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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)
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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE,
KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTAION.
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NAME OF THE CANDIDATE
AND ADDRESS. Mr. VIJAY.H.DURAGANNAVAR
FIRST YEAR MSc. NURSING,
SRI RAMANAMAHARSHI COLLEGE OF
NURSING, TUMKUR.-572106,
KARNATAKA.
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NAME OF THE INSTITUTION. SRI RAMANAMAHARSHI COLLEGE OF
NURSING, TUMKUR-572106,
KARNATAKA.
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COURSE OF STUDY AND
SUBJECT.
FIRST YEAR M.Sc. NURSING,
MEDICAL SURGICAL NURSING.
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DATE OF ADMISSION TO
COURSE. 15-07-2011
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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”.
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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
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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.
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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
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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
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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
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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.
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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
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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