CHAPTER I

INTRODUCTION
1.1 Background of the Study Coronary Heart Disease (coronary artery disease) has been defined as the impairment of heart function due to inadequate blood flow to the heart compared to its needs, caused by obstructive changes in the coronary circulation to the heart. It is the cause of death in the most industrialized countries. CHD may manifest itself in many presentations: Angina pectoris, Myocardial infarction, Irregularities of the heart, Cardiac failure, and Sudden death. Coronary artery disease is the narrowing or blockage of arteries that surround the heart muscle. It results when the fatty plague builds up in the artery walls (known as atherosclerosis). The build is associated with high levels of cholesterol in the blood. Highest coronary mortality is seen at present in North Europe and in English speaking countries e.g.: Scotland, Northern Ireland, and Finland. On the other hand rates in southern Europe are much less e.g.: Italy, France, and those in Japan. (k park , 2007) It is that 12.6 % of worldwide death was from Coronary Artery disease (CAD) .MI continues to be a significant problem in industrialized countries and is becoming an increasingly significant problem in developing countries. Worldwide more than 3 million people have ST Elevation Myocardial Infarction and Non ST Elevation Myocardial Infarction a year. (Mallinnsonn et al:2010) Every 20 seconds an Americans suffers coronary artery events and approximately every one minute someone dies of coronary event. Every year about 1.1 million American have acute myocardial infarction. About 60,000people die of heart disease in the United states every year that is in every 4 deaths. More than half of the deaths due to heart disease in 2009 were in men. CHD is the common type of heart disease killing more than 385,000 people annually. Every year about 715,000 Americans have 1

heart attack, of these 525,000 are a first heart attack and 190,000 happen in people who have already had a heart attack.(American heart Association2011) According to the data of WHO 2010, deaths by CHD in United Kingdom is 92,299 its % is 19.77 %.The age adjusted death is 68.8 per 100,000 of population and world rank is 155. According to WHO data 2010 deaths by CHD in CONGO is 2,153, AND ITS % is 5.47%.The age adjusted rate is 127.7 per 100,000 population , and world rank is 75. In India, about 25% of deaths in age group 25-69 years occurs because of heart diseases. In urban areas , deaths our because of heart alignments, while this % in rular areas is 22.9%.If all age groups are included heart disease accounts for about 19% Death by CHD is 1,249,587 around 13%, Rate of CHD is 165.79 , and world rank of CHD is 37(WHO 2010) According to the latest WHO data published in April 2011 CHD deaths in Nepal reached 21,152 or 14.24% of total Deaths. The age adjusted death rate is 152.62 per 100,000 of population , ranks of Nepal is 47 in the world.

Menopause
Menopause is a stage in life when a women stops having her monthly period. It is normal part of aging and marks the end of womens reproductive years, menopause typically occurs in womens late 40s to early 50s, however women who have their ovaries surgically removed undergone sudden menopause. (www.webmed.com)

Post menopause

The years following menopause are called post menopause A woman is considered to be postmenopausal when she has not had her period for an entire year. once the women is in postmenopausal stage, she may regain energy and feel emotionally normal once again, but the lower level of estrogen in her body may put you at higher risk for certain conditions, such as: osteoporosis, heart disease, and changes in the vagina and bladder.(www.webmd.com) Even if women is postmenopausal, getting regular check-ups and preventive

screening tests such as pelvic exams, Pap smears, and mammograms are among the most important things done.. Coronary artery disease is the narrowing or blockage of arteries that surround the heart muscle. It results when the fatty plague builds up in the artery walls ( known as atherosclerosis).The build is associated with high levels of cholesterol in the blood. After menopause a womens risk of CAD increases. This increase may be linked with the loss of estrogen in the women who have had the premature menopause without the benefit of estrogen. ( my.clevelandclinic.org/disorders/Menopause) Estrogen helps to maintain healthy levels of cholesterol in the blood. It may also improve blood flow to the heart muscle and reduce blood clotting factors. However it has not been shown to prevent the risk of blood clots and stroke. A healthy diet, not smoking and getting regular exercise are the best option to prevent heart disease. Treating elevated blood pressure, diabetes, and maintaining cholesterol levels with attain medications and aspirin therapy for selected at risk persons are the standard of care. (www.34-menopause-symptoms.com/postmenopausal) 1.2 Rational of the Study Heart disease is increasing worldwide day by day. Approximately 12 million people are dying each year due to heart disease in world. Among them more than 60 lakhs people are dying due to heart disease in developing countries (Regmi 2003). CVDs are the leading cause of deaths and disability in the world. Although a large proportion of CVD is preventable they continue to rise mainly because preventive measures are inadequate.(WHO 2011).

