation, but only 10.8% knew the donation law, 68.8% would consider donating organs of their own, 58.7% would consider signing a consent card, and only 36.7% would donate organs from their family members. Although, the majority had positive views about the issue only 34.4% showed willingness to talk to families and ask for donations, 84.0% would inform potential donors in the unit. Adequate knowledge and level of education were the factors effecting acceptance and willingness to be involved in organ harvesting efforts (p < 0.001 and p < 0.05).(28)

A study conducted on Knowledge and attitudes of critical care nurses regarding organ donation. Of the 147 critical care nurses who responded to the survey, over 92% supported organ donation in principle. However, only 65.3% had completed organ donor cards. Nurses responded correctly to 71.2% of the questions testing knowledge. Attitudes regarding organ donation tended to be positive, but 85% of nurses indicated reluctance to approach potential organ donors. Critical care nurses scored higher than other groups of nurses on the knowledge, attitude, and professional involvement in organ donation subscales. (29)

5. Literature related to effectiveness of planned teaching programme regarding organ donation.

A study conducted on Efficacy of an educational programme for secondary school students on opinions on renal transplantation and organ donation. Eight intervention and eight control schools were randomly selected. Questionnaire was used as a tool. The educational intervention increased favourable (31.5 to 42.9%) and uncertain (34.8 to 41.1%) opinions and decreased negative ones (33.7 to 16%). Study concluded that Educational interventions are effective in increasing interest and improving opinions about cadaveric organ donation. (30)

A study conducted to assess the effects of an educational programme about organ donation delivered by (ex-) patients with a successfully transplanted donor kidney on the willingness of adolescents to register their organ donation preference. A total of 319 secondary school students were randomly assigned to a control group who received no specific educational information about organ donation or to an experimental group who received a 45-min lesson provided by an (ex-) patient. Study showed that the educational programme increased the intention of the students to register their organ donation preference. Also, positive outcome expectancies, self-control over the decision, and knowledge increased and negative outcome expectancies decreased. It concluded that (Ex-) patients with experience with organ donation can successfully encourage adolescents to make a well-considered choice with regard to organ donation registration. (31)

A study conducted on The European Donor Hospital Education Programme (EDHEP): enhancing communication skills with bereaved relatives. A prospective study was conducted to determine what impact EDHEP has on communication skills. . Doctor-nurse pairs were taken as an experimental and control group for encountering Breaking Bad News and Donation Request to the relatives. Nurses showed no change in communication skills. Experimental group doctors showed significant improvement in breaking bad news and requesting donation; most of these improvements were not maintained. Control group doctors showed some improvement in breaking bad news. Study concluded that Attendance at EDHEP does lead to significant improvement in some, but not all, communication skills essential in breaking bad news and requesting donation. (32)

Statement of the problem

A study to assess the effectiveness of video assisted teaching on knowledge and attitude regarding organ donation among staff nurses in selected hospital, Bangalore.

6.3. Objectives of the study

1. To assess the pre-test knowledge regarding organ donation among staff nurses.

2. To assess the pre-test attitude regarding organ donation among staff nurses.

3. To assess the effectiveness of video assisted teaching on knowledge and attitude regarding organ donation among staff nurses.

4. To find out the correlation between the post-test knowledge and attitude regarding organ donation among staff nurses.

5. To find the association between post-test knowledge of staff nurses and their selected demographic variables.

6. To find the association between post-test attitude of staff nurses and their selected demographic variables.

Operational definitions

1. Assess: It refers to the statistical estimation of knowledge and attitude on organ donation among staff nurses by using structured knowledge questionnaire and attitude scale.

2. Effectiveness: It refers to significant gain in the knowledge and attitude regarding organ donation after video assisted learning as measured by structured knowledge questionnaire and attitude scale.

3. Video assisted teaching: It refers to planned teaching programme duly assisted by an audio visual aid such as LCD projector in delivering lecture on organ donation. 4. Knowledge: It refers to the response of the staff nurses regarding organ donation as elicited by structured knowledge questionnaire.

5. Attitude: It refers to expressed feeling of respondents regarding organ donation as measured by attitude scale.

6. Organ donation: It refers to the gifting of an organ or tissue (Heart, lung, liver, pancreas, renal, eye and bone marrow) to a needed person with organ failure by the person who is willing to donate his organ.

