PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

DISSERTATION PROPOSAL

“A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED

TEACHING PROGRAMME ON KNOWLEDGE REGARDING UPPER

GASTRO-INTESTINAL ENDOSCOPY AMONG PATIENTS WHO ARE

UNDERGOING UPPER GASTRO-INTESTINAL ENDOSCOPY AT

SELECTED HOSPITALS, TUMKUR”.

SUBMITTED BY:

Mr. VIJAY.H.DURAGANNAVAR

FIRST YEAR MSc. NURSING,

MEDICAL SERGICAL NURSING,

SRI RAMANAMAHARSHI COLLEGE OFNURSING,

TUMKUR.

(2011-2013)

1

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE,

KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTAION.

1

1

NAME OF THE CANDIDATE

AND ADDRESS. Mr. VIJAY.H.DURAGANNAVAR

FIRST YEAR MSc. NURSING,

SRI RAMANAMAHARSHI COLLEGE OF

NURSING, TUMKUR.-572106,

KARNATAKA.

2

2

NAME OF THE INSTITUTION. SRI RAMANAMAHARSHI COLLEGE OF

NURSING, TUMKUR-572106,

KARNATAKA.

3

3

COURSE OF STUDY AND

SUBJECT.

FIRST YEAR M.Sc. NURSING,

MEDICAL SURGICAL NURSING.

4

4

DATE OF ADMISSION TO

COURSE. 15-07-2011

5

5

TITLE OF THE TOPIC. “EVALUATE THE EFFECTIVENESS OF

STRUCTURED TEACHING

PROGRAMME ON KNOWLEDGE

REGARDING UPPER GASTRO-

INTESTINAL ENDOSCOPY AMONG

PATIENTS WHO ARE UNDERGOING

UPPER GASTRO-INTESTINAL

ENDOSCOPY AT SELECTED

HOSPITALS, TUMKUR”.

2

3

6. BRIEF RESUME OF INTENDED WORK

INTRODUCTION :

The introduction of increasingly complex procedures in the health sector makes it

necessary not only to evaluate the efficacy and cost of procedures, but also its appropriateness

in the clinical setting in question. In the specialty of gastroenterology, the problem of

appropriateness is particularly perceived with regard to the use of upper gastrointestinal (GI)

endoscopy, because of the open access to its application all over the world. To deal with this

problem, guidelines have been drawn by various associations to make the use of upper-GI

endoscopy more rational. The appropriation of the procedure in a clinical setting, though

established in the USA and the UK where an early upper GI endoscopy is done for those

above the age of 45 years, may not hold true for a distinct south Asian population. Guidelines

are not yet available for our population.1

The word “Endoscopy” is derived from the Greak word Endo (means inside) and

“spokein”(means to examine).Endoscopy means direct visual examination of the internal

body parts by means of an endoscopy passed a along the interior of hallow organ with the

same Endoscopy.2

The term, dyspepsia, encompasses a heterogeneous group of upper abdominal

symptoms often referred to as discomfort, pain, bloating, fullness, burning or indigestion,

which poses a diagnostic and therapeutic challenge to the clinician. Additionally, the number

of upper endoscopies for dyspepsia has increased and its appropriateness needs to be all the

more studied. With this background, a cross-sectional and prospective study was undertaken

to devise a guideline for the Asian region, based on the outcome of endoscopy in patients with

dyspepsia, viz. ulcer and dysmotility – either alone or in combination with or without alarm

symptoms. The second objective was to identify the cut-off age for endoscopy among patients

with dyspepsia from an Indianperspective.1

4

The endoscopy is usually inserted (except othalmoscopoy) into a natural body orifice

such as mouth, anus or urethra. It may also be inserted through a small skin incision and

through abdominal puncture or vaginal wall (Laproscopy) .From head to foot nearly every

area of the body can be visualized with an endoscope. An endoscopic procedure is designated

by the anatomic structure to be visualized and likewise the endoscope is named for the

anatomic area it is designed to visualize.2

Upper GI endoscopy is a procedure that uses a lighted, flexible endoscope to see inside

the upper GI tract. The upper GI tract includes the esophagus, stomach, and duodenum—the

first part of the small intestine3.

Upper G-I Endoscopy is the use of flexible tube (fiber-optic endoscopy) to visualize the

Gastro-Intestinal tract and to perform certain diagnosistic and therapeutic procedure. Images

are produced through a video screen to teloscopy eyepiece. The tip of the endoscope moves in

four direction, allowing for wide angle visualization .The endoscopy can be inserted through

the rectum or mouth depending on which portion of the Gastro-intestinal tract is to be

viewed.4

Endoscopy contains multiple channels that allows for air insufflations, irrigation, fluid

aspiration and the passage of special instrument .These instruments include biopsy forceps,

cytology brushes, needles wire baskets, laser probes and electro cautery shares. Endoscopy

function other than visualization include biopsy of cytology of lesion, removal of foreign

objects or polyp, control of internal bleeding and opening of strictures4

Upper Gastro-Intestinal Fibroscopy ,Oesophagogastroduodenoscopy: Fibescopy are

flexible scopes equipped with fiberoptic lens ,Fibroscopy of the the Upper Gastro-Intestinal.