Coronary heart disease is the main cause of death in women. Women during reproductive Years are at lower risk for coronary heart disease than men but this difference tends to disappear after the menopause Even though the research have been done in CHD among menopause but still because of lack of knowledge about risk factors such as obesity , diabetes , high blood pressure , dislipidemia , smoking and sedentary life style this disease is a leading cause of death among postmenopausal women. Though the disease is preventable, client they dont have any idea about its preventive measures. In years experience in new medical ward at shahid gangalal national heart centre, many CHD patient were provided care among them female of postmenopausal period suffer from coronary heart disease. Most of them were at risk because of diabetes, smoking, alcoholism, sedentary lifestyles. Because of the complication of disease, sudden death occurred though the treatment was done properly. The effort of this study is to identify the knowledge of client regarding contributing factors and preventive measures of CHD in postmenopausal women. Finding of the study will be helpful for the individual, family, community and country. As a whole will be helpful in reduction of risk for developing the complication of CHD. 1.3 Statement of the Problem Knowledge regarding contributing factors and.preventive measures of coronary heart disease among postmenopausal women. The burden of CHD is increasing globally, particularly in developing countries .About 21,152 or 14.24%of total death is caused by CHD in Nepal. World rank is 47 (WHO2011) 1.4 Objectives of the Study a) General objective:

To assess the knowledge of postmenopausal women regarding contributing factors and its preventive measures of CHD.

b) Specific objectives: To assess the knowledge of postmenopausal women regarding contributing factors of CHD. To assess the knowledge of postmenopausal women regarding preventive measures of CHD. 1.5 Research questions What is level of knowledge of the post menopausal women on contributing factors and preventive measures of CHD? 1.6 Operational Definition Of Relevant Terms a. knowledge: knowledge refers to an understanding of clients regarding CHD,its contributing factors and preventive measures b. Postmenopause:it refers to the period after the menstruation stops. c. Contributing factors: it refers to factors that cause CHD d. Prevention: it refers to stop the occurrence of CHD in the coming years.

CHAPTER II
LITERATURE REVIEW
2.1 Review of related literature Different literature related to this research topic was reviewed thoroughly to gain in depth knowledge as well as to support the study. The literature review was carried out through non-electronic (books, newspapers, journals) and electronic medias. Katerina et al.(2006) stated that there is higher incidence of CHD in postmenopausal women than the women of reproductive age. Coronary artery stenosis is found to be more advanced in postmenopausal than in premenopausal .estrogen deprivation play an important role in the appearance of early CHD in women. Shorter lifetime exposure to endogenous estrogen is an important risk factor for the presence and severity of CHD.Endogenous estrogen appear to play a protective role for the cardiovascular system. N.Agrnier et.al (2009) reported that the CHD risk increases during the sixth decades could be explained not only by estrogen deprivation but also by an effect on lipid profile which is likely to occur in perimenopouse period. A study done on CCU of shahid gangalal national heart centre shows that the prematurity and severity of CAD decrease starts at an early age and has a malignant course. Acute coronary syndrome patient below 40 years admitted are altogether 54 patients , male 44 (81%), and female 10 (19 %).from 2008 to 2009. Among the major risk factors (smoking, hypertension, diabetes, and dyslipidemia) dyslipidemia was the most common i.e83.3%, followed by HTN 70%, smoking 70%, abnormal blood glucose level 50%, DM IN 22%, IFG in 27.7%. High blood cholestrolis the

