Development And Description Of Tool

Published Date: 02 Nov 2017

Methodology of research organizes all the components of study in a way that most likely will lead to valid answers for the problems that have been posted (Burns and Groove, 2008).

This chapter deals with the methodology adopted for the study. It includes the research approach, research design, variables, setting, population, sample, criteria for selection of the sample, sample size, sampling technique, development and description of the tool, content validity, pilot study, reliability of the tool, data collection procedure and plan for data analysis

3.1 RESEARCH APPROACH

A quantitative research approach was used to carry out the study

3.2 RESEARCH DESIGN

The research design used for this study was quasi experimental, equivalent control group post test only design. According to Polit and Hungler (2012), the schematic representation of quasi experimental study is shown below:

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Group

Nursing intervention (X)

Post test (02)

Experimental group

Self instructional discharge protocol for cancer patients

Assessment of post test level of knowledge and practice on self instructional discharge protocol for cancer clients among nurses by using structured questionnaire and observational checklist

Control group

Hospital routine discharge protocol

Assessment of post test level of knowledge and practice on self instructional discharge protocol for cancer patients by using structured questionnaire and observational checklist

3.3 VARIABLES

3.3.1 Independent Variable

Self instructional discharge protocol for cancer patients by the nurses.

3.3.2 Dependent Variable

Knowledge and practice of nurses

3.3.3 Extraneous Variables

Age in years, educational status, gender, years of caring for cancer patients and the position held in the ward.

3.4 SETTING

The research setting was Cancer Institute, Adyar which has a bed strength of 423. The Hospital has the Medical, Surgical Oncology wards, day care facilities and radiation therapy unit in the Main and Annexe block. The number of patients admitted in Cancer Institute per day is about 20 to 30. Every month about 300 to 400 discharges are done in this hospital.

3.5 POPULATION

3.5.1Target Population

The study population consisted of all the registered nurses (qualified with Diploma in General Nursing and Midwifery, BSc Nursing degree or Post Basic BSc Nursing ) who takes care of cancer patients and participate in the discharge procedure.

3.5.2 Accessible Population

148 nurses who were available during data collection period and who took care of cancer patients and participated in their discharge, at Cancer Institute Adyar.

3.6 SAMPLE

The registered nurses, who satisfied the inclusive criteria were the samples of the study i.e., the nurses in the experimental group were chosen from the annexe block and the control group from the main block of the Cancer Institute, Adyar.

3.7 SAMPLE SIZE

It consisted of 60 nurses, 30 nurses each in the experimental group and control group who were working in the Medical and Surgical Oncology wards of annexe and main blocks respectively of Cancer Institute, Adayar.

3.8 CRITERIA FOR SAMPLE SELECTION

3.8.2 Inclusive Criteria

Nurses assigned to discharge cancer patients during the morning shift.

Nurses with educational qualification of Diploma in General Nursing and Midwifery,PB.BSc(N) or BSc Nursing.

Nurses who are willing to participate in the study.

Nurses who had experience of more than 6 months in the specified areas

3.8.2 Exclusive Criteria

Nurses who have undergone special education and training on discharge instructions.

3.9 SAMPLING TECHNIQUE

The sampling technique used in the study was non probability convenient sampling technique. The investigator conducted a need assessment for the nurses in the medical and surgical oncology wards of the annexe block and 30 nurses were conveniently selected as the experimental group.

In the same way the need assessment was done for the nurses in the medical and surgical unit of main block and 30 nurses were selected using convienient sampling technique as the control group. Homogeneity between group was maintained on the basis of level of need, gender and position held in the ward.

3.10 DEVELOPMENT AND DESCRIPTION OF TOOL

After an extensive review of literature, discussion with the experts and with the investigator’s personal and professional experience, a structured questionnaire was developed to assess the knowledge and an observational checklist to assess the post practice of nurses utilizing the self instructional discharge protocol for cancer patients.

The tool constructed for the study consisted of 2 parts:

3.10.1 PART A: DATA COLLECTION TOOL

3.10.1.1 Section A: Personal data sheet.

3.10.1.2 Section B: Need assessment scale.

3.10.1.3 Section C: Structured knowledge questionnaire.

3.10.1.4 Section D: Observational checklist.

3.10.2 PART B: INTERVENTION PROTOCOL

3.10.2.1 Section E: Self Instructional Discharge Protocol for Nurses.

3.10.1 PART A: DATA COLLECTION

3.10.1.1 Section A: Personal Data Sheet

Personal data sheet was used to collect the demographic characteristics, consisting of 5 variables to assess the background of the nurses. This included the age in years, educational status, gender, years of experience in caring cancer patients and position held in the ward.

