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Ensuring the Physical well being of children

INTRODUCTION

Jesus said “suffer little children and forbid them not, to come unto me; for of such is the kingdom of heaven” Mathew 19:14

Children are the future and hope of mankind. Health is wealth. Todays children will be the masters of future world. If children are healthy, future generation will be healthy, resulting in a healthy nation. The physical health of a child is very important because of its association with good mental and social development. The crippled are made and not born. “Crippled” means deformed in any part of the body other than legs and lame means deformed in either or both of the legs. (Malhotra.s,1994)

Poliomyelitis is an acute viral infection caused by a RNA virus. It is primarily an infection of the human alimentary tract but the virus may infect the central nervous system in a vary small percentage of cases resulting in varying degrees of paralysis, and possibly death. As a result of disability, the person experiences certain problems in his life and is not able to discharge the obligations required and play the role expected by him in society. Physically disabled people find themselves deeply debilitating and oppressive. Since the creation of vaccine in 1988, the Global polio eradication initiative has helped out the global toll of polio paralysis from an estimated 3, 50,000 to fewer than 500 in 200 An incidence of polio in the whole world during 1980 was about 52,552 and in 1990 the rate declined to about 23,484 and in the year 2000 the number of cases recorded were about 2979 and statistic of WHO reports cases of lesser than 500 in the year 2002. During the year 2008 (Nov) a total of 532 cases of polio were reported in India, as against 874 cases in the year 2007. (Park J, 2009)

The feeling of parents and other members of the family at the birth of a child will be in extreme delight. Children here get an important place in the human lives. They are loved and cared for by everyone in the family. But sometimes they may become the cause for their sorrow because of their disability (Malhotra.s, 1994)

Health is a state of complete physical, mental, social wellbeing and not merely absence of disease or infirmity (WHO, 1948). This is the universal definition of health. The individual who has any major illness will be affected mentally, physically and socially. The person will have difficulties in all aspects of his life situations and surrounding environment. The children who are affected by any illness will need the support from his family members, parents, friends, teachers and other significant members. Coping successfully with stress require adaptation, or process of the persons effort to manage internal and external demands. Coping is usually described as a problem solving process or strategy by which the person manages the out-of-the ordinary events or situations with which he or she is presented. Although coping may be entirely cognitive it is more likely to be a psycho physiologic activity involving an integration of the mind and body. So it is major process in the successful response to stress and crucial to the persons growth and development.

SIGNIFICANCE AND NEED FOR THE STUDY:

According to a conservative estimate, 10% of India’s population is physically challenged in one way or the other. Thus, there are about 40 million physically challenged people in the country at present. World wide, there are about 400 million physically challenged children. Each child with a physical disability has individual care needs. Routines that are taken for granted can be difficult or even impossible. Special exercises, special equipment, understanding and patience are the keys to helping children with physical disabilities and be as independent as possible. Independence is essential, not only for future living but also for the development of the child’s future living but also for the development of the child’s positive self concept. Self-care skills such as eating, dressing, bathing, and using toilet are fundamental to this independence. Whatever the limitations a child with a disability must deal with, he or she should be encouraged to handle as much of the routine as possible. (Girdle stone, 1996)

In south East Asia region, India is the only country reporting polio cases. During the year 2008 a total of 532 cases of polio were reported in India as against 374 cases in the year 2007. Polio was made in temperate conditions. Most of the studies in poliomyelitis found in sub-continent region are of endemic type of infantile paralysis. Only 2% of children with polio die in the acute illness and about 95% of all cases have paralysis of one or both the legs. In south India there are about 3.5/1000 population implying an annual incidence in the whole population of around 15/10,000. Now what that means is that in every class of about 100 students we can see at least one child who is paralyzed due to polio. (Ravindran.N, 1997) (Wyatt.H.V, .1988)

Coping strategies are the specific ways in children with polio. Cope with stressors, as distinguished from coping styles, which relatively unchanging personality characteristics or outcomes of coping. (Ryan.Wenger1992)

Research indicates that as children age they tend toward a more internal locus of control and use more vigilant modes of coping. Children as with adults, respond to everyday stress by trying to change the circumstances or trying to adjust circumstances the way they are. (LaMontagne &others,1996)

Ohlinc (1991) stated that, as a result of handicap, whether it is mild or severe, the handicapped children are facing a number of problems. He also stated that the problems may be emotional, social or adjust mental. Thus it is emotional and social adjustment to the problem.

The goal of nursing is the promotion of adequate responses which positively affect the health nursing seeks to decrease ineffective responses and promote adaptive responses. During the clinical posting where giving care to children with polio, the investigator identified that these children are with different psychosocial problems. It was felt by the investigator to assess their coping strategies and hence this study

Statement of the problem

A descriptive study to assess the psychosocial problems and coping levels among children with polio attending special school at Madurai 2010.