common form of dyslipidemia followed by high LDL 44.4%, and low LDL in 31.4 %. ( Nepalese heart journals, 2010) Wfred miser et al ( 2011 ) stated that Cardiovascular disease (CVD) is the leading cause of death in adults, accounting for one out of every 2.8 deaths in the United States.1 Daily use of low-dose (75 to 325 mg) aspirin as a secondary preventive measure reduces all-cause mortality by 18 %, and subsequent myocardial infarctions by 30 % in persons with known CVD. Aspirin use prevents CVD by inhibiting cyclooxygenase, which blocks the formation of thromboxane A2 and thus disrupts platelet aggregation and prevents vasoconstriction. The American Heart Association recommends that daily aspirin be used indefinitely in all patients with known CVD, unless contraindicated, for secondary prevention American heart association (2011) over 50,000 American women die of cardiovascular disease each year .This twice the number of deaths from all cancers combined (lung cancer, the leading cause of cancer deaths, claims approximately 65,000 deaths per year and breast cancer kills around 40,000 women per year) -One in three women has some form of cardiovascular disease. -38% of women who have heart attacks die within the first year compared to 25%of men. - 35% of women have a second heart within six years of the first attack compared to 18%of men. - Over 60,000 women die of stroke each year, approximately 60%stroke deaths occur in women. Frank B (2002) reported that that diets using non hydrogenated unsaturated fats as the predominant form of dietary fat, whole grains as the main form of carbohydrates, an abundance of fruits and vegetables, and adequate omega-3 fatty acids offer significant protection against CHD. Such diets, together with regular physical activity, avoidance of smoking, and maintenance of a healthy body weight, may prevent the majority of cardiovascular disease in Western populations.

2.2 Summary of literature review: CHD is a common leading problem of death among the people in this world. Risk factors of CHD is hypertension , smoking , diabeties, dyslipidemia, hypertension and sedentary lifestyle.CHD is mostly seen in postmenopausal women , along with above factors , obesity increases in the women after menopause and the risk of CHD increases. diets using non hydrogenated unsaturated fats, whole grains , an abundance of fruits and vegetables, and adequate omega-3 fatty acids , regular physical activity, avoidance of smoking, and maintenance of a healthy body weight and use of Aspirin, may prevent the CHD.

CHAPTER III
RESEARCH METHODOLOGY
3.1 Research Design A simple descriptive type of research design will be used for this study. 3.2 Research Area The study will be conducted at OPD (medical, gyane) and medial ward of Patan Hospital. 3.3 Research Population All the respondents will be age of 45-55 years women at the time of data collection. 3.4 Sample size The sample size will be 50. 3.5 Sampling technique Purposive sampling technique will be used to select the sample. 3.6 Inclusion criteria Respondents meeting the following criteria will be interviewed for the study Respondent who are willing to participate in the study. Respondent who are the age of 45-55 years.

3.7 Variables Independent variables: Education Health facilities Media Socio-economic background Occupation

Dependent variable: Knowledge

3.8 Data gathering tools On the basis of related literature review along with the consultation with advisor and colleagues, open and closed ended questionnaire will be developed. It consists of: a. Demographic information of the respondents. b. Questions related to knowledge regarding contributing factor of CHD among postmenopausal women. c. Questions related to knowledge regarding preventive measures of CHD in postmenopausal women.

3.9 Data collection procedure a. Written permission will be taken from the authorities. b. Verbal consent will be taken from the respondents. c. The data will be collected by the researcher using interview (face to face) using structured questionnaire for 15 minute for each respondent. 10

d. Interview will be taken at the corner of gyane opd.

3.10

Pretest

To test the reliability of the instrument, a pre-test will be done among 10% (5 respondents) of the similar population in gyane, OPD. The result of the test will be used to make the needed change to the questionnaire to maintain validity and reliability. The respondents who will be involved in the pilot study will be excluded in final study. 3.11 Reliability and Validity of Data

a. Validity In order to maintain validity of instruments, the interview questionnaire will be developed by studying and reviewing the related literature. The questionnaire will be shown to advisor, experts, teachers and colleagues. Also, it will be translated into Nepali language so that the respondents could understand it.

b. Reliability The reliability of the instrument will be obtained by thorough pre-testing of the instrument in the 10% of the total sample and necessary modification will be done to make it more relevant.