Tract allows direct visualization of the Esophageal, Gastric and duodenal mucosa through

alighted endoscope (gastroscopy).This procedure called Oesophagogastroduodenospy is

especial valuable when esophageal, gastis or duodenal abnormalities or inflammatory,

noeplastic or infection or infection process are suspected. This procedure also can be used to

5

evaluate esophagus and gastric mortality and to collect secretion of tissue specimens for their

analysis5

During Endoscopy patient stomach and duodenum must be empty for the procedure to

be thorough and safe, so patient will not be able to eat or drink anything for at least 6 hours

beforehand . For the procedure you will swallow a thin, flexible, lighted tube called an

endoscope. Right before the procedure the physician will spray throat with a numbing agent

that may help prevent gagging. .The endoscope transmits an image of the inside of the

esophagus, stomach, and duodenum, so the physician can carefully examine the lining of

these organs. The scope also blows air into the stomach; this expands the folds of tissue and

makes it easier for the physician to examine the stomach5.

Upper endoscopy enables the physician to look inside the esophagus, stomach, and

duodenum (first part of the small intestine). The procedure might be used to discover the

reason for swallowing difficulties, nausea, vomiting, reflux, bleeding, indigestion, abdominal

pain, or chest pain. Upper endoscopy is also called EGD, which stands for EsophaGogastro-

Duodenoscop5.

Upper Gastro-Intestinal fibroscopy also can be therapeutic procedure when it is

combined with other procedures. Therpeutic endoscopy can be used to remove common bile

duct stones, dilates strictures ,and treat gastric bleeding and esophageal varices .laser –

compatible scopes can be used to provide laser therapy for upper Gastro-intestinal neoplasma.

Sclerosing solution can be injected through the scope in an attempt to control upper gastro-

intestinal bleeding5.

Possible complications of upper endoscopy include bleeding and puncture of the

stomach lining. Most people will probably have nothing more than a mild sore throat after the

procedure. The procedure takes 20 to 30 minutes. Because you will be sedated, you will need

to rest at the endoscopy facility for 1 to 2 hours until the medication wears off 5.

6

6.1 NEED FOR THE STUDY

Diagnoses and Procedures, the principal diagnosis is that condition established after

study to be chiefly responsible for the patient’s admission to the hospital. Secondary

diagnoses are concomitant conditions that coexist at the time of admission or that develop

during the stay.6

The principal procedure is the procedure that was performed for definitive treatment

rather than performed for diagnostic or exploratory purposes (i.e., the procedure that was

necessary to take care of a complication). If two procedures appear to meet this definition, the

procedure most related to the principal diagnosis was selected as the principal procedure.6

The need of this study is to investigate the discomfort, anxiety, fear and avoiding the

procedure felt by the patients undergoing upper gastrointestinal endoscopy for diagnostic or

therapeutic purpose. With regard to their effect on the patient's comfort during the

procedure.7

A study conducted at Singapore in 2008 , a total 3,432 endoscopies were performed

during the study period. There were 2,068 men and 1,364 women, with a male-to-female

ratio of 1.5:1. The overall mean age was 41.6 ± 5 (range 7–85) years.Overall, endoscopy

was normal in 1,453 patients (42.3%) and benign lesions were seen in 1,695 patients

(49.4%). The remaining 284 patients (8.3%) had a histology-confirmed malignant lesion.

Among The alarm symptoms, 231 patients (51.7%) presented with dysphagia, anaemia in

26 (5.8%) patients, mass in epigastrium in four (< 1%) and upper GI bleed in 68 (15.2%).

Combination of alarm symptoms was present in 118 patients (26.4%). There was an inverse

relation between the duration of illness and malignant outcome at endoscopy . This was

statistically significant (2 = 327.6; p = 0.001). The prevalence of benign lesions was

(10.9%), gastric ulcer (GU) (5.3%), oesophageal ulcer (< 1%), oesophagitis (5.1%), erosive

gastritis (12.2%) and duodenitis (7.7%). Achalasia cardia, cricopharyngeal web, Barrett’s

oesophagus and benign stricture of the oeosophagus were noted in < 1%. The overall

prevalence of peptic ulcer disease was 16.6%.8

7

Oikonomidou E, Anastasiou F et all had been conducted [2010 Jun] study on Upper

gastrointestinal endoscopy for dyspepsia: exploratory study of factors influencing patient

compliance at Thessaloniki, Greece with an aim that Upper gastrointestinal endoscopy is the

most preferable diagnostic examination for patients when upper gastrointestinal symptoms

appear. The study shows that 992 patients were recorded, 159 of them (16%) were found

positive for dyspepsia and gastro-esophageal reflux disease according to the questionnaire.

