RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1) NAME OF THE CANDIDATE AND ADDRESS

: Mr. PRIYANKA CHOPPARA1ST YEAR M.Sc. NURSING.PRAGATHI COLLEGE OF NURSING#33 BYRATHI EXTN, NEAR EBENEZER HOSPITAL, HENNUR BAGALUR MAIN ROAD, KOTHANURPOST, BANGALORE:560077

2) NAME OF THE INSTITUTION

: PRAGATHI COLLEGE OF NURSING#33 BYRATHI EXTN, NEAR EBENEZER HOSPITAL, HENNUR BAGALUR MAIN ROAD, KOTHANURPOST, BANGALORE:560077

3) COURSE OF STUDY AND SUBJECT

: DEGREE OF MASTERS IN NURSINGMEDICAL SURGICAL NURSING

4) DATE OF ADMISSION TO THE COURSE

: 14/07/2011

5) TITLE OF THE STUDY

: A DESCRIPTIVE STUDY TO ASSES THE KNOWLEDGE ON ENDOSCOPIC PROCEDURE AMONG 2NDYR B.SC, (N) STUDENTS AT SELECTED COLLEGE OF NURSING BANGALORE.

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6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

Belief about health and illness are major feature of every known culture. Health is often

viewed as a continuum on which optimal wellness, at one end, is the highest level of function

and illness at the other end result in death. Every person is somewhere on the continum. As one’s

health state changes, the location on the continuum changes 1.

Deviation from normal health state is known as illness. The process of defining oneself as ill

is based on one’s own perception of others, or both. Each person reacts differently to illness.

When assessing the illness experience, the nurse considers the type of illness and the change that

make place in the client and the family when illness occurs. Illness has broader meaning than

disease. Disease refers to a biologic or psychological alteration, such as peptic ulcer, gastritis

chronic bowel syndrome, diabetes mellitus and hepatitis, which result in a malfunction of a body

organ or system2.

The word Upper Gastro intestinal endoscopy is a procedure that uses a lighted, flexible

endoscope to see inside the upper Gastro intestinal tract. The upper GI tract includes the

esophagus, stomach, duodenum and the first part of the small intestine. An endoscopy is a

medical procedure used to view the digestive tract and other internal organs non surgically.

Through the use of an endoscopy, a flexible tube with a lighted camera attached, the internal

body structure is seen on a color monitor by the physician or a procedure looking at the inside of

body cavities, such as the esophagus or stomach.

The nurse cares for the endoscopic patients as well as the equipment required to conduct

endoscopy. It is essential that the nurse must be able to interpret the data and make clinical

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decisions based on that data. The nurse must know how to detect and prevent complications of

this clinical tool.3

Risk associated with upper GI endoscopy include abnormal reaction to sedatives,

bleeding from biopsy, accidental puncture of the upper GI tract, Patients who experience any of

the following rare symptoms after upper GI endoscopy should contact their doctor immediately,

Swallowing difficulties, throat, chest, and abdominal pain that worsens, vomiting, bloody or very

dark stool and fever.4

Nursing care starts when the patient is advised to undergo endoscopy Upper

gastrointestinal (GI) endoscopy is a procedure that uses a lighted, flexible endoscope to see

inside the upper GI tract. To prepare for upper GI endoscopy, no eating or drinking is allowed

for 4 to 8 hours before the procedure. Smoking is also prohibited. Patients should tell their

doctor about all health conditions they have and all medications they are taking. Driving is not

permitted for 12 to 24 hours after upper GI endoscopy to allow the sedative time to wear off.

Before the appointment, patients should make plans for a ride home. Before upper GI

endoscopy, the patient will receive a local anesthetic to numb the throat. An intravenous (IV)

needle is placed in a vein in the arm if a sedative will be given. During upper GI endoscopy, an

endoscope is carefully fed into the upper GI tract and images are transmitted to a video monitor.