3.12 Ethical considerations a. Study will be conducted only after the approval of research committee of the campus. b. Permission will be obtained from the related authority of Patan Hospital after submitting the official letter from campus. c. The subjects will be explained verbally about the purpose of the study. d. Verbal consent will be taken with each respondent before using questionnaire. Nobody will be forced for the participation and anonymity and confidentiality will be maintained.

11

3.13 Data analysis procedure a. Collected data will be checked daily for its accuracy and completeness. b. All data will be checked and rechecked after completing data collection. c. Collected data will be coded. d. Data processing will be done with the help of computer (Excel). e. Data will be analyzed using various statistical measures. f. Necessary findings will be made on the basis of research objectives g. The findings will be presented on relevant tables, bar graph and pie chart.

3.14Budget and time schedule

Budget will be self financed Time for research is 5 week

day. They were analyzed on the basis of the percentage, and tables and figures have been used to make the presentation clear and meaningful. This study was conducted with the primary purpose to analyze the determinants and occurance of side- effects of radiotherapy. To carry out this study, fifty respondents were purposely selected and interviewed using an open and close ended questionnaire. The research study was carried out in the Radiotherapy department of Bir Hospital. The findings of this study are presented in two parts. 1. Demographic Information. 2. Knowledge Questions related to: 12

 Side effects of Radiotherapy Self management following Radiotherapy treatment.

PART I DEMOGRAPHIC INFORMATION

Table 4.1:

Distribution of the respondents according to the

demographic characteristics:
n=50 Demographic Characteristics Age 16-30 31-45 46-60 Above 60 Sex Male Female Marital Status Married Unmarried Occupation Agriculture Service Business Frequency 4 7 17 22 22 28 45 5 12 8 5 13 Percentage (%) 8 14 34 44 44 56 90 10 24 16 10

Homemaker Student Retired Education Illiterate Primary Secondary Higher secondary

17 2 6 23 7 12 8

34 4 12 46 14 24 16

Ethnic Groups Brahmin and Chhetri Newar Rai, Limbu, Gurung, Magar & Tamang Tharu Family structure Single Nuclear Joint Address VDC Municipality Relation coming treatment Alone Family members Friends

Frequency 16 11 22 1 7 15 28 23 27

Percentage (%) 32 22 44 2 14 30 56 46 54

for

the 10 35 5 20 70 10

Table 4.1 is a breakdown of demographic information that dipicits the respondents. The majority of the respondents were of age group above 60 years 22(44%). There were more female than male respondents, 28(56%) compared to 22(44%) respectively. Ninety percent of the respondents were married and 17(34%) were homemakers. Similarly, most of the respondents 11(22%) belonged to Newar ethnic groups and majority of the respondents 27(54%) were literate. The maximum number of respondents 28(56%) lived in joint family and most of them 27(54%) were from the municipality. The analysis also showed that 35(70%) of the respondents came for the Radiotherapy treatment with their family members.

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PART II KNOWLEDGE RELATED

n=50

Figure 4.1 shows that a majority of the respondents 34(68%) had knowledge on their treatment and rest of them 16(32%) were had no knowledge regarding the treatment using Radiotherapy.

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Table 4.2 - Distribution of the respondents according to knowledge on types of treatment: n=50 Types of treatment Radiotherapy Do not know Frequency 34 16 Percentage (%) 68 32

Table 4.2 shows that the majority of the respondents 34(68%) had knowledge about their treatment types while 16(32%) do not had any knowledge about their treatment types.

n=50

Figure 4.2 reveals that 29(58%) of the total respondents had knowledge about the meaning of radiotherapy while 17(34%) of the respondents had no idea and the 16

remaining 4(8%) answered that they think it is used for suppressing the cancerous cells. n=50

Figure 4.3 shows the duration of treatment the respondents had been undergoing. The majority of the respondents (39) were receiving radiotherapy up to 15 days, whereas (10) respondents were receiving radiotherapy from 16-30 and one of the clients has been undergoing treatment for 31-45 days respectively.

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Table 4.3 - Distribution of the respondents according to treatment of body part receiving radiotherapy: n=50 Affected body parts Lungs Breast Neck Cervix Rectum/anus Pharynx Head Spinal cord Larynx Cheeks Vagina Frequency 9 9 9 6 6 3 2 2 1 1 2 Percentage (%) 18 18 18 12 12 6 4 4 2 2 4

Table 4.3 reveals that the majority of the respondents receiving treatment for Lung cancer (9), breast cancer (9) and cancer of the neck (9). This is followed by (6) who were suffering from cervix and rectum cancer. Other forms of cancer that were treated were pharynx (3), head (2), spinal cord (2), Larynx (1), cheeks (1) and vagina (2).