Out of the above, 131 (83.6%) patients refused further investigation with endoscopy. Patients

who refused upper endoscopy were predominantly female (87.8%) (p = 0.036) and over the

age of 50. Study concluded that Patients with dyspepsia in Greece tend to avoid upper

gastrointestinal endoscopy, with two major axons considered to be the causes of patients'

refusal and their beliefs towards endoscopy.9

Ersöz F, Toros AB, et al. [2010 Mar] Conductuded a stydy on Assessment of anxiety levels

in patients during elective upper gastrointestinal endoscopy and colonoscopy. At Research

Hospital Council of Forensic Medicine, Istanbul. In which 98 consecutive outpatients

undergoing upper gastrointestinal endoscopy and colonoscopy were interviewed to evaluate

anxiety. State anxiety scores increased from 36.9 (28.5 42.5) to45.7 (27.5 48.0) (p=0.001) in

patients undergoing upper gastrointestinalendoscopy and from 36.2 (26.5 38.5) to 44.8 (30.5

48.0) (p=0.001) in patients undergoing colonoscopy in both groups. The study concluded that

Diagnostic outpatient upper gastrointestinal endoscopy and colonoscopy were associated with

remarkable anxiety in patients. So it is important to relive’s the anxiety of the patient, before

going into the procedure.10

Hackett ML, Lane MR, McCa et al [1998 oct] Conducted a study on Upper gastrointestinal

endoscopy: are preparatory interventions effective at department of Gastroenterology,New

Zealand .study was designed to examine the effects of preparatory cognitive and behavioral

information on self-confidence, anxiety, and negative affect elicited by an impending upper

gastrointestinal endoscopy. 48 male and female out-patients, between 18 and 65 years of age,

scheduled for a first-time, non-emergency, endoscopic examination.The results of this study

show that preparatory information in general is effective in reducing anxiety and in increasing

self-confidence before an upper gastrointestinal endoscopy.11

8

Upper gastrointestinal endoscopy is a widely used procedure for diagnosis and

treatment of upper gastrointestinal diseases. Although it is considered a safe and well-

tolerated procedure, significant discomfort has been noted in patients undergoing endoscopy

without sedation. It is also known that endoscopists tend to underestimate the discomfort of

patients. The fiber-optic endoscopes have improved the quality and safety of the procedure

and the focus now is to reduce the discomfort experienced by the patients during the

procedure.9

Recent studies have documented that although sedated diagnostic endoscopy is

costlier, yet it increases the rate of successful endoscopies and makes the procedure more

tolerable that would reduce patient's in the endoscopy suite.9

After the endoscopy, if sedative medicines have been used, patients will be observed

for feel tired or have difficulty concentrating, and patients should not drive or return to work

after the procedure. The most common discomfort after the examination is a feeling of

bloating as a result of the air introduced during the examination. This should resolve quickly.

Some patients also have a mild sore throat. Most patients are able to eat about 30 - 45 minutes

after the examination.14

The lack of severe symptoms, fear of pain, concerns of sedation, comorbidity and

competing life demands were reported by patients as barriers to performing an endoscopic

investigation. Patients with dyspepsia in tend to avoid upper gastrointestinal endoscopy, with

two major axons considered to be the causes of patients' refusal, their beliefs towards

endoscopy and their personal capability to cope with it.

From above research statistical data, researchers intended that patient knowledge is

very poor about endoscopy procedure . Refusal of endoscopy are also more , So it is role of

the Nurses that patients should be educated about importance of procedure by dissolving or

reliving the patient anxiety ,discomfort, fear confusion about the endoscopic by creating the

awareness about the pre-operative interventions and post-operative intervention about the

endoscopic procedure by assessing the through the research.

6.2 REVIEW OF LITERATURE: 9

The purpose of review of literature is to obtain comprehensive knowledge base and in depth

of information from previous studies.

REVIEWS ARE DIVIDED AS FOLLOWING SUB HEADING:

Studies related to upper gastro –intestinal endoscopy

Studies related to assessment of knowledge of patient undergoing upper

gastro –intestinal endoscopy

Studies related to structured teaching programme on upper gastro –

intestinal endoscopy.

Studies related to endoscopy.