Special tools that slide through the endoscope allow the doctor to perform biopsies, stop

bleeding, and remove abnormal growths. After upper GI endoscopy, patients may feel bloated

or nauseated and may also have a sore throat. Unless otherwise directed, patients may

immediately resume their normal diet and medications. Possible risks of an upper GI endoscopy

include abnormal reaction to sedatives, bleeding from biopsy, and accidental puncture of the

upper GI tract.4

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6.1 NEED FOR THE STUDY

Nursing as a profession is now responsible to account for its competence and

performance. This has been the birth of the language of outcomes. Outcome is a mechanism to

evaluate the quality, improve effectiveness and link practices to professional accountability.5

Gastro intestinal system support of critically ill patients requires non-invasive and

invasive monitoring of physiological indicators of gastric function including factors that affect

gastric performance (Digestion, Hydrochloric acid release) and the balance between food

consumption and demand.6

Gastro intestinal surgeries are relatively very complicated in treatment and monitoring

which needs a thorough understanding of condition where it always require continuous

assessment and diagnosis of the complex conditions. This can be achieved only by good and

sound knowledge in Hemodynamic monitoring.7

In the present day nursing there is a wide variation in the quality of assessment,

monitoring, and documentation of these parameters, due to range of factors including intra and

inter-observer reliability, equipments malfunction and patients preparation. Education of nurses

and other health workers in the physiological and technical rationale under pinning the collection

of vital signs data, and the significance of alteration in findings remains an important challenge. 8

Nurse acting in her capacity as a monitor ,observes a patient, she decides whether his

actual state is deviated from his individual homeostatic limits, she determines what actions must

be taken to reduce any difference that she observes between the actual and desired states on this

basis of the decision . She may take actions by herself or transmit the information to physician.

The author highlights the importance of observation and decision making capacity on the part of

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nurses for which they should have clear knowledge regarding the procedure of monitoring.9

Two studies published in Digestive Diseases and Sciences have demonstrated that an

improved method for performing the standard upper endoscopy examination done on over eight

million Americans with heartburn each year increases the detection of pre-cancerous cells in the

esophagus by over 40 percent.  Esophageal adenocarcinoma has increased by 600 percent over

the last 25 years, making it the fastest growing form of cancer in the United States.  It is also one

of the most lethal of cancers, with a five year survival rate of less than 20 percent. The two large

nationwide multi-center studies found the addition of a specialized brush biopsy with computer-

assisted laboratory analysis of the specimen  to the standard upper endoscopy procedure,

significantly increases the detection of both Barrett's esophagus and esophageal dysplasia (still-

harmless, but pre-cancerous cells). This large increase in detection was found in the study that

included academic centers and a second study that included community-based gastroenterology

practices.10

6.2 REVIEW OF LITERATURE 

The review of literature related to this study has been discussed under the following sections.

Section I: Studies related to knowledge on endoscopic procedure:

Retrospective population-based study was conducted using the National Cancer

Screening Program (NCSP) database. We evaluated GC detection rates, sensitivity, specificity,

and positive predictive value (PPV) of endoscopic screening program for the average-risk

Korean population aged 40 years and older, who underwent NCSP from 2002 through 2005.

The detection rates of GC by endoscopy in the first and subsequent rounds were 2.71 and 2.14

per 1,000 examinations, respectively. Localized cancer accounted for 45.7% of screen-detected

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GC cases. The sensitivity of endoscopy was 69.0% (95% CI: 66.3-71.8). The endoscopic

screening was less sensitive for the detection of localized GC (65.7%; 95% CI=61.8-69.5) than

for regional or distant GC (73.6%; 95% CI=67.4-79.8). In the multiple logistic models for

localized GCs and all combined GCs, whereas the OR of sensitivity for the mixed type was

lower than that for the differentiated type. The sensitivity of endoscopic test in a population-

based screening was slightly higher for detection of regional or distant GC than for localized