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n=50

Figure 4.4 shows that most of the respondents 43(86%) had felt discomfort during the time of radiotherapy whereas 7(14%) had experienced minimal discomfort.

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Table 4.4 - Distribution of the respondents according to the common side effects experienced immediately during radiotherapy: n=50 Discomfort and Problems No problem Nausea and vomiting Fatigue Dyspnoea Dysphagia Coughing Anorexia Constipation Dry throat Dizziness Burning sensation in cervix Frequency 5 18 3 10 3 3 1 1 1 2 3 Percentage (%) 10 36 6 20 6 6 2 2 2 4 6

Table 4.4 reveals that the immediate side effects after radiotherapy experienced by the respondents was highest for nausea and vomiting 18(36%) followed by dyspnoea 10(20%) and 5(10%) of the respondents said that they had experienced no problems during or, following radiotherapy treatment whereas fatigue, dysphagia, coughing and burning sensation in cervix were experienced by 3(6%) of the sample respectively. Also, 2(4%) of the respondents experienced dizziness and 1(2%) experienced anorexia, constipation and dry throat.

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Table 4.5 - Distribution of the respondents according to the common side effects developing for long time after radiotherapy: n=50 Discomfort and problems Anorexia Alopecia Dyspnoea Coughing Skin reactions Burning sensation in cervix Throat pain Fever and constipation Diarrhea Frequency 26 3 6 1 3 1 1 1 8 Percentage (%) 52 6 12 2 6 2 2 2 16

Table 4.5 shows that anorexia was the most common long term side effect of the respondents 26(52%) followed by diarrhea 8(16%) and dyspnoea 6(12%). Alopecia and skin reactions were developed in 3(6%) of the respondents whereas coughing, burning sensation in cervix, throat pain, fever and constipation were symptoms developed in 1(2%) respectively. Table 4.6 - Distribution of the respondents according to symptoms of side effects first occur: n=50 Starting time Up to 10 days 11 to 20 days 21 to 30 days Frequency 40 8 2 Percentage (%) 80 16 4

Table 4.6 reveals that the time when symptoms of side effects first occur. The side effects most often within the first10 days 40(80%) during radiotherapy, followed by those who answered 11-20 days 8(16%) and from 21-30 days in the remaining 2(4%) of the respondents.

21

n=50

Figure 4.5 shows that 28(56%) of the fifty respondents worry about the side effects of Radiotherapy whereas 22(44%) do not worry at all.

n=50

Figure 4.6 reveals that most of the respondents 36(72%) had adequate knowledge about the care regarding diet, skin and clothing, whereas 12(24%) had some basic knowledge about the care on clothing and diet and the remaining 2(4%) had little or, no knowledge about the care regarding diet and skin. 22

n=50

Figure 4.7 shows that the maximum number of the respondents 40(80%) had knowledge for taking the prescribed medicines regularly according to doctors advice and 10(20%) do not, which may be because of the accessibility and the economy of the respondents. n=50

Figure 4.8 reveals that the all of the respondents had knowledge to come to the hospital for follow up appointments. n=50 23

Figure 4.9 shows that the majority of respondents 39(78%) had knowledge for receiving proper rest and sleep and 8(16%) do not think that it is necessary to receive proper rest and sleep, while 3(6%) of the respondents never think to take proper rest and sleep. n=50

Figure 4.10 reveals that only 20(40%) of the respondents had knowledge regarding the use of lotions and creams according to their doctors advice during the time of radiotherapy, whereas 30(60%) do not have any knowledge regarding the use of creams and lotions for their skin care.