3.10.1.2 Section B: Need assessment scale.

This section consists of Need Assessment Scale which included positive worded questions to identify the need for discharge protocol. In this section, 5 positive worded questions were formulated.

Scoring Key: The items were scored as ‘1’ for ‘Yes’ and ‘0’ for ‘No’

Total item score: 5, Maximum Score was ‘5’ and Minimum Score was ‘0’.The raw score was converted to percentage to interpret the level of need. The level of need was interpreted as

Score

Level of Need

<50%

Low Level of Need

51 – 75%

Moderate Level of Need

>75%

High Level of Need

3.10.1.3 Section C: Structured Questionnaire.

In the structured questionnaire 30 questions were formulated under separate sub headings to assess the knowledge of the nurses on self instructional discharge protocol for cancer clients as follows:

Items

No. of questions

Personal hygiene

Pain management

Safe use of medication

Dietary management

Rest and activity

Management of selected adverse effect of chemotherapy and radiation therapy

Follow up

Family responsibility

4

4

3

4

4

4

4

3

Scoring Key:

Each item was a close ended multiple choice questions with a single correct answer. Scoring for the correct answer was "1" and the wrong answer was "0". Total score of the items was "30". Maximum score was 30 and minimum score was 0. The raw score was converted to percentage to interpret the level of knowledge. The level of knowledge was interpreted as

Score

Level of Need

<50%

Low Level of Need

51 – 75%

Moderate Level of Need

>75%

High Level of Need

3.10.1.4 Section D: Observational checklist.

Post intervention level of practice among nurses was assessed using observational checklist on self instructional discharge protocol for cancer patients.

OBSERVATIONAL ITEM CHECKLIST

Items

No. of items

Personal hygiene

Pain management

Safe use of medication

Dietary management

Rest and activity

Management of selected adverse effect of chemotherapy

and radiation therapy.

Follow up

Family responsibility

2

2

2

4

2

1

2

1

Scoring Key: The items were rated as ‘1’ for yes (providing education) and ‘0’ for No (Not providing education). The raw score was converted to percentage to interpret the level of practice. The level of practice was interpreted as

Score

Level of Practice

<50%

Need improvement in practice

51 – 75%

Average practice

>75%

Good practice

3.10.2 PART B: INTERVENTIONAL PROTOCOL

3.10.2.1 Section E: Self instructional discharge protocol

Self instructional discharge protocol for cancer patients given to all the samples to improve their knowledge and practice. It comprises of discharge education which includes

Personal hygiene instructions.

Pain management.

Safe use of medication.

Dietary management

Rest and activity

Management of selected adverse effect of radiation therapy and chemotherapy

Follow up.

Family responsibility.

3.11 CONTENT VALIDITY

The content validity of the data collection tool and intervention protocol was ascertained from the expert’s opinion in the following field of expertise.

Medical Oncologist – 2

Nursing Expert – 3

Nursing Practice Expert – 1

Modifications suggested by the experts in the tool were related to the options for the questions on care of wound and personal hygiene, which was incorporated in the tool. All the experts had their consensus and then the tool was finalized.

3.12 ETHICAL CONSIDERATION

Ethics is a system of moral values that is concerned with the degree to which the research procedures adhere to the professional, legal and social obligations to the study participants. Polit and Hungler (2011)

A Beneficience

The investigator followed the fundamental ethical principle of beneficence (doing good) by adhering to

The right to freedom from harm and discomfort

The study will be beneficial for the participants as it enhances their knowledge about self instructional discharge protocol and improves their practice while taking care of clients with cancer.

The right to protection from exploitation

The investigator explained the procedure and nature of the study to the participants and ensured that none of the participants in both control and experimental group would be exploited or denied fair treatment.

B. Respect for human dignity

The investigator followed the second ethical principle of respect for human dignity. It includes the right to self determination and the right to self disclosure.

The right to self-determination.

The investigator gave full freedom to the participants to decide voluntarily whether to participate in the study or to withdraw from the study and the right to ask questions.

b) The right to full disclosure.

The researcher has fully described the nature of the study, the person’s right to refuse participation and the researcher’s responsibilities based on which both oral and written informed consent was obtained from the participants.

C. Justice

The researcher adhered to the third ethical principle of justice, it includes participant’s right to fair treatment and right to privacy.

a) Right to fair treatment

The researcher selected the study participants based on the research

requirements. The investigator followed hospital routine for control group.