GC. Further evaluation of the impact of endoscopic screening should take into account the

balance of cost and mortality reduction.11

A prospective, multicenter, randomized, controlled study to evaluate tolerance and degree

of intestinal cleanliness during CE following three types of bowel preparation. The degree of

cleanliness of the small bowel was classified by blinded examiners according to four categories

(excellent, good, fair or poor). The degree of patient satisfaction, gastric and small bowel transit

times, and diagnostic yield were measured. Study finding reveled that the degree of cleanliness

did not differ significantly between the groups (P = 0.496). Inter observer concordance was fair

(k = 0.38). No significant differences were detected between the diagnostic yields of the CE

(P = 0.601). Gastric transit time was 35.7 ± 3.7 min (group A), 46.1 ± 8.6 min (group B) and

34.6 ± 5.0 min (group C) (P = 0.417). Small-intestinal transit time was 276.9 ± 10.7 min (group

A), 249.7 ± 13.1 min (group B) and 245.6 ± 11.6 min (group C) (P = 0.120). CL was the best

tolerated preparation. Compliance with the bowel preparation regimen was lowest in group C

(P = 0.008). The study concluded stating that a clear liquid diet and overnight fasting is sufficient

to achieve an adequate level of cleanliness and is better tolerated by patients than other forms of

preparation.12

Retrospective study was conducted with the aim of to investigate the safety of capsule

endoscopy systems. A standardized questionnaire was sent to high volume centers in Germany

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and in Austria. The study findings reveled Data from 62 patients were retrieved for this study.

Capsules used were Given Imaging (n=58; M2A, M2Aplus, Pill Cam SB2), Olympus

EndoCapsule (n=3), Given PillCam Colon (n=1). The collective included patients with

pacemakers/ICDS from seven brands (Biotronik, Medtronic, St. Jude Medical, Guidant, Boston

Scientific, Ela Sorin, Vitatron) with a total of 19/8 (pacemaker/ICD) different types. In two

patients interference between capsule endoscopy and telemetry (loss of images/gaps in video)

was recorded. None of the cardiac pacemakers or ICDs was impaired in function. No clinically

evident event was observed in any of these patients. At last study concluded saying Clinical use

of these CE types is safe in patients with cardiac pacemakers and ICDs. Interference can occur

between CE and ECG-telemetry leading to loss of images or impaired quality of video.13

Section I: Studies related to trends and impact of endoscopic procedure

In a article it as stated that wireless capsule endoscopy is a revolutionary technology that

allows physicians to examine the digestive tract of a human body in the minimum invasive way.

Physicians can detect diseases such as blood-based abnormalities, polyps, ulcers, and Crohn's

disease. Although this technology is really a marvel of our modern times, currently it suffers

from two serious drawbacks: 1) frame rate is low (3 frames/s) and 2) no 3-D representation of

the objects is captured from the camera of the capsule. In this paper we offer solutions

(methodologies) that deal with each of the above issues improving the current technology

without forcing hardware upgrades. They also extract and represent the texture of the surface of

the digestive tract in 3-D. Thus the purpose of our methodology is not to reduce the time that the

gastroenterologists need to spend to examine the video. On the contrary, the purpose is to

enhance the video and therefore improve the viewing of the digestive tract leading to a more

qualitative and efficient examination. The proposed work introduces 3-D capsule endoscopy

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textured results that have been welcomed by Digestive Specialists.14

In a article it as stated that Over the past decade Wireless Capsule Endoscopy (WCE)

technology has become a very useful tool for diagnosing diseases within the human digestive

tract. Physicians using WCE can examine the digestive tract in a minimally invasive way

searching for pathological abnormalities such as bleeding, polyps, ulcers and Crohns disease. To

improve effectiveness of WCE researchers have developed software methods to automatically

detect of these diseases at a high rate of success. This paper proposes a novel synergistic

methodology for automatically discovering polyps (protrusions) and perforated ulcers in WCE

video frames. Finally, results of the methodology are given and statistical comparisons are also

presented relevant to other works.15

Wireless Capsule Endoscopy (WCE) is a revolutionary technology that allows physicians

to examine the patients whole gastrointestinal tract, especially the small intestine. However,

reviewing capsule endoscopic video is a labor intensive task and very time consuming. In this

paper we propose a novel method to detect key frames with abnormalities. It is based on the

adaptive non-parametric corner detection approach using both the color and texture features.