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Table 4.7 - Distribution of the respondents according to their knowledge about clothing during radiotherapy n=50 Knowledge about Clothing Loose soft cotton Polyester Frequency 47 3 Percentage (%) 94 6

Table 4.7 shows that the majority of the respondents 47(94%), had knowledge of the importance of wearing loose soft cotton clothes which are not an irritant to the skin, while 3 (6%) think of that polyester clothes are suitable to wear. n= 50

Figure 4.11 shows that the majority of the respondents, 32(64%), had knowledge to drink more than 2 liters of fluid during radiotherapy, while 10(20%) respondents had knowledge to take fluids as usual, whereas 6(12%) had knowledge to take 1 liter, and only 2(4%) respondents had knowledge to take 2 liters of fluid during radiotherapy.

n=50

25

Figure 4.12 shows that the majority of respondents, 30(60%), had knowledge for eating fish, meat and egg as a diet during the radiotherapy while 12(24%), had knowledge and gave opinion for fruits and vegetables and 5(10%) as usual and 3(6%) were others. n=50

Figure 4.13 shows that most of the respondents, 32(64%), had knowledge of saving ink marks during radiotherapy, while 18(36%) said that it is not necessary to save those ink marks.

26

Table 4.8 - Distribution of the respondents according to their knowledge about the management of nausea and vomiting n=50 Management Taking foods routinely Take jeevan jal Take medicines Take jeevan jal Frequency 5 7 8 and 20 5 1 4 Percentage (%) 10 14 16 40 10 2 8

medicines Routine foods and medicines Routine foods and jeevan jal Take rest and jeevan jal

Table 4.8 shows that the majority of the respondents, 20(40%), had knowledge for taking jeevan jal and medicines in case of nausea and vomiting, 8(16%) take medicines only, 7 (14%) take jeevan jal only while 5(10%) had knowledge for having foods routinely and taking foods with medicines respectively. Similarly, 4(8%) had knowledge for taking enough rest and jeevan jal and 1(2%) for taking foods as well as jeevan jal.

Table 4.9 - Distribution of the respondents according to their knowledge about the management of skin reactions

27

n=50 Management Scratch Use lotions Not to do anything Frequency 3 29 18 Percentage (%) 6 58 36

Table 4.9 reveals that the majority of the respondents, 29(58%), had knowledge on managing the skin reactions by using lotions, 18(36%) think that they should not do anything on such skin reactions, while 3(6%) think that they should scratch the skin if they have to.

n=50

Figure 4.14 shows that the majority of the respondents, 22(44%), had knowledge to drink plenty of water and take prescribed medicines for the management of dryness of the mouth. Similarly, 18(36%) of the respondents replied drink plenty of water and 4(8%) replied to take prescribed medicines, whereas 2(4%) of the respondents had knowledge for taking nutritious foods and plenty of water and nutrition respectively and 2(4%) do not do anything. Table 4.10 - Distribution of the respondents according to the source of information for self care during radiotherapy n=50 Source of Information Doctors Frequency 23 28 Percentage (%) 46

Nurse Radiation technicians Patients under radiotherapy Family members

3 11 10 3

6 22 20 6

Table 4.10 reveals that the majority of the respondents, 23(46%), get their information from the doctors, 11(22%) from the radiation technicians, 10(20%) from other patients who were undergoing radiotherapy while 3(6%) received information from the nurse and family members respectively.

n=50

Figure 4.15 reveals that 47(94%) of the total respondents contact their doctor while 3(6%) consult with the radio technicians if they had any health problems.

Table 4.11 Distribution of the respondents according to knowledge mean score n=50 Full score 1150 Obtained score 703 Number 50 Mean score 14.06 Mean percent 61.13

29

Table 4.11 shows that the mean score obtained by 50 respondents which was 61.13%.This shows the attempt of the respondents approaching for the right knowledge was 61.13 percent.

Figure 4.16 - Distribution of the Respondents According to their Knowledge Score Obtained n=50

Figure 4.16 shows the knowledge score of all the respondents regarding the management of side effects of Radiotherapy. The highest knowledge score obtained was 18 by two respondents. Similarly, the minimum score 7 was obtained by one respondent. Table 4.12 Distribution of the respondents according to their knowledge score regarding side effects and self management of radiotherapy n=50 S.N. Level of knowledge score Number 1. Inadequate knowledge score (< or 8 = 50%) 2. Moderate knowledge score (51% 40 to 75%) 30 80 14.62 Percentage 16 Mean score 10.25

3. Adequate (>75%)

knowledge

score 2

18.00

Table 4.12 reveals that of the respondents, 8 of them have inadequate knowledge, with a percentage of (16) and the mean score obtained by them were 10.25. Similarly, the moderate knowledge score was found among 40 respondents (80%) and the mean score obtained by them were 14.62, while the adequate knowledge score was obtained by 2 respondents with their mean score of 18.