Right to privacy.

The researcher maintained the participant’s privacy throughout the study.

3.13 PILOT STUDY PROCEDURE

Pilot study is the trial run for the main study. Pilot study was conducted at

V.S Hospital, Chetpet, after obtaining formal written permission from the Principal of Omayal Achi College of Nursing, the Director, and the Nursing Superintendent of V.S Hospital for conducting the pilot study. The study was conducted for a period of one week from 7th June to 13th June 2012. The investigator introduced self to the nurses in the medical and surgical oncology units.

After a brief explanation about the purpose of the study, a written consent from the nurses was obtained for data collection, following which the need assessment was done for the nurses. After this, the investigator selected 6 nurses (3 nurse from the morning shift as control group and 3 nurses from night shift as experimental group) who fulfilled the sample selection criteria using non probability convenient sampling technique.

The investigator first selected the control group and administered structured knowledge questionnaire to assess the level of knowledge on self instructional discharge protocol and observed the practice of discharge procedure once using observational checklist.

For experimental group, the investigator provided the self instructional discharge protocol and on the 7th day the investigator assessed the level of knowledge using structured questionnaire and observed the practice of discharge procedure once using observational checklist. Each sample took 30 minutes time to answer the questions. The module on self instructional discharge protocol was given to the nurses in the control group at the end of the study, on the basis of ethics.

. The pilot study results revealed that the data collection tool and self instructional discharge protocol for cancer patients was feasible and practicable to conduct the main study.

3.14 RELIABILITY

The reliability of the tool was assessed using both test retest method and interrater method. The test retest was used to assess the reliability of the self instructional discharge protocol knowledge questionnaire where the ‘r’ value was 0.88. With regard to observational checklist, the interrater method was used. The ‘r’ value was 0.84 which proved the high reliability of the knowledge questionnaire and observational checklist. Hence the tools were found to be reliable to incorporate in the main study.

3.15 PROCEDURE FOR DATA COLLECTION

The main study was conducted after obtaining formal permission from the Principal, Omayal Achi College of Nursing. Ethical Committee clearance was obtained from the International Centre for Collaborative Research and written permission was obtained from Medical Director and Nursing superintendent of Cancer Institute, Adyar.

The study was conducted for a period of 4 weeks. A brief introduction of self and explanation on the purpose of the study was given. After obtaining written consent from the nurses, data collection was commenced. At first the demographic detail was elicited using personal data sheet and then the need assessment was done by using the positive worded questionnaire. After need assessment the investigator selected 30 nurses each who fulfilled the inclusion criteria, using non probability convenience sampling technique from the medical and surgical oncology wards of Cancer Institute, Adyar.

To prevent bias among the experimental and control group, the researcher selected the experimental group(n=30) from the annexe block and the control group(n=30) from the main block of Cancer Imstitute, Adyar. The samples were assigned an identification number to maintain confidentiality.

Following the need assessment, the nurses in the control group were gathered in a room in the main block, which was well ventilated and had comfortable seating arrangement. The structured knowledge questionnaire was administered on the day one. It took 30 minutes to the nurses to answer the questions. No intervention was given for the nurses in the control group. Following this, the investigator observed the practice of discharge procedure by the nurses once using observational checklist. The researcher assessed the practice of around 8-10 nurses per day. Same way done for all the samples.

Then the experimental group were gathered together in the well ventilated room in the annexe block which had comfortable seating arrangement. The module on self instructional discharge protocol was given to all the samples in the experimental group. At the end of the 7th day the post interventional level of knowledge was assessed using structured questionnaire and practice of discharge procedure using self instructional discharge protocol by the nurses was assessed once using observational checklist and per day about 8-10 discharge practice was assessed. Same way it was done for all the samples.

3.16 PLAN FOR DATA ANALYSIS

The data obtained were analyzed using both descriptive and inferential statistics.

3.16.1 Descriptive Statistics

Frequency and percentage distribution was used to analyze the selected demographic variables.

Frequency and percentage distribution of level of need of the nurses in the control and experimental group

Mean and standard deviation was utilized to analyze the post test level of knowledge and practice.

3.16.2 Inferential Statistics

Unpaired ‘t’ test was used to assess the effectiveness of self instructional discharge protocol between the control and experimental group.

Correlation coefficient was utilized to find the relationship between post test level of knowledge and practice among control and experimental group.

Chi square test was used to find out the association between post test level of knowledge and practice with selected demographic variables of the nurses in the experimental group.