Objectives

To assess the psychosocial problems of children with polio

To assess the coping levels of children with polio

To find out the association between the psychosocial problems and selected demographic variables of children with polio

To find out the association between the coping levels and selected demographic variables of children with polio

To correlate the psychosocial problems and coping levels of children with polio

Hypotheses

H1 There will be a significant relation between the level of psychosocial and coping level among children with polio

H2 There will be a significant association between the level of psychosocial and selected demographic variables among children with polio

H3 There will be a significant association between the level of coping and selected demographic variables among children with polio

OPERATIONAL DEFINITIONS

.Psychosocial problems

In this study psychosocial problem of children with polio include difficulty in attending social functions, taking leadership in the class, participating in school athletic meet as well as in recreational activities and feeling neglected by others.

Coping level

In this study coping levels of adjusting, and to the independent life as far as possible means overcoming the physical deficit.

Children with polio

In this study children13-18 years of age who are all children diagnosed with polio at varying degrees of paralysis. These children are lower limb defects of the nervous system.

Assumptions

The children with polio will have certain problems due to their condition.

The children with polio will use various coping strategies to overcome their problem.

Delimitations

Study is delimited only to verbal response of the children in special school their social living was not observed.

Projected outcome

Findings of this study will help to identify assess the psychosocial problems among children with polio. Assess the coping strategies of children with polio. Find out the association between the psychosocial problems and coping levels in relation to selected demographic variables

CHAPTER-II

REVIEW OF LITERATUIRE

Review of literature is an essential component of a worthwhile study in any field of knowledge. It helps the investigator to gain information on what has been done previously and to gain information on what has been done previously and to gain deeper insight in to the research problem. It also helps to plan and conduct the study in systematic manner.

In this chapter, the investigator has presented the available research studies and relevant literature from which the strength of the study was drawn.

1. Studies related to cervical cancer

2. Studies related to HPV vaccination.

STUDIES RELATED TO CERVICAL CANCER

MiocLee,C.(1999) conducted a qualitative study with eight focus groups (number of sample=102) by using eleven question derived from the health belief model. Focus group revealed that there was misinformation and a lack of knowledge about cervical cancer. The women there fore were confused about causative factors and preventive strategies related to cervical cancer. The findings showed that major structured barriers were economic and time factors. The main psychological barriers were fear, denial confusion thinking. Participants stated that medical advice and education would influence them to undergo Pap test. Recommendations were made to reduce certain barrier and to increase knowledge and motivation.

Sheila,Twin. (2005) conducted a study among chinese women from a total sample of 467 in order to identify the knowledge about cervical cancer. Evident suggested that women knowledge about cervical cancer and preventive strategies are significant their screening practices. The need for further knowledge about the cervical screening and preventive measure was demonstrated.

HkoLiou, Xueminling. (2009) conducted cross sectional descriptive design on responses action and health promoting behaviors among rural Taiwanese women with abnormal Pap test. The result shows that nearly 14% were diagnosed as precancerous and underwent further treatment. 24%of the women took no action during the 3 month after receiving the result. As many as 96% were not aware about localized cervical cancer. These analyzed results may prove useful in developing intervention strategies to assist women with positive Pap test results to choose treatment modalities and adopted health behaviors.

STUDIES RELATED TO HPV VACCINATION

Kwan,T, et .al. (2007) conducted a cross sectional community based study to explore Chinese women’s perception of human papilloma virus vaccination and their intention to be vaccinated . A total of 1450 ethnic chinese women aged 18 and above who attended the health centers. The result shows about 38% of participants (n=527) had heard of HPV and about 50% (n=697) had heard of vaccination against cervical cancer. 88% of the participants(n=1219) indicate that they would likely to be vaccinated. Majority of the participants believed that sexually experienced women should be vaccinated; while27%opposed vaccinating sexually naïve women. study suggested that HPV infection was perceived to be stigmatizing to intimate family and social relationships, despite misconception and a grossy inadequate knowledge about HPV and HPV vaccination,

NubiaMunoz, et .al. (2007) conducted study among 17, 622 women aged 15–26 years who were enrolled in one of two randomized, placebo-controlled, efficacy trials for the HPV6/11/16/18 vaccine (first patient on December 28, 2001, and studies completed July 31, 2007). Vaccine or placebo was given at day 1, month 2, and month 6. All women underwent cervico vaginal sampling and Pap testing at day 1 and every 6–12 months there after. A result shows that vaccination was up to 100% effective in reducing the risk of HPV16and 18 related high-grade cervical, vulvar, and vaginal lesions and of HPV 6 and 11-related genital warts. In the intention-to-treat group, vaccination also statistically significantly reduced the risk of any high-grade cervical lesions (19.0% reduction; rate vaccine = 1.43, rate placebo = 1.76, difference = 0.33, 95% confidence interval [CI] = 0.13 to 0.54), vulvar and vaginal lesions (50.7% reduction; rate vaccine = 0.10, rate placebo = 0.20, difference = 0.10, 95% CI = 0.04 to 0.16), genital warts (62.0% reduction; rate vaccine = 0.44, rate placebo = 1.17, difference = 0.72, 95% CI = 0.58 to 0.87), Pap abnormalities (11.3% reduction; rate vaccine = 10.36, rate placebo = 11.68, difference = 1.32, 95% CI = 0.74 to 1.90). Conclusion of the study is High-coverage HPV vaccination programs among adolescents and young women may result in a rapid reduction of genital warts, cervical cytological abnormalities.