Cotton PB et al conducted the study [2011 Sep; ] on Quality endoscopists and quality

endoscopy units at, Digestive Disease Center Medical University of South Carolinaz.

USA . These study. Concluded that endoscopy plays an important role in the diagnosis

and treatment of digestive diseases. The benefits are maximized when procedures are

performed at an optimal level of quality. We all need to agree on the metrics of

endoscopic performance, to develop the infrastructure to collect and analyze the data,

and to use the resulting knowledge to stimulate improvements in practice and benefit

the patients.14

Stöltzing H, Ohmann C.et al conducted study on Diagnostic emergency endoscopy in

upper gastrointestinal bleeding do w have any decision aids for patient selection at ,

Heinrich Heine University, Germany The benefit of emergency endoscopy and

10

therapeutic policies based on certain stigmata of bleeding has recently been

demonstrated in patients with peptic ulcer hemorrhage. Applying a simple method of

computer-aided diagnosis to a set of prospective data (n = 571) we investigated the

question as to whether information on the history (28 variables) and clinical

examination (8 variables) could be used to predict ulcer bleeding or certain stigmata of

bleeding. The patients were assigned to either a high-risk group (probability greater

than 0.50 for ulcer bleeding, arterial bleeding, etc.) or a low-risk group (p less than

0.50), and the prediction was compared with the actual findings at endoscopy. The

results were disappointing, with an overall accuracy of 71% for the prediction of

bleeding peptic ulcer and 71% for the prediction of a bleeding or non-bleeding visible

vessel. Despite a relative risk of 2.8 for "bleeding ulcer" and 2.5 for "visible vessel" in

the high-risk group, only 72% of all "bleeding ulcer" patients, and 69% of the "visible

vessel" patients could be identified by the model. .. Emergency endoscopy should

therefore be performed in all patients with gastrointestinal bleeding.15

A study conducted by Tedesco FJ on Endoscopy in the evaluation of patients with

upper gastrointestinal symptoms: indications, expectations, and interpretation. Upper

gastrointestinal endoscopy is the most sensitive diagnostic test in patients with upper

gastrointestinal symptoms. Endoscopy performed by trained examiners, however, still

misses lesions. Single-contrast upper gastrointestinal x-ray adds little new information

to a complete endoscopic examination by a trained endoscopist. With the availability

of "skinny" endoscopes as well as the ability to obtain directed cytology and biopsy

via the endoscope, a clinician may well choose upper gastrointestinal endoscopy as the

first and possible only diagnostic test in the evaluation of upper gastrointestinal

symptoms. The Endoscopists use of this procedure as the initial diagnostic test.16

Studies related to assessment of knowledge of patient undergoing upper gastro –

intestinal endoscopy.

11

A study conducted on acceptance and understanding of the informed consent procedure

prior to Gastrointestinal endoscopy by patients in KOREA. [2010 Feb] the aim of this

study was to evaluate the appropriateness of the informed consent procedure in Korea.

Methods used was a total of 209 patients who underwent endoscopy were asked to

answer a self-administered structured questionnaire on the informed consent procedure

for gastrointestinal endoscopy .a study results that one hundred thirteen patients

completed questionnaires and were enrolled. In the survey, 91.2% answered that they

understood the procedure and the degree of understanding decreased with age; 85.8%

were informed of the risks of the procedure and the proportion was higher for inpatients

and for those receiving therapeutic endoscopy; 60.2% were informed of alternative

methods, and the proportion was higher in older patients; 76.1% had the opportunity to

ask questions during the informed consent procedure, and the proportion was higher in

inpatients. About 80% had sedation before endoscopy and only 56% were informed of

the risks of sedation during endoscopy. A study concluded that the current informed

consent process may be reasonably acceptable and understandable to the patients. 17

A randomized trial study was conducted on combined written and oral information

prior to gastrointestinal endoscopy compared with oral information alone. Geneva,

Switzerland in 2008 Jun. A study shows that assess the effects of combined written

and oral information, compared with oral information alone on the quality of

information before endoscopy and the level of anxiety. Researcher designed a

prospective study in two Swiss teaching hospitals which enrolled consecutive patients

scheduled for endoscopy over a three-month period. A study results that a 718 eligible

patients 577 (80%) returned their questionnaire. Patients who received written leaflets

(N = 278) rated the quality of information they received higher than those informed

verbally (N = 299), for all 8quality-of-information items. The two groups reported

similar levels of anxiety before procedure (p = 0.66), pain during procedure (p =

0.20), tolerability throughout the procedure (p = 0.76), problems after the procedure

(p = 0.22), and overall rating of the procedure between poor and excellent (p = 0.82).

study concluded that Written information led to more favorable assessments of the

12

quality of information and had no impact on patient anxiety nor on the overall

assessment of the endoscopy. 18

A study had been conducted on Information, social support and anxiety before

gastrointestinal endoscopy, In USA [2006 Nov]. Researchers conducted a Structured

interviews method and taking a with 113 hospital out-patients about to undergo GI

endoscopy. Participants indicated their perceptions of how much support and how

much clear and useful information they had received from both their general

practitioner and a patient information developed in collaboration with health

psychologists as well as their perceptions of how much social support they had

obtained from other patients, family and friends. Anxiety was measured with a

population-specific trait and state adaptation of the Hospital anxiety and depression

scale .Result shows that the majority of the sample experienced high anxiety levels.

