RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA, BANGALORE ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. Name of the candidate and address (in block letters)

MS. AKSHATHA R.K I YEAR M. Sc. NURSING MASOOD COLLEGE OF NURSING BIKARNAKATTA, MANGALORE

2.

Name of the Institution

MASOOD COLLEGE OF NURSING BIKARNAKATTA, MANGALORE

3.

Course of Study and Subject

M. Sc. NURSING OBSTETRICS AND GYNAECOLOGICAL NURSING

4. 5.

Date of Admission to the Course

28.10.2010

Title of the study

A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING WORKING PROGRAMME IN ON KNOWLEDGE MATERNITY REGARDING HOSPITALS, PLACENTAL STEM CELL BANKING AMONG STAFF NURSES SELECTED MANGALORE.

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Brief resume of the intended work

6.1 The need for the study

With the development and simplification of the procedures for placental blood banking and transplantation field experience should be continuously analysed by an expert group to ensure timely application of this technology for treatment of acute and chronic diseases. Studies are in progress to establish standards for collection of placenta cord blood and to determine the safety and utility of this source of stem cells in haematopoietic reconstitution. Compared to cord blood banking alone placenta blood banking yields 39% more of a particular type of stem cell called cd34 stem cell. Studies have shown that using more cd34+ stem cells can lead to significant survival advantage in transplant patients. Cord blood stem cells have been used to treat over 80 diseases. Over 8000 cord blood stem cell transplants have been performed. Banking placental stem cells in addition the cord blood, doubles the number of segments preserved and increase the total number of stem cells available for treatment1. Investigations were done to find the role of human placenta in embryonic and foetal hematopoietic development. Two cell population cd34++, cd45low and cd34+, cd45low were found in chorionic villi.cd34++, cd45low cells display many markers that are characteristics of multipotent primitive hematopoietic progenitors and hematopoietic stem cells. The number of cd34++, cd45low cells increased throughout the gestation in parallel with placental mass. To investigate the possibility that the placenta supports hematopoietic development, the first step was to adapt enzymatic method of dissociation of the placenta to obtain maximum number of hematopoietic progenitors. It was found that 0.26-0.38% of cd34+, cd45low cells with double digestion method in placenta were detected and 0.48-1% obtained with the triple enzymatic digestion method in placenta, ranging from 7 to 9 weeks of gestation, suggesting that the hematopoietic progenitor compartment is located deep within the placental tissue. Together these data suggested that the human placenta is potentially an important hematopoietic organ, opening the possibility of banking placental hematopoietic stem cells along with the cord blood for transplantation2. The All India Institute of Medical Sciences, Delhi has pioneered a stem cell treatment in which patients are injected with stem cells to improve their condition. Stem cells are the versatile cells that have the ability to grow into any type of tissue in the skin, heart, liver, or any other organ leading to regeneration. A total of 35 patients with heart conditions 2

that could not be treated by bypass surgery were injected with stem cells. After 6 months, 56% of dead heart muscles in all the patients were revived and after 18 months the revival was 84%.There was no mortality among the patients. Two patients suffering from chronic diabetes, requiring 36 units of insulin daily were injected with stem cells and now require half a tablet daily. Thus potential for stem cell for the future is immense. This is particularly for India where every kind of disease is often diagnosed at a late stage. This is where the regenerative aspect of stem cell is helpful3. A paediatric cancer transplant specialist saved a life of four year old child

suffering with acute lymphocytic leukaemia through transplant using stem cells which his parents banked. This made many paediatricians to recommend the placental derived stem cell banking for potentially lifesaving transplant4. A national stem cell centre is being set up in AIIMS which would co ordinate the research findings and its applications. Stem cell transplant in India costs a fraction of what it costs in abroad, but the country has very few centres where the procedures can be done and not enough dedicated staffs are available. There are only 10-12 centres where it can be done. A stem cell transplant can cost up to one crore in abroad whereas in India it is much cheaper to rupees three to four lakhs depending upon the type of procedure. Stem cell transplants have shown up to 50% success rate in treating certain types of cancer and other major conditions where bone marrow does not produce sufficient new cells to replenish blood cells5. Stem cell transplant has shown 70-80% success in treating non malignant diseases like aplastic anaemia. Stem cells can be taken from siblings and family members after tissue matching, known as allogenic transplant or can be harvested from a new born umbilical cord or placenta which is the rich source of such cells6. Around 500 stem cell transplants are done in India every year, which is very small, compared to the need. Many more centres are needed in India. For this purpose of setting more stem cell transplants in India, more trained doctors are needed as well as hospital staff. More awareness is required among the health care providers, so that they refer the patients at the right time for a stem cell transplant and spread about the procedure among patients family and community7. Stem cells are believed to be the greatest untapped resources currently available for prevention and treatment of many diseases. As a health resource professionals, communicator, advocator and health educator, staff nurses are in a position to advance dialogue about this promising technology7. Nurses can be an important source of information in order to help parents understand the issue of placental stem cell banking. In the light of result of many studies it is clearly known that placenta contains extremely valuable stem cells that have 3