Infectious Disease Obstetric Gynecology journal. (2006) suggested that Vaccines which protect against infection with the types of human papillomavirus (HPV) commonly associated with cervical cancer (HPV 16 and 18) and genital warts (HPV 6 and 11) are expected to become available in the near future. Because HPV vaccines are prophylactic, they must be administered prior to exposure to the virus, ideally during preadolescence or adolescence. The young age of the target vaccination population means that physicians, parents, and patients will all be involved in the decision-making process. Research has shown that parents and patients are more likely to accept a vaccine if it is efficacious, safe, reasonably priced, and recommended by a physician. Widespread education of physicians, patients, and parents about the risks and consequences of HPV infection and the benefits of vaccination will be instrumental for fostering vaccine acceptance.

Andrea Licht,S, et. al. (2009) conducted study on HPV vaccination. The aims of this study were to assess HPV vaccination rates and to examine whether knowledge and risk perceptions regarding HPV were associated with the reported use of the HPV vaccine among female college students. A cross-sectional design was used among 406 women aged 18–26 years were recruited at two public universities and completed a self-administered survey. Respondents who reported having received at least one dose of HPV vaccine were classified as 'vaccinated' (n=177, 43.6%). Responses, stratified by the receipt of HPV vaccine, were compared using descriptive statistics and multivariate models. Results based on multivariate logistic regression modeling, 18-year-old women were approximately four times more likely to report use of the HPV vaccine compared with respondents aged 19–26 years. Respondents who correctly indicated that HPV caused genital warts were 1.85 times more likely to have received at least one HPV vaccine. African American and Asian women were each less likely to be vaccinated compared with white women. Risk perception was not significantly associated with vaccine uptake, however, the majority of respondents failed accurately to recognize their high risk of both acquiring and transmitting HPV. These findings suggest knowledge deficits and misperceptions about HPV risk as potential themes for educational campaigns encouraging the greater use of the preventive HPV vaccine among this subgroup

Allison Friedman,L. (2004) suggested that genital human papilloma virus (HPV) infection is the most common sexually transmitted virus in the united States, causing genital warts, cervical cell abnormalities, and cervical cancer in women. To inform HPV education efforts, 35 focus groups were conducted with members of the general public, stratified by gender, race/ethnicity, and urban/rural location. Focus groups explored participants' knowledge, attitudes, and beliefs about HPV and a hypothetical HPV vaccine as well as their communication preferences for HPV-related educational messages. Audience awareness and knowledge of HPV were low across all groups. This, along with an apparent STD-associated stigma, served as barriers to participants' hypothetical acceptance of a future vaccine. Although information about HPV's high prevalence and link to cervical cancer motivated participants to learn more about HPV, it also produced audience fear and anxiety. This research suggests that HPV- and HPV-vaccine-related education efforts must be approached with extreme

Raley, JC. (2004) suggested that Human papilloma virus (HPV) is the causative agent of cervical neoplasia and genital warts. A vaccine has recently been developed that may prevent infection with HPV. Vaccination for HPV may become a routine part of office gynecology. Researcher surveyed members of the American College of Obstetricians and Gynecologists (ACOG) to determine their attitudes to HPV vaccination. A survey was sent to Fellows of ACOG to evaluate gynecologists' attitudes. Vaccine acceptability was analyzed by using 13 scenarios with the following dimensions and respective attributes: age of patient (13, 17 and 22 years); efficacy of vaccine (50% or 80%); ACOG recommendation (yes or no); and disease targeted (cervical cancer, warts or both). Each scenario was rated by means of an 11-point response format (0 to 100). Responses were evaluated using conjoint analysis. Results of 1200 surveys that were sent out, 181 were returned and included in our analysis. ACOG recommendation was considered the most important variable in vaccine distribution (importance score = 32.2), followed by efficacy (24.5), age (22.4) and, lastly, disease targeted (20.9). Of these variables, higher efficacy was favored; preference was given to age 17 years, with a strong disinclination to vaccinate at age 13 years; and protection against cervical cancer, or genital warts, or both. Demographic characteristics of the gynecologists (i.e., age of physician, gender, and practice setting and community size) did not play an important role in the decision to recommend vaccination. Professional society recommendation is important for acceptability of a potential HPV vaccine. Gynecologists are willing to include this vaccine in their practice.

Chun Chao, et. al (2007) conducted study among 34,193 female who initiate HPV vaccination. The aim of the study was to examine the rate and correlate the completion of HPV vaccination. The result shows that the completion rate was 41.9% among age group between 9- to 17-year and 47.1% in the 18- to 26-year. Black race - 95% confidence interval and lower neighborhood education level were associated with lower regimen completion. A history of sexually transmitted diseases, abnormal Pap test results, and immune-related conditions were not associated with HPV vaccination regimen completion.