Showing females to be more anxious than males, F (1,84)=5.68, p<.05.The model was

significant with R(2)=0.452, F(11, 47)=3.522 and p=0.001.finally study revealed that

The clarity, but not the amount, of information and social support from important

others, but not GPs, were both mediating the stress experience of the patients by

reducing their perceived anxiety.19

A study was conducted on preparing patients for gastrointestinal endoscopy: the

influence of information in medical situations [2004 Jan]. Study shows that the effects

of the provision of information were tested in a sample of patients who underwent a

gastrointestinal endoscopy for the first time (N=260). On the basis of their

Threatening Medical Situation Inventory (TMSI)-monitoring score these patients

were divided in high monitors versus low monitors. On the basis of the existing

literature each group received the type of information that was considered most

beneficial with regard to their coping style, and each group was compared with a

control group receiving standard care. Dependent variables were anxiety at different

points in time, heart rate and skin conductance, pain, experience of the procedure,

course of the procedure, duration of gagging, and satisfaction with the information 13

provided.It is concluded that reservedness is required in providing extensive

information to patients who ask for this. Furthermore, considering the rather

unpredictable and uncontrollable course of a gastrointestinal endoscopy, coaching by

a nurse remains a valuable type of support.20

Studies related to structured teaching progromme on upper gastro –intestinal endoscopy.

A Study was conducted on the effects of providing pre-gastrointestinal endoscopy

written educational material on patients' anxiety: a randomized controlled trial. Ankara,

Turkey in 2010. The objective of this study is to determine the effects of written

educational material related to the endoscopy procedure on the anxiety level of the

patient before gastrointestinal endoscopy. A randomized controlled trial design were

used it contain case and control groups. 140 patients assigned randomly who applied for

gastro intestinal endoscopy. the control group in our study consisted of 70 people who

were briefly informed by the relevant unit about pre-endoscopy preparation. The case

group consisted of 70 people who were also given brief information about the pre-

endoscopy preparation by the relevant unit. The results that a significant difference in

the average state anxiety scores was found between the case and the control group

(p<0.05). An important difference was found in the average state anxiety scores between

the case and the control group who had not undergone endoscopy before our study

(p<0.05).finally study concluded that Use of written material including detailed

information to inform the patient before endoscopy was useful in lessening their anxiety

level.21

A study conducted on the effect of an information brochure on patients undergoing

gastrointestinal endoscopy. Netherlands [ 2006 July]. The present study shows that

the potential beneficial effects of an information brochure on undergoing a

gastrointestinal endoscopy for the first time .Patients were randomly assigned to an

experimental group receiving the brochure at least 1 day before the gastroscopy 14

(N=47), or to a control group not receiving the brochure (N=48).The results show that

all experimental subjects except one fully read the brochure. Those receiving the

brochure experienced less anxiety before the gastroscopy and afterwards they reported

greater satisfaction with the preparation for it. With regard to coping style there were

some small moderating effects into the direction expected. High monitors (those

seeking information under impending threat) receiving the brochure showed reduced

anxiety during the gastroscopy as compared to low monitors (tendency).researcher

conclude that providing patients with the developed brochure constitutes an efficient,

beneficial intervention.22

An observational study was conducted of Information required to provide informed

consent for endoscopy of patients' expectations. The aim of this study was to

determine how much information patients require about the risk of complications in

order to provide informed consent to undergo endoscopy. The patients were asked

how common each complication would have to be for them to require information

about the complication before providing adequately informed consent. Study results

that Data were obtained from 150 gastroscopy patients (51% male, median age 55.5

years) and 150 colonoscopy patients (60% male, median age 54.4 years).Patients in

both groups were more likely to want to know about major rather than minor

complications at a lower level of risk .Similar proportions of gastroscopy patients (n =

29, 19%) and colonoscopy patients (n = 21, 14 %) wanted to know about all possible

complications. Study concluded that the information patients require in order

providing informed consent is very variable. The process may be improved by

providing procedure-specific information leaflets that offer information regarding

common and serious complications.23

STATEMENT OF THE PROBLEM:

“A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED

TEACHING PROGRAMME ON KNOWLEDGE REGARDING UPPER GASTRO-

15

INTESTINAL ENDOSCOPY AMONG PATIENTS WHO ARE UNDERGOING

UPPER GASTRO-INTESTINAL ENDOSCOPY AT SELECTED HOSPITALS,

TUMKUR”.