Table 4.13 Calculation of Variation

X(Score) 7 10 11 12 13

f(n) 1 2 5 6 3

f X 7 20 55 72 39

X-X -7.06 -4.06 -3.06 -2.06 -1.06 31

(X X)2 49.84 16.48 9.36 4.24 1.12

f(X-X)2 49.84 32.96 46.80 25.44 3.36

14 15 16 17 18

11 4 12 4 2 n =50

154 60 192 68 36 f X =703

-0.06 0.94 1.94 2.94 3.94

0.0036 0.88 3.76 8.64 15.52

0.039 3.52 45.12 34.56 31.04 =270.439

(X X)2= 109.87 f(X X)2

X = fX / f

= 703 / 50

= 14.06

Standard Deviation (S.D) = [ f(X X)2 ]1/2 / [ n 1 ]1/2 = 2.349 Coefficient of Variation (C.V.) = S.D. / X 100% = 2.349 /14.06 100% = 9.08%

CHAPTER V
SUMMARY, CONCLUSION AND RECOMMENDATION
5.1 Summary The study entitled Knowledge on side effects and self management among the cancer patients receiving radiotherapy at Bir Hospital was based upon 50 respondents who received radiation therapy in Bir Hospital.

32

The researcher reviewed many literatures and studied many materials related to this study. The study was based on the simple descriptive methodology and used nonprobability purposive sampling technique. Open and close ended questionnaire was used to collect the data. An interview schedule was developed with the help of relevant literature and consultation with the teachers and experts. The tool was prepared in two parts: Part A- Demographic Information and Part B- Knowledge Related. Validity and reliability of the tool was maintained. Permission from the concerned authority was obtained and the pre testing was conducted at Radiotherapy Department of Bir Hospital. This pretest was not included in the final study. 5.2 Summary of Major Findings Part I Demographic related findings Out of 50 respondents, (44%) were of age group above 60 years. Most of the respondents (56%) were female and (44%) were male. Majority of the respondents (90%) were married and (34%) were homemakers. Majority (22%) of the respondents ethnic group was Newar and most of them were literate (54%). Maximum number of respondents (56%) lived in joint family and most of them (54%) were from municipality. Among them (70%) of the respondents came for the treatment with their family members. Majority of the respondents (68%) knew for why they were coming to the hospital as well as about their treatment techniques. Part II Knowledge related findings Maximum number of respondents (68%) answered their treatment is Radiotherapy. Regarding Radiotherapy (58%) of the respondents answered that it is treatment called Sekaune in general language while 8% of them answered that it is for suppressing the cancerous cells. Duration of receiving radiotherapy of the respondents was mostly up to 15 days that is (39). 33

 Regarding the reason for treatment, the majority of respondents (18%) were suffering from either lung cancer, breast cancer and cancer of neck. Most of the respondents (86 %) had felt discomfort during the time of radiotherapy. Majority of the respondents (36%) experienced immediate side effects such as nausea and vomiting. Majority of the respondents (52%) suffered from anorexia as a common long term side effects. Eighty (80%) respondents experienced the starting time of appearing side effects within 10 days of radiotherapy More than half of the respondents (56%) were worried about their side effects they experience. Majority of the respondents (72%) had knowledge about the care regarding diet, skin and clothing, whereas (24%) had knowledge about the care on clothing and diet and the remaining (4%) had knowledge about the care regarding diet and skin. The majority of respondents (80%) had knowledge for taking the prescribed medicines regularly according to doctors advice. All of the respondents had knowledge to come to the hospital for follow up appointments. More than half of the respondents (78%) had knowledge for taking proper rest and sleep during the time of radiotherapy. Only (40%) of the respondents had knowledge regarding the use of lotions and creams according to doctors advice during the time of radiotherapy. The majority of respondents (94%) had knowledge on the importance of wearing loose soft cotton cloths which do not irritate the skin. Majority of the respondents (64%) had knowledge to drink more than 2 liters of fluid during radiotherapy. The majority of respondents (60%) had knowledge for eating fish, meat and egg as a diet during the radiotherapy. Majority of the respondents (64%) gave the correct answer to save ink marks during radiotherapy.