Caron, et. al. (2008) conducted a cross sectional study among college women, the study reveals that cervical cancer is primarily caused by the human papillomavirus (HPV) and is the second most common cause of cancer-related mortality among women. Purpose: College women may be at risk for contracting HPV based on their sexual behavior. An exploratory analysis was conducted, following the release of the HPV vaccine, Gardasil[R], the am of the study is to (1) determine awareness of HPV and Gardasil[R], (2) assess attitudes, behaviors, and beliefs about the HPV vaccine, (3) identify information sources that college women are accessing. Methods: A cross-sectional study of college women (n=293) enrolled in a Northeastern university voluntarily completed a self-administered questionnaire regarding knowledge, attitudes, behaviors, and beliefs about correlations, and paired sample t-tests. Results: Sexually active respondents would recommend the HPV vaccine to others and disagree that HPV vaccination would encourage risky sexual behavior. Yet, "need more information" is the predominant reason respondents would not get the HPV vaccine if it were offered for free. Discussion: Correlations are identified on how self-reported knowledge influenced attitudes, behaviors, and beliefs regarding the HPV vaccine. These findings should assist health educators in developing integrated public health education efforts for HPV vaccination that are targeted towards this at-risk population.

CHAPTER –III

METHODOLOGY

Methodology session includes the research approach, research design, setting of the study, population, sampling techniques, criteria of sample selection, sample size, method of sampling, description of the tool, scoring procedure, validity and reliability of the tool, data collection procedure, plan for data analysis, pilot study, and protection of human rights.

RESEARCH APPROCH

In this study experimental approach was adopted.

RESEARCH DESIGN

The research design selected for the present study was quasi experimental design with one group pretest post test design.

O1 X O2

O1 - Knowledge and attitude score before manipulation.

X - Manipulation of independent variable by planned teaching

Programme.

O2 - Knowledge and attitude score after manipulation.

SETTING OF THE STUDY

In this study C.S.I Jeyaraj Annapackiam college of nursing and C.S.I School of nursing was selected to be the setting. C.S.I Jeyaraj Annapackiam College of nursing is situated at pasumalai, Madurai. It is 3 kilometer away from the heart of the city. It runs PhD, M.Sc Nursing and B.Sc Nursing programme with annual intake of 50 students. The college has a total of 187 students. Among them 47 students are studying final year B.Sc nursing and C.S.I school of nursing is situated at kelavasal.It is 4 kilometers away from

C.S.I Jeyaraj Annapackiam college of nursing. The school of nursing has a total of 105 students. Among them 45 students are studying final year General Nursing and Midwifery.

POPULATION

The target population for the study was all the nursing students at Madurai. The accessible populations in this study were final year B.Sc Nursing and General nursing and midwifery. B.Sc Nursing students at C.S.I Jeyaraj Annapackiam College of nursing pasumalai and General nursing and midwifery students at C.S.I School of nursing in Madurai.

SAMPLE SIZE

.The sample size in this study was 90 nursing students.

CRITERIA FOR SAMPLE SELECTION

INCLUSION CRITERIA

Final year nursing students who were

studying in B.Sc Nursing and General nursing and midwifery.

willing to participate.

from both genders.

EXCLUSION CRITERIA

Final year nursing students who were

absent during the time of study.

sick during the tie of study

vaccinated with HPV vaccination.

METHOD OF SAMPLING

In this study purposive sampling technique was used to select the subjects. The participants were selected 45 nursing students from college of nursing and 45 nursing students from School of nursing.

DESCRIPTION OF THE TOOL

The instrument was developed by the investigator with the help of various resources and review of literatures. The questionnaires was prepared to asses the knowledge and attitude among nursing students on HPV vaccination. The tool consist of three parts

Part I - Demographic variables

Part II - Assessment of knowledge by using self administered

questionnaire.

Part III - Assessment of attitude by using five point likert

scale.

The questionnaire analysis was done based on the content of the planned teaching program on HPV vaccination. The knowledge on HPV vaccination was assessed by using a self administered questionnaire. The questionnaire included all the aspects of HPV vaccination. It consists of 35 questions on knowledge. The questions were of multiple choices. Each of the question had 3 responses with one correct answer on HPV vaccination. The attitude was assessed by 15 statements related to HPV vaccination.

SCORING PROCEDURE

Part II

Assessment of knowledge by using self administered questionnaire. Each question had three responses with one correct response. A score of one was given for each correct responses and score of zero for wrong response.Thus the maximum score for question on knowledge was 35. The knowledge score was interpreted as follows

> 75% - Adequate knowledge

51-74% - moderately adequate knowledge

< 50% - inadequate knowledge

Part III

Included statement on attitude related HPV vaccination among nursing students. There were totally 15 statements among which 10 were positive statements and 5 were negative statements with 5 point likert scale such as “strongly agree”, “agree”, “uncertain”, “disagree”, “strongly disagree”. The score positive statement strongly disagree means “1” score, disagree means “2” score, uncertain means “ 3” score, agree means “4” score, strongly agree means “5” score. The reverse score was given to negative statements. . The maximum score is 75.