6.3 OBJECTIVES OF THE STUDY:

1. To assess the pretest knowledge of regarding regarding Upper Gastro-intestinal

Endoscopic procedures

2. To develop and administer structural teaching programme regarding Upper Gastro-

intestinal Endoscopy

3. To assess the post test knowledge score regarding the Endoscopic procedures.

4. To find out significant difference between pre-test and post-test knowledge regarding

Upper Gastro-intestinal Endoscopy.

5. To determine the association between post test knowledge score and demographic

variables.

6.4 OPERATIONAL DEFINITIONS:

EVALUATE: Evaluate refers to measure the knowledge of patient regarding Upper

Gastro-intestinal Endoscopic procedures.

EFFECTIVENESS: It refers to the extent to which the structural teaching

programme on Upper Gastro-intestinal Endoscopy achieves desired effect in

improving the knowledge of patient as evidence from gain in knowledge score.

STRUCTURAL TEACHING PROGRAMME: It refers to the systematically

develop instructional method and teaching aids designed for the the patient who are

16

undergoing Upper Gastro-intestinal Endoscopy to provide information on Upper

Gastro-intestinal Endoscopy procedure.

KNOWLEDGE: It refers to response of the patient cognitive ability to interpret the

information regarding Upper Gastro-intestinal Endoscopy and to answer the

questions regarding it reasonably and correctly.

UPPER GASTRO-INTESTINAL ENDOSCOPY: It refers to the use of flexible

tube to visualize the upper Gastro-Intestinal tract to perform certain diagnostic and

therapeutic procedure.

PATIENT: A person who is suffering from the upper Gastro-Intestinal Disorders.

HOSPITAL: An institution for the care, diagnosis and treatment of the sick and

injured.

6.5 HYPOTHESES:

H1: There will be significant difference between pretest and posttest

knowledge scores regarding the knowledge of patient who undergoing upper

Gastro-Intestinal Endoscopy.

H2: There will be a significant association between posttest knowledge score with

selected demographic variables.

6.6ASSUMPTIONS

17

The patient who undergoing upper Gastro-Intestinal Endoscopy may have minimal

knowledge regarding Endoscopic procedures.

Structured teaching programme provides an opportunity for learning and better

understanding regarding knowledge of Endoscopy and among patient who undergoing

Endoscopic procedures.

The patient who undergoing Endoscopic procedures could positively utilize the

knowledge regarding Endoscopic procedures.

6.7 DELIMITATIONS OF THE STUDY:.

The patient who undergoing upper Gastro-Intestinal Endoscopy who are

available at the period of study.

Effectiveness of Structural teaching programme in terms of knowledge.

Measurements of scores for knowledge once before and after Structural teaching

programme.

6.8VARIABLES

Variables are an attribute of a person or object that varies or takes different

values.

INDEPENDENT VARIABLE: Stractured teaching programme on upper

Gastro-Intestinal Endoscopy

DEPENDENT VARIABLES: Knowledge level of patient regarding the upper

Gastro-Intestinal Endoscopy

DEMOGRAPHIC VARIABLES: Age, sex, place of residence, occupation,

education, source of information, family income and types of Gastro-Intestinal

Disorders.

6.9 PILOT STUDY

18

The pilot study will be conducted on 10 samples.

Let the study is to assess the:

Find out feasibility of conducting the final study.

Determine the method of data analysis.

Assess the practicability of carrying out the main study

7. MATERIALS AND METHODS OF THE STUDY :

7.1.1 SOURCE OF DATA COLLECTION:

The data will be collected from the patient who undergoing upper Gastro-Intestinal

Endoscopy in selected hospital at Tumkur.

7.1.2RESEARCH DESIGN:

One group Pre test Post test Research Design.

7.1.3 RESEARCH APPROACH:

An evaluative approach is considered to be appropriate for this study.

7.1.4RESEARCH SETTING:

The study will be conducted at Siddaramanna hospital,Shri, Devi hospital and District

hospital Tumkur.

7.1.5POPULATION:

TARGET POPULATION:-

Patient who has diagnosed as Gastro-intestinal disorder and reffered for upper Gastro-

Intestinal Endoscopy.

ACCESSIBLE POPULATION:-

19

The population of present study includes the patient who undergoing upper Gastro-

Intestinal Endoscopy in selected hospital at Tumkur.