Real world patient videos including abnormal findings are adopted to evaluate the performance

of the proposed method. The experimental results demonstrate that the proposed approach

leadsto the reduction of the number of frames in the WCE video without losing critical

information.16

STATEMENT OF THE PROBLEM

A descriptive study to asses the knowledge on endoscopic procedure among 2ndyrB.sc, (n)

students at selected college of nursing Bangalore.

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6.3. OBJECTIVES

6.3.1 To assess the knowledge on endoscopic procedure among 2nd yr. B.sc, (n) students.

6.3.2 To determine the association between the knowledge level on endoscopic procedure among

2nd yr. B.sc, (n) students with their selected demographic variables.

6.4 HYPOTHESES

H1 There will be significant associations between the knowledge scores of the 2nd yr. B.sc,

(n) students and selected demographic variables.

6.5 ASSUMPTIONS

6.5.1 2nd yr. B.sc, (n) students may have some knowledge regarding endoscopic procedure.

6.6 OPERATIONAL DEFINITION

Assess: it is the organized, systematic and continuous process of collecting data from 2nd

yr. B.sc, (n) students regarding endoscopic procedure.

Knowledge: it refers to the correct responses of respondents of knowledge items on

endoscopic procedure by structured knowledge questionnaire schedule

Endoscopic procedure: It refers to diagnostic procedure involves insertion of

instrument such as endo scope to obtain a view of the interior wall of upper alimentary

tract.

Nursing students: it refers student nurses.

7. MATERIAL AND METHODS

7.1 SOURCES OF DATA

2nd yr. B.sc, (n) students at selected college of nursing Bangalore.

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7.2.1 RESEARCH APPROACH

In the present study descriptive survey approach is used.

7.2.2 RESEARCH DESIGN

A non-experimental descriptive design was adopted for the study.

7.2.3 SETTING OF THE STUDY

The study will be conducted at selected college of nursing Bangalore.

7.2.4 RESEARCH VARIABLES

Independent variables: Knowledge questionnaire is used in the study.

Dependent variables: level of knowledge regarding endoscopic procedure

among 2nd yr. B.sc, (n) students.

7.2.5 POPULATION

2nd yr. B.sc, (n) students at selected college of nursing Bangalore

7.2.6 SAMPLE SIZE

A Sample size of 40 2nd yr. B.sc, (n) students at selected college of nursing Bangalore.

7.2.7 SAMPLING TECHNIQUE

Convenient sampling technique will be adopted.

7.2.8 SAMPLE CRITERIA

INCLUSIVE CRITERIA

Students who are studying in 2nd year B.sc (N).

The students who are present at the time of data collection.

EXCLUSIVE CRITERIA

Students who have previously received information in endoscopic procedure.

Students who are regular absent.

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7.2.9 DATA COLLECTION TOOL

The data will be collected by using structured knowledge questionnaire which consist of

two parts.

Part I – It consists of socio demographic variables such as Age, Sex, Marital Status and source

of information.

Part II –. It consists of structured knowledge questionnaire on endoscopic procedure.

7.2.10 DURATION OF THE STUDY

As per university guidelines that is 4 to 6 weeks.

7.2.11. DATA ANALYSIS METHOD

The collected data will be analyzed through descriptive inferential statistics.

Descriptive statistics- it includes mean, frequency, percentage, range, standard deviation

to describe demographic variables and knowledge aspects.

Inferential statistics- it includes parametric paired t’ test and non-parametric chi-square

test to assess the association between the Knowledge scores with selected demographic

Variables.

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7.2 DOES THE STUDY REQIRE ANY INTERVENTION TO BE CONDUCTED

IN A PATIENTS OR OTHER HUMANS OR ANIMALS?