Attitude score was interpreted as follows

> 80% - Positive attitude

61-79% - Neutral attitude

< 60% - Negative attitude

DEVELOPMENT OF PLANNED TEACHING PROGRAM

The researcher prepared the planned teaching program after an expansive literature review. The content of planned teaching program on HPV vaccination , it includes introduction to cervical cancer and HPV infection , types of HPV virus, HPV viruses and associated diseases, symptoms of HPV infection, investigations, preventive measures for HPV infections, introduction to HPV vaccination, types of HPV vaccination, timing and dosage of HPV vaccination, route of administration of HPV vaccination, Age limit for HPV vaccination, mode of action of HPV vaccination, common side effects of HPV vaccination, serious side effects of HPV vaccination, precautions of HPV vaccination,draw backs of HPV vaccination, storage availability and cost effect of HPV vaccination. Audio visual aids like LCD, flash cards, charts, video clippings, pictures were used for explaining the content of HPV vaccination. The time taken for planned teaching program was one hour.

VALIDITY AND RELIABILITY OF THE TOOL

The tool used was validated by six nursing experts and one gynecologist. The questions were evaluated for its appropriateness, adequacy, relevance, completeness and comprehensiveness. Expert’s suggestions were invited and appropriate modifications were made accordingly and tool was finalized after establishing the validity.

The reliability of the tool was elicited by using test retest method .The tool was administered to ten samples among which five students from college of nursing and five from school of nursing. The interval between the pretest and post test was 5 days. The reliability of the tool was 0.9. The tool was found to be highly reliable.

VALIDITY OF THE PLANNED TEACHING

The structured teaching program was assessed by experts for the appropriateness, organization of content and language.

DATA COLLECTION PROCEDURE

Data was collected for a period of six weeks except on sunday. Data collection was done on separate days in the school of nursing and college of nursing. The purpose of the study was explained to the concerned authorities of selected institutions to get permission.

The principal of selected institutions and the class coordinators of the respected classes were approached by the investigator. The purpose of the study was explained to the nursing students and their consent to participate in this study was obtained. The self administered questionnaire was given to the nursing students in their class rooms. The pretest questionnaire was given to the nursing students and asked them to put the option in the right sided box given in each question. Next day after the pre test the planned teaching program was given by using LCD, flash cards, charts, video clippings. Seven days after the planned teaching program post test was given with same questionnaire. The questionnaire used in the pretest was used for post test. All the subjects were very cooperative and investigator expressed her gratitude for their cooperation.

Data collection schedule

S.no Name of the place Number of pretest intervention posttest

Subject

C.S.I .Jeyaraj

Annapackiam 45 8.7.10 9.7.10 16.7.10

College of nursing

2. C.S.I.School

of nursing 45 11.7.10 12.7.10 19.7.10

Time spent to asses the pretest level of knowledge and attitude was 30 minutes.

Time spent for planned teaching programme was one hour.

Time spent to asses the post test level of knowledge and attitude was 30 minutes.

PLAN FOR DATA ANALYSIS

The data was analyzed by using descriptive and inferentialstatistics.

PILOT STUDY

Pilot study was conducted to find out the feasibility and practicability of the study. It was conducted among five students from school of nursing and five students from college of nursing. The students were selected from Madha College of nursing at Mana Madurai and Senbagam School of nursing at Madurai. Manner in which the final study was done. Structured interview questionnaire was used for data collection in the pre test to asses the knowledge by self administered questionnaire and attitude by five point likert scale. Next day after the pretest planned teaching program on HPV vaccination was given to the nursing students by using LCD, flash cards, charts, video clippings, pictures. Seven days after planned teaching program was given, post test was administered among nursing students of the pilot study group. The time taken to complete the tool was formed to be satisfactory in term of simplicity and clarity. Based on the time of the data collection, arbitrary decision was taken to keep the sample size to 90. No changes were made in the tool after pilot study as the tool was found reliable.

PROTECTION OF HUMAN RIGHTS

Research proposal was approved by the dissertation committee prior to the pilot study and the main study. Permission was sought from the principal C.S.I Jeyaraj Annapackiam College of nursing. A formal consent was obtained from the nursing students before the data collection.

CONCEPTUAL FRAME WORK

The conceptual frame work for the study was derived from Ludwing Von Bertalanffy (1968), General system theory.

It is as a model for viewing people as interacting with the environment. According to this theory a system consist of a set of an interacting component with in a boundary that first the type and rate of exchange in this environment. All living system is open in that there is continual exchange of matter, energy and information. Open system have varying degree of interaction with environment from which the system receive input and gives output in the from of matter, energy and information.

Input

Input refers to matter, energy and information received from the environment; input refers to the learner or target group with their characteristics, level of competencies, learning needs and interest. In this study input refers to demographic variables of the nursing students , assessment of knowledge and attitude level by using self administered questionnaires and likert scale, Plan for planned teaching programme on HPV vaccination.

Throughput

Through refers to matter, energy and information that is modified are transformed with in the system. In this study through put refers to the active phase that the intervention has been taken place are administration of planned teaching programme regarding HPV Vaccination among nursing students.

Output

Output refers to, energy and information that are released from the system in to the environment. In this study output refers that, the level of knowledge gained by nursing students, which was classified as adequate, moderately adequate and inadequate and attitude was classified as positive, neutral and negative. The researcher was expected the nursing students to gain adequate knowledge and positive attitude regarding HPV Vaccination.