7.1.6 METHODS OF DATA COLLECTION

The data will be collected from the patient who undergoing upper Gastro-Intestinal

Endoscopy by using structured interview schedule to assess the pre existing knowledge

regarding the Endoscopic procedure. After administration of structural teaching programme

the data will be collected 7 days later from who undergoing upper Gastro-Intestinal

Endoscopy by using structured interview schedule to assess the improvement in the

knowledge. The data collection procedure will be carried out for a period of three month.

7.2.1SAMPLING TECHNIQUE

Purposive sampling technique for the present study.

7.2.2SAMPLE SIZE

The sample comprised of 60 Patients who under-going endoscopy procedure who

available during the data collection.

SAMPLING CRITERIA

7.2.3 INCLUSIVE CRITERIA

Patient. Under-going endoscopy who are willing to participate in the study.

Patient undergoing endoscopy who are who are between 18-60 age of years.

Patient t undergoing endoscopy who can understand kannada.

7.2.4 EXCLUSIVE CRITIRIA

20

Patient posted for emergency Upper G-I Endoscopy

Patient, who are sedated or confused.

Patient who are not available during the study.

Patient who are unconscious

7.2.5 TOOLS FOR DATA COLLECTION

The structured interview schedule is used to collect data from the patient undergoing

gastro-intestinal endoscopy. Content validity will be established by requesting the experts to

go through the developed tool and give their valuable suggestions.

The structured questionnaire should consist of the following sections.

SECTION A: Questionnaire related to the demographic data.

SECTION B: Questionnaires to assess the level of knowledge regarding the upper

Gastro-Intestinal Endoscopy

7.2.6 PLAN FOR DATA ANALYSIS

The data collected will be analyzed by means of descriptive and inferential statistics

(A) DISCRIPTIVE STATISTICS:

Mean, Mean percentage & standard deviation of subject will be used to qualifying the

level of knowledge regarding Upper Gastro-Intestinal Endoscopy among patient undergoing

upper Gastro-Intestinal Endoscopy

(B) INFERENTIAL STATISTICS:

21

Paired t-test will be used to examine the effectiveness of structure teaching

programme by comparing pre and post test scores. And to find out the difference in

knowledge between pre and post test.

The chi square will be used to find out the association between socio demographical

variables of patient undergoing Upper Gastro-Intestinal Endoscopy with post test knowledge

scores. The data will be planned to present in the form of tables and figures.

7.2.7 TIME AND DURATION OF THE STUDY

The time and duration of study will be limited to three months or as per guidelines of

university.

7.3 DOSE THE STUDY REQURIRE ANY INVESTIGATION OR INTERVERTION

TO BE CONDUCTED ON PATIENT OR HUMAN OR ANIMAL? IF SO PLEASE

DISCRIBE BRIEFLY.

Yes, Structural teaching programme is the intervention that is going to be given to the

patient undergoing Upper Gastro-Intestinal Endoscopy.

7.4: HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR

INSTITUTIONS?

The pilot study and the main study will be conducted after the approval of the research

committee. Permission will be obtained from the concerned head of the institution. The

purpose and details of the study will be explained to the study subjects and an informed

consent will be obtained from them. Assurance will be given to the study subjects regarding

the confidentiality and anonymity of the data collected from them.

8. LIST OF REFERENCES:

22

1. Sumathi B, Navaneethan U, Jayanthi V. Appropriateness of indications

fordiagnostic upper gastrointestinalendoscopy in India. [serial on the Internet]

2008[cited 2011]; 49 (12) : 970; [about 7 p.].

Available from:http://smj.sma.org.sg/4912/4912a1.pdf

2. Sr. Nancy.M.S.J.Principles And Practice Of Nursing N R brothers

publication.2009;p337.

3. Upper GI Endoscopy; National Digestive Diseases Information Clearinghouse

(NDDIC) u.s. department of health and human services 2009-may Available

from:http://digestive.niddk.nih.gov/ddiseases/pubs/upperendoscopy/

4. Williams, Wilikins.Lippincott Manual of Nursing practice.9thed. New Delhi:

Wolters Kluwer; 2009;p649.

5. Brunner,Suddarth.Medical Surgical Nursing.10thed.London:

LippincottWilliams, Wilikins; 2004.p952.

6. Hospital Utilization among Oldest Adults,2008 Available from:http://www.census.gov/popest/states/NST-ann-est.html.

7. Sachdeva A, Bhalla A, et al . “The effect of sedation during upper gastrointestinal

endoscopy”. Saudi J Gastroenterol [serial online] 2010 [cited 2011 Nov 26];16:280-4.