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 Majority of the respondents (40%) had knowledge to take jeevan jal and medicines for the management of nausea and vomiting, (16%) take medicines, (14%) take jeevan jal while (10%) had knowledge for having foods as usual and taking foods as usual with medicines respectively. Similarly (8%) had knowledge for taking enough rest and jeevan jal and (2%) for taking foods as well as jeevan jal. The majority of respondents (58%) had knowledge on managing the skin reactions using lotions according to Doctors advice. In case of dryness of mouth, the majority of the respondents (44%) had knowledge to drink plenty of water and take prescribed medicines. Similarly (36%) of the respondents drink plenty of water and (8%) take prescribed medicines whereas 2% of the respondents had knowledge for taking nutritious foods, plenty of water and nutrition and do not do anything respectively. Out of total, (46%) received information for self care from the doctors, (22%) from the radiation technicians, (20%) from the patients who were undergoing radiotherapy while (6%) received information from the nurse and family members. When majority of the respondents (94%) contact the doctors while (6%) consult with the radio technicians. 5.3 Conclusion The study was conducted to assess the knowledge of patients regarding side effects and self management of radiotherapy. They had different types of common side effects such as nausea and vomiting, dyspnoea, anorexia, fatigue, skin problems, dry mouth, diarrhea and so on. The highest common problems were anorexia, nausea and vomiting. Only (4%) respondents had adequate knowledge regarding side effects and self management of radiotherapy, while (80%) had moderate and (16%) had inadequate knowledge regarding side effects and self management of radiotherapy. It is concluded that the mean percent of score regarding the side effects and self management of side effects of Radiotherapy which included immediate and late such as knowledge of basic diet, proper clothing, medication, care on skin and electrolyte balance was 61.13 percent. The information level was carried out on the basis of 35

giving score for the correct answer. The respondent might give the correct answer regarding the knowledge of basic diet however he/she might or, might not have the knowledge for other care. Statically, the mean correct answer given by each respondent was 14.06, for which the standard deviation was 2.349. The coefficient of variation was found to be 16.7%. This shows that there was not much variation in the score. 5.4 Implication of the study The findings of the study might be helpful to the concern authority to find out the need to improve knowledge on side effects and self management among the cancer patients receiving radiotherapy. The findings of this study might be helpful in providing background information to carry out similar research in the future. The findings of the study provide useful information to carry out a large scale research on the same topic. The study will help the nurses to gain a better knowledge about side effects of radiotherapy, self care measures and practices to minimize side effect experienced by their patients. 5.5 Recommendation Further study can be done on this research topic in a large scale. So the findings can be generalized. Health education Programme should be carried on a regular basis to improve the health and knowledge of the cancer patients receiving radiotherapy. Provision of any posters, booklets or guides related to side effects and self care would be helpful to them. Counseling program for all cancer patients receiving radiotherapy could be established to provide emotional support. A training package about side effects and its self care measures of radiotherapy should be provided for all nurses of institutions for self development. 5.6 Strength of the study 36

 The study tried to explore the actual knowledge of the respondents. The researcher had gained in-depth knowledge about the side effects and self management of side effects of radiotherapy through literature review. Researcher has gained confidence to conduct research in other topics in future. 5.7 Difficulties during the study As this research was a new learning experience, the researcher experienced difficulties during topic selection. The researcher faced difficulties during instrument development, scoring, analyzing and interpretation due to lack of experience and knowledge in research methodology. It was time consuming to collect the data, as some of the respondents were busy in their own work and may not have had enough time to respond properly with the researcher.

5.8 Limitations of the study The study was limited within radiotherapy department of Bir Hospital. Study was limited to 50 respondents only. This was the researchers first research with little or, no experience in research studies. 5.9 Budget and time schedule Budget: Self finance Time: 5 weeks 5.10 Plan for dissemination Library of Lalitpur nursing campus Research advisor.

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