Feed back

Feedback is the emphasis to strengthen the input, throughput and output. It shows that whether adequate knowledge and positive attitude or inadequate knowledge and negative attitude are obtained. In this study it is emphasis to strengthen the knowledge from inadequate to adequate and changing the attitude from negative to positive. For researcher convenience not included under the study.

CHAPTER V

DISCUSSION

The study was conducted to evaluate the effectiveness of planned teaching programme regarding HPV vaccination among nursing students. The result of the study had been discussed according to study objectives.

To asses the pretest knowledge and attitude regarding HPV vaccination among nursing students in selected institution.

Among 90 nursing students most of the nursing student52 (57.78%) had inadequate knowledge and 38(42.22%) had moderately adequate knowledge and no one had adequate knowledge, regarding attitude majority of the nursing students 71(78.89%) had negative attitude and18 (20%) had neutral attitude and 1(1.1%) had positive attitude regarding HPVvaccination in pretest. The finding of this present study supported by Dual,B,et.al. (2009) reported was Target educational efforts are needed to ensure nurses involvement in the prevention of Human papilloma virus related diseases.

To asses the posttest knowledge and attitude regarding HPV vaccination among nursing students in selected institution.

Among 90 nursing students majority of the nursing students 74 (82.22%) had adequate knowledge and 11(16.7%) had moderately adequate knowledge and 1(1.1%) had inadequate knowledge and majority of the nursing students 81(90%) had positive attitude and 9 (20%) had neutral attitude and (0%) had negative attitude regarding HPVvaccination in posttest. The finding of this study supported by Beatly, et al. reported that after integration of HPV education in curriculum the knowledge base on HPV vaccination was improved.

To find the difference between pre test and post test knowledge and attitude regarding HPV vaccination among nursing students in selected institution.

The obtained post test mean value of knowledge 27.2 was higher than the pre test value 17.6. The mean difference between pre and post test was 9.6 and the obtained paired’t’ test value was 21.81 (p< 0.05) was highly significant.The obtained posttest attitude mean value 60.48 was higher than the pre test attitude mean value 39.97.the mean difference between pretest and post test attitude was 20.51and obtained paired‘t’ value was 26.27(p<0.05) was highly significant.

To find the association between pretest, post test knowledge and attitude regarding HPV vaccination with selected demographical variables among nursing students in selected institution.

The finding of the study concluded that pretest knowledge had a significant association with educational status (Chi-square = 10.02) and post test knowledge with age (Chi-square = 7.37) and post test attitude with source of information (Chi-square = 6.04) and other demographical variables such as religion, family income , family history of cancer had not significantly associated with pre test and post test knowledge and attitude. These findings are supported by Chun Chao et al.(2007) Reported that there was statistically significant association between demographic factors with HPV vaccination.

LIMITATIONS

The study is limited to nursing students who were studying in the C.S.I.Jeyaraj annapackiam college of nursing and C.S.I.School of nursing and also study is limited with six weeks of data collection.

CHAPTER VI

SUMMARY, FINDING, CONCLUSION,

IMPLICATION AND RECOMMENDATION

The essence of any research project lies in reporting the findings. This chapter includes brief of the present study, conclusion, nursing implications and recommendations for the future studies.

SUMMARY OF THE STUDY

A quasi experimental study to evaluate the effectiveness of planned teaching programme regarding HPV Vaccination among Nursing students in selected institutions at Madurai was under taken by J.Eswari in partial fulfillment of the requirement for the Degree of Master Science in Nursing, Pasumalai, affliated to the Tamilnadu Dr. M.G.R Medical university, Chennai. The conceptual frame work of the study was based upon Ludwig Von Bertanlanffey’s general system theory. The instrument used for the data collection was a structured self administered questionnaire regarding HPV Vaccination. It was prepared based on the review literature with the help of the subject experts. A purposive sampling technique was used to collect data from the study participants. Data was collected for a period of six weeks. The data was gathered through structured self administered questionnaire. Descriptive and inferential statistics were used to analyze the data. Data on association between knowledge and attitude with selected demographical variables were analyzed by chi-square test. Majority 52 (57.78%) had inadequate knowledge, 38(42.22%) had moderately adequate knowledge and majority 71(78.89%) had negative attitude, 18(20%) had neutral attitude regarding HPV Vaccination before planned teaching programme.But after the planned teaching programme Majority 74 (82.22%) had gained adequate knowledge and 15(16.17%) had moderately adequate knowledge and majority 81(90%) developed positive attitude and 9(10%) regarding HPV Vaccination.

Main findings of the study

The Majority 52 (57.78%) had inadequate knowledge, 38(42.22%) had moderately adequate knowledge and majority 71(78.89%) had negative attitude, 18(20%) had neutral attitude regarding HPV Vaccination before planned teaching programme.But after the planned teaching programme Majority 74 (82.22%) had gained adequate knowledge and 15(16.17%) had moderately adequate knowledge and majority 81(90%) developed positive attitude and 9(10%) regarding HPV Vaccination.