7. Staff nurses: It refers to the person working in a hospital setting after completion of his/her diploma/degree in nursing (GNM, B.Sc, Post basic) and have registered in State Nursing Council.

Hypothesis

H1: There will be a significant difference between pre-test and post-test knowledge scores regarding organ donation among staff nurses.

H2: There will be a significant difference between pre-test and post-test attitude scores regarding organ donation among staff nurses.

H3: There will be significant correlation between post-test knowledge and attitude scores regarding organ donation among staff nurses.

H4: There will be significant association between post-test knowledge regarding organ donation among staff nurses and their selected demographic variables.

H5: There will be significant association between post-test attitude regarding organ donation among staff nurses and their selected demographic variables.

Assumptions 1. Staff nurses working in hospital have some knowledge regarding organ donation.

2. Video assisted teaching may enhance the latest information and improve the attitude of staff nurses on organ donation.

Limitations:

The study is limited to the staff nurses who:

1. Have GNM/B.Sc/Post basic degree in Nursing.

2. Staff Nurses working in selected hospital.

7. Materials and methods:

7.1. Source of Data Data will be collected from staff nurses of selected hospital, Bangalore.

7.2. Method of Data

collection

Research Design Pre Experimental design- one group pre-test post-test will be used.

Setting Study will be conducted in selected hospital at Bangalore.

Population Staff Nurses

Sample The staff nurses working in selected hospitals will be the samples of the study.

Sample size 40 Staff Nurses Sampling technique Convenient sampling technique will be used to select the staff nurses at selected hospital.

Inclusion Criteria Staff Nurses who: 1. Can understand, read and write English.

2. Are available at the time of data collection.

3. Are willing to participate.

4. Have registered in State Nursing Council.

Exclusion Criteria Staff Nurses working in night duty at the time of data collection.

Tool will be divided in following sections:

Tool Section A: Structured knowledge questionnaire to assess the demographic data of staff nurses.

Section B: Structured knowledge questionnaire to assess the knowledge of the staff nurses regarding organ donation.

Section C: Attitude scale to assess the attitude of staff nurses regarding organ donation.

Section D: Planned teaching programme assisted by video teaching.

Data Collection Prior to data collection, permission will be obtained from concerned authority. Consent will be obtained from the staff nurses prior to the conduction of the study. Data will be collected by the investigator herself by using self administered structured knowledge questionnaire and attitude scale before intervention i.e. video assisted teaching. Then investigator teaches the staff nurses by means of video assisted teaching. Again the investigator herself will collect the data after the intervention.

Data analysis, Data The collected data will be organized by Presentation 1. Descriptive statistics: Frequency distribution, percentage, mean, and standard deviation will be used to assess the demographic variables and the pre-test and post-test knowledge and attitude.

2. Inferential statistics:

 Paired t-test will be used to compare the pre-test and post-test knowledge and attitude.

 Coefficient of correlation will be used to assess the relationship of post-test knowledge and attitude scores.

 Chi-square test will be used to determine the association of post-test knowledge and attitude with the selected demographic variables of staff nurses.

Analyzed data will be presented in the form of tables, diagrams, graphs based on the findings.

7.3. Yes, Pre test and post-test will be conducted among staff nurses before and after video assisted teaching regarding organ donation.

7.4 Yes, Informed consent will be obtained from concerned authority of institution and subjects prior to study. Privacy, confidentiality and anonymity will be guarded. Scientific objectivity of the study will be maintained with honesty and impartiality Ethical Committee:

Title of the topic A study to assess the effectiveness of video assisted teaching on knowledge and attitude regarding organ donation among staff nurses in selected hospital, Bangalore.

Name of the Candidate Ms. POONAM SHARMA

st Course of the Study and Subject M.Sc. (N) 1 year.

Medical Surgical Nursing.

Name of the guide Prof. Vasantha Chitra.D Head of the Department Department of Medical Surgical Nursing, Diana College of Nursing, Bangalore – 64.

Ethical committee Approved Members of Ethical committee:

1. Prof. Veda vivek

Principal and HOD

Department of Community Health Nursing