YES

7.3 HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR

INSTITUTION?

YES, Ethical clearance certificate enclosed.

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8. LIST OF REFERENCES

01. Suddarth, Brunner. Text book of medical surgical nursing. 8ht ed. Philadelphia: Lippincot

publication; 1995.

02. Black M Joyce, Jacobs Matassarin Esther. Medical Surgical Nursing clinical managementfor

continuity of care. 3rd ed. New Delhi: W.B. Saunders Company; 1997.

03. Woods SL, Shivarajan Folicher ES, Motzer SU, Bridges EJ. Cardiac Nursing. 5th ed.

Lippincott Williams and Wilkin: 2005. p. 470 -71.

04. Phipps. Medical Surgical Nursing, Health and Illness. Perspectives. eight editions,

published by Elsevier, Noida.2009,

05. John Ebenezer. Nurses responsibility. Can Med Assoc J 1991, Sep 15;145(6): 621

06. Dennison PL, Kenneth JS, Sharon Williams. Cardiac Nursing.6thed. Lippincott Williams and

Wilkin; 2004. p. 408 -79.

07. Bare G Brinda, Smeltzer C Suzanne. Brunner and Suddarth’s Text Book of Medical-Surgical

Nursing; 10th ed. USA: Lippincott Williams and Wilkin; 2004. p. 678-80.

08. Quinn T. Cardiovascular Monitoring. J Adv Nurs 1998; 27(3): 666.

09. Houland D. Approach to nurse monitor research. Am J Nurs1996; 66(3); 556.

10. Advance against the most Rapidly Growing Cancer. Improved endoscopy method increase

detection of Esophageal pre-cancer by over 40 percent. Publication digestive diseases and

sciences. NewYourk, May 19, 2011.

11. Choi KS, Jun JK, Lee HY, Park S, Jung KW, Han MA, Choi IJ, Park EC. Performance of

gastric cancer screening by endoscopy testing through the National Cancer Screening

Program of Korea. Cancer Sci. 2011 May 12. doi: 10.1111/j.1349-7006.2011.01982.

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12. Pons Beltran V et. al. Evaluation of Different Bowel Preparations for Small Bowel Capsule

Endoscopy : A Prospective, Ramdomized, Controlled Study. Dig Dis Sci. 2011 Apr 10.

13. Bandorski D et. Al. Capsule endoscopy in patients with cardiac pacemakers and implantable

Cardioverter-defibrillators – a retrospective multicenter investigation. J Gastrointestin Liver

Dis. 2011 Mar;20(1):33-7.

14. Karargysris A, Bourbakis N. Three-dimensional reconstruction of the digestive wall in

capsule endosocopy videos using elastic video interpolation. IEEE Trans Med Imaging. 2011

Apr; 30(4):957-71. Epub 2010 Dec 10.

15. Karargysris A, Bourbakis N. Detection of small bowel polyps and ulcers in wireless Capsule

Endoscopy videos. IEEE Trans Biomed Eng. 2011 May 16.

16. Zhao Q, Meng MQ. Novel detection strategy for abnormalities in WCE Video clips Conf

Proc IEEE Eng Med Biol Soc. 2010;2010:4084-7.

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SIGNATURE OF THE STUDENT :

REMARKS OF THE GUIDE : The research topic selected for the

candidate is suitable as there is a need for

improving the knowledge of

students regarding endoscopic

procedure.

NAME AND DESIGNATION OF THE GUIDE

GUIDE NAME AND ADDRESS : Mrs. Babu D

Professor

SIGNATURE OF THE GUIDE :

HEAD OF THE DEPARTMENT : Mrs Babu D

Professor

SIGNATURE OF HOD :

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REMARKS OF THE PRINCIPAL : The research topic selected for the

candidate is appropriate. There is a

need for improving the knowledge of

students regarding endoscopic

procedure.

SIGNATURE OF THE PRINCIPAL :

16