There is significant association between pre test knowledge with educational status, post test knowledge with age and post test attitude with source of health information .But there was no significant association between pretest attitude with selected demographic variable. The obtained post test mean value of knowledge 27.2 was higher than the pre test value 17.6. The mean difference between pre and post test was 9.6 and the obtained paired’t’ test value was 21.81 (p< 0.05) was highly significant. The obtained posttest attitude mean value 60.48 was higher than the pre test attitude mean value 39.97.the mean difference between pretest and post test attitude was 20.51and obtained paired‘t’ value was 26.27(p<0.05) was highly significant. The finding shows that the planned teaching programme has a significant effect in increasing the knowledge and attitude of nursing students regarding HPV vaccination.

CONCLUSION

Existing knowledge and attitude regarding HPV vaccination showed that majority of nursing students had inadequate knowledge and negative attitude.

There was a significant association between pretest knowledge with educational status and post test knowledge with age and posttest attitude with source of health information and there was no significant association between pretest attitude with selected demographical variables.

Structured teaching programme was found to be very effective in increasing knowledge and changing desired attitude of nursing students regarding HPV vaccination.

IMPLICATIONS

The implication of the findings has been discussed in relation to nursing service, nursing education, nursing administration and nursing research.

IMPLICATION IN NURSING EDUCATION

Nursing curriculum need to be strengthened to enable nursing students to know about the newly introduced vaccination in order to provide guidance to public.

The study stress on the importance of nurses being knowledgeable to provide adequate information about HPV vaccination.

The nursing students may be motivated to give health education at community level regarding HPV vaccination.

IMPLICATION FOR NURSING SERVICE

Since nurses are the first source of knowledge for the public, so they have to be enhanced their knowledge regarding patients oriented health topics and educate the public regarding HPV vaccination.

Nurses should be knowledgeable and skillful and updated their knowledge based on newer innovations and practices.

Senior Nurses and Midwives can guide the nursing students based an newer practice as a integral part of their profession.

The result of the study will create awareness and motivate nursing students to guide the publics in right way to adopt HPV vaccination.

IMPLICATION IN NURSING RESEARCH

The finding of the study served as a basis of the nursing students on

Increasing awareness regarding HPV vaccination.

The study can be published in journal to disseminate knowledge regarding HPV vaccination.

The finding of the study served as a basis for the nursing professionals and students to conduct further studies regarding newer vaccination.

IMPLICATION IN NURSING ADMINISTRATION

The nursing leader must utilize newer study findings, which is essential in teaching nursing students through in-service education programme.

Nursing administrator should take active part in health policy making, developing protocol, procedures and standing orders related to vaccination administration.

Nursing administrator should give special attention to modify immunization schedule based on newer vaccination.

Nursing administrator has to use their creativity, interest ability to educate the public regarding disease preventive measures like vaccination.

Extensive use of mass media propaganda regarding HPV vaccination can help in reducing the prevalence of cervical cancer due to HPV infections.

RECOMMENTATIONS

A similar study can be conducted among non nursing personals.

A comparative study can be conducted on knowledge regarding HPV vaccination between urban and rural mothers of adolescent girls.

A descriptive study can be conducted on knowledge and attitude regarding HPV vaccination among adolescent girls.

A experimental study can be conducted regarding efficacy of the

HPV vaccination

Table -1

Distribution of nursing students according to selected Demographic Variables

n =90

Demographic Variable no. (%)

Age in Years

15-18 5 5.55

19-22 84 93.34

23-26 1 1.11

Educational Status

B.Sc (Nursing) 45 50

G.N.M 45 50

Religion

Hindu 18 19.99 Christian 71 79

Muslim 01 1.11

Family Income

Below 5,000 14 15.56

5,000 – 10,000 63 70

Above 10,000 13 14.44

Family history of cancer

Parents 02 2.22

Grand Parents 04 4.44

None 84 93.34

Source of health information

Health Personnel 84 93.34

Television 03 3.33

Newspaper 03 3.33

The data in table-1 shows that out of 90 nursing students majority 84 (93.34 %) belong to the age group of 19-22years. Educational status ,45(50%) were from B.Sc nursing and 45(50%) were from General Nursing and Midwifery. Religion, majority 71(79%)were Christian. Occupation, majority 63(70%) were belong to family income of 5,000-10,000. Family history of cancer, 2(2.22%) having the family history of cancer with parents and 4 (4.44%) having the family history of cancer with grant parents. Source of health information, majority of nursing students 84(93.34%) received information from health personals.

Table 2

Distribution of nursing students based on difference between pre test, post test knowledge and attitude regarding HPV Vaccination.

Variables Pre test Post test Mean difference ‘t’ value

Mean S.D Mean S.D

Knowledge 17.6 3.6 27.2 2.9 9.6 21.81

Attitude 39.97 5.9 60.48 4.7 20.51 26.27

Table 2 shows that obtained post test mean value of knowledge 27.2 was higher than the pre test value 17.6. The mean difference between pre and post test was 9.6 and the obtained paired‘t’ value was 21.81 (p< 0.05) was highly significant. The obtained posttest attitude mean value 60.48 was higher than the pre test attitude mean value 39.97.the mean difference between pretest and post test attitude was 20.51and obtained paired ‘t’ value was 26.27(p<0.05) was highly significant.