Available from: http://www.saudijgastro.com/text.asp?2010/16/4/280/70616

8. Sumathi B, Navaneethan U, Jayanthi V. Appropriateness of indications fordiagnostic

upper gastrointestinalendoscopy in India. [serial on the Internet] 2008[cited 2011]; 49

(12) : 972

9. Oikonomidou E, Anastasiou F et al” Upper gastrointestinal endoscopy for dyspepsia: exploratory study of factors influencing patient compliance in Greece” Free PMC Article Rev Col Bras Cir. 2010 Jun;37(3):234-9. Available from:http://www.ncbi.nlm.nih/pubmed/:21320314

10. Ersöz F, Toros AB, et al “Assessment of anxiety levels in patients during elective

upper gastrointestinal”. Turk J Gastroenterol. 2010 March;21(1):29-Available

from:http://www.ncbi.nlm.nih/pubmed/: 20533109

23

11. Hackett ML, Lane MR et al “ Upper gastrointestinal endoscopy: are preparatory

interventions effective”. Comment in Gastrointest Endosc. 1998 Oct;48(4):430-

Available from:http://www.ncbi.nlm.nih/pubmed/: 9786104

12. Upali Weragama 'Endoscopy' 2009-APR-19Available from:

http://sundaytimes.lk/090419/MediScene/mediscene_8.html

13. Cotton PB . “Quality endoscopists and quality endoscopy units. Digestive Disease

Center”. Medical University of South Carolina. USA. 2011 Sep;43(9):802-7.

Avalaible from: http://www.ncbi.nlm.nih.gov/pubmed/21776431

14. Stöltzing H, et al “Diagnostic emergency endoscopy in upper gastrointestinal bleeding

do have any decision aids for patient selection”. Hepatogastroenterology. 1991

Jun;38(3):224-7,

Avalaible from: http://www.ncbi.nlm.nih.gov/pubmed/.1937359

15. Tedesco FJ ,et al,”Endoscopy in the evaluation of patients with upper gastrointestinal

symptoms:indications, expectations, and interpretation”.J Clin Gastroenterol.

1981;3(Suppl 2):67-71. , Avalaible from: http://www.ncbi.nlm.nih.gov/pubmed/.

7320470

16. Song JH, Yoon HS et al.” Acceptance and understanding of the informed consent

procedure prior to gastrointestinal endoscopy by patients”. Korean J Intern Med. 2010

Mar; 25(1) page no: 36-43. Epub 2010 Feb 26. : Available

from:http://www.ncbi.nlm.nih/pubmed/:20195401

17. Felley C, Perneger TVet et al,” Combined written and oral information prior to

gastrointestinal endoscopy compared with oral information alone a randomized trial”

BMC Gastroenterol. 2008 Jun 3;8:22.(15) : Available

from:http://www.ncbi.nlm.nih/pubmed/:18522729

24

18. Eberhardt J, van Wersch A et al” Information, social support and anxiety before

gastrointestinal endoscopy” . Br J Health Psychol. 2006 Nov; 11( Pt 4) :551-9.(16) :

Available from:http://www.ncbi.nlm.nih/pubmed/:17032483

19. Van Vliet MJ, Grypdonck “Preparing patients for gastrointestinal endoscopy: the

influence of informationin medical situations” , M Patient Educ Couns. 2004

Jan;52(1):23-30.(19) : Available from:http://www.ncbi.nlm.nih/pubmed/:14729287

20. Kutlutürkan S, Görgülü et al “The effects of providing pre-gastrointestinal endoscopy

written educational material on patients' anxiety” .Int J Nurs Stud. 2010

Sep;47(9):1066-73. Epub 2010 Feb 23.9(13) : Available

from:http://www.ncbi.nlm.nih/pubmed/: 20181334

21. Van Zuuren FJ, Grypdonck M et al, “The effect of an information brochure on

patients undergoing gastrointestinal endoscopy”. Patient Educ Couns. 2006 Dec;64(1-

3):173-82. Epub 2006 Jul 21.(17) : Available

from:http://www.ncbi.nlm.nih/pubmed/:16859866

22. Brooks AJ, Hurlstone DP et al “Information required to provide informed consent for

endoscopy: an observational study of patients expectations Endoscopy”. 2005

Nov;37(11):1136-9.(18) : Available

from:http://www.ncbi.nlm.nih/pubmed/:16281146

6

9

SIGNATURE OF THE

CANDIDATE

25

1

10

REMARKS OF THE GIDE

1

11

11.1 NAME AND

DESIGNATION OF GUIDE

11.2 SIGNATURE

11.3 CO-GUIDE

11.4 SIGNATURE

11.5 HEAD OF THE

DEPARTMENT

11.6 SIGNATURE

1

12.

12.1 REMARKS OF THE

CHAIRMAN AND PRINCIPAL.

12.2 SIGNATURE

26