Table 3

Distribution of nursing students based on association between pre test knowledge with selected demographic variables.

Demographic Variables Above Below Chi – Square

Mean Mean ‘2’ Value

Age in Years

15-18 2 3

19-22 45 39 #1.34

23-26 0 1

Educational Status

B.Sc (N) 31 14 *10.02

G.N.M 16 29

Religion

Hindu 11 7

Christian 35 36 #1.81

Muslim 1 0

Family Income

Below 5,000 6 8

5,000 – 10,000 32 32 #3.45

Above 10,000 9 3

Family history of cancer

Parents 2 0

Grand Parents 3 1 #3.19

None 42 42

Source of health information

Health personnel 44 40

Television 0 3 #3.38

Newspaper 2 1

* Significant at 0.05 level

# Not significant at 0.05 level

Table-3 shows that there is significant association between pre test knowledge with educational status. But there is no significant association between pre test knowledge with age, religion, family history of cancer and source of health information among nursing students.

Table 4

Distribution of nursing students based on association between pre test attitude with selected demographic variables.

Demographic Variables Above Below Chi – Square

Mean Mean ‘2’ Value

Age in Years

15-18 3 2

19-22 45 39 #1.09

23-26 0 1

Educational Status

B.Sc (N) 26 19 #2.17

G.N.M 19 26

Religion

Hindu 9 9

Christian 37 34 #1.03

Muslim 0 1

Family Income

Below 5,000 8 6

5,000 – 10,000 30 33 #0.43

Above 10,000 7 6

Family history of cancer

Parents 0 2

Grand Parents 2 2 #2.04

None 42 42

Source of health information

Health personnel 41 43

Television 1 2 #3.37

Newspaper 3 0

* Significant at 0.05 level

# Not significant at 0.05 level

Table-4 shows that there is no significant association between pre test attitude with age, educational status, religion, family income, family history of cancer and source of health information among nursing students.

Table 5

Distribution of nursing students based on association between post test knowledge with selected demographic variables.

Demographic Variables Above Below Chi – Square

Mean Mean ‘2’ Value

Age in Years

15-18 5 20

19-22 68 16 *7.37

23-26 0 1

Educational Status

B.Sc (N) 35 10 #1.21

G.N.M 39 6

Religion

Hindu 15 4

Christian 59 11 #2.79

Muslim 2 0

Family Income

Below 5,000 13 1

5,000 – 10,000 48 15 #5.46

Above 10,000 13 0

Family history of cancer

Parents 1 1

Grand Parents 3 1 #1.34

None 70 14

Source of health information

Health personnel 70 15

Television 3 0 #1.72

Newspaper 1 1

* Significant at 0.05 level

# Not significant at 0.05 level

Table-5 shows that there is significant association between post test knowledge with age. But there is no significant association between post test knowledge with educational status, religion, family income, family history of cancer and source of health information among nursing students.

Table - 6

Distribution of nursing students based on association between post test attitude with selected demographic variables.

Demographic Variables Above Below Chi – Square

Mean Mean ‘2’ Value

Age in Years

15-18 5 0

19-22 75 9 #0.70

23-26 1 0

Educational Status

B.Sc (N) 42 3 #1.11

G.N.M 39 6

Religion

Hindu 15 4

Christian 65 5 #3.32

Muslim 2 0

Family Income

Below 5,000 11 3

5,000 – 10,000 57 6 #3.49

Above 10,000 13 0

Family history of cancer

Parents 1 1

Grand Parents 4 0 #4.02

None 76 8

Source of health information

Health personnel 76 9

Television 3 0 *6.04

Newspaper 2 0

* Significant at 0.05 level

# Not significant at 0.05 level

Table-6 shows that there is significant association between post test attitude with source of health information. But there is no significant association between post test attitude with age, educational status, religion, family income, and family history of cancer among nursing students.

CHAPTER-IV

DATA ANALYSIS AND INTERPRETATION

This chapter deals with the analysis and interpretation of the data collected from 90 nursing students in selected nursing institutions. With reference to find difference on knowledge and attitude regarding HPV vaccination before and after planned teaching program. The data were analyzed based on the objectives and hypothesis by using descriptive and inferential statistics.

The data collected were analyzed and presented under the following headings

Distribution of nursing students according to selected demographic variables

Distribution of nursing students based on pre test and post test knowledge regarding HPV vaccination.

Distribution of nursing students based on pre test and post test attitude regarding HPV vaccination.

Distribution of nursing students based on difference between pretest, post test knowledge and attitude regarding HPV vaccination.

Distribution of nursing students based on association between pre test knowledge with selected demographic variables.

Distribution of nursing students based on association between pre test attitude with selected demographic variables.

Distribution of nursing students based on association between post test knowledge with selected demographic variables.

Distribution of nursing students based on association between post test attitude with selected demographic variables.

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