ability to differentiate not only into red blood cells, white blood cells and platelets but also into other types of tissue. In other words they have the benefits of embryonic stem cells without controversy or medical drawbacks5. With a shelf life of 21 years, stem cells are seen as a form of health insurance .It is known that a health care provider is the best source of information for queries and concerns related to medical problems. One among easily approachable care provider is a nurse, who needs to give all information regarding placental stem cell banking to the needed couples 3. Hence this study will help to provide optimum knowledge to the nurses regarding the significance of placental stem cell banking. 6.2 Review of literature A study was done to compare the hematopoietic stem cells with placental blood and umbilical cord blood in children hospital and research centre, Oakland. Placental haematopoietic progenitors were isolated using the basic method of isolation of enzymatic digestion treatment of placental cell and staining them. Isolation of hematopoietic progenitors from umbilical cord blood was done by the same method. At least three preparations of same type were analysed. Placental samples from 5.4 weeks to 39.5 weeks were analysed for cells expressing both cd34 and cd45 hematopoietic progenitors cell surface markers , and it was observed that frequency of placental cells was cd34+ cd45(2.86-20.91%) and cd34+ +cd45low(0.03-1.2%)that was significantly more contained myeloid and erythroid than hematopoietic progenitors cell that indicative of active insitu were found in umbilical cord blood. in addition to multipotent progenitors ,the placenta committed progenitors hematogenesis. These data suggest that the human placenta is important hematopoietic stem cells along with cord blood for transplantation8. A descriptive study was conducted in two antenatal outpatient clinics in Istanbul to determine pregnant womens knowledge and attitude towards placental stem cells and their banking. The sample consisted of 334 pregnant women during routine prenatal visits. Data were collected in an interview. At the end of the study, it was revealed that the majority (86.6%) of the participants had a lack of knowledge about stem cells and placental stem cell banking and wanted information from media. It was determined that they wanted information before they conceived, more from their obstetrician but also from nurses and midwives. The majority (78.2%) also wanted to store their infants placental and cord blood and stated that they would be more likely to chose a public cord blood bank .The study concluded that those giving antenatal and perinatal care need to offer a accurate and scientific counselling services 4

on this subjects to parents who need to be informed9. A study was conducted on effectiveness of self instructional module on the knowledge regarding placental cord blood banking among staff nurses in selected hospitals in Kasargoad, by approaching one group pre test post test design. The sample consisted 60 staff nurses selected by convenient sampling and data was collected by using structured knowledge questionnaire .The result showed the significant difference suggesting that self instructional module was effective in increasing the knowledge of staff nurses (t=14.34).The mean post test knowledge (x2=43.17) higher than the mean pre test knowledge(x1=30.40).There was no association between the pre test knowledge scores and the selected demographic variables10. A study was conducted to evaluate the effectiveness of planned teaching programme on knowledge and attitude of various health professionals regarding placental stem cell and its utilization at selected hospitals in Bangalore. Purposive sampling technique was used. One group pre test post test design with pre experimental approach was adopted. The data was collected from 50 respondents before and after administration of planned teaching programme. The pre test median score was (20.1) and that of the post test was (40.5).Hence, the planned teaching programme was effective in improving the knowledge of staff nurses11. A study was done to investigate the placental stem cell markers cd34, cd45 levels in normotensive and pre eclamptic women, Boston. The study population consisted of 21 women with pre eclampsia.twenty normotensive pregnant women served as controls and were matched to pre eclamptic patients by gestational age at delivery. Decidual sample obtained from the central part of the placenta were stored in -70o until analysis.cd45 were qualified in homogenates by enzyme linked immune sorbent assay, while cd34 qualified cytometry.The pre eclamptic and normotensive groups were watched .There were no significant differences in age, parity, weight and gestational age at birth, between the group(p>0.05).the mean placental levels of cd34(6.55) cd44(385.24) were significantly higher in pre eclamptic compared with normotensive women12. A study was conducted to investigate placental blood as a source of hematopoietic stem cells for transplantation into unrelated recipients by duke university medical centre, USA. Twenty five consecutive patients, primarily children were evaluated for hematogenic and immunologic reconstitution. Human leukocyte antigen (HLA) matching was done before transplantation by serologic typing and best match was selected. In 23 of the 25 transplant recipients, the infused hematopoietic stem cells engrafted. Acute graft versus host disease 5

occurred in 2 of the 21 patients who could be evaluated and 2 patients had chronic graft versus host disease. Invitro proliferative responses of T cells and B cells to plant mitogens were detected 60 days after the transplantation. With a median follow up 13 months and a minimal follow up of 100 days, the overall 100 day survival rate among these patients was 64% and overall event free survival rate was 48%.Study concluded that HLA mismatched placental blood from unrelated donors is an alternate source of stem cells for hematopoietic reconstitution in children13. 6.3 Statement of the problem A study to assess the effectiveness of structured teaching programme on knowledge regarding placental stem cell banking among staff nurses working in selected maternity hospitals, Mangalore. 6.4 Objectives of the study 1. To assess the level of knowledge regarding placental stem cell banking among staff

nurses working in selected maternity hospitals, Mangalore. 2. To determine the effectiveness of structured teaching programme on knowledge

regarding placental stem cell banking among staff nurses. 3. To find the association between the pre test and post test level of knowledge scores with

their selected demographic variables. 6.5 Operational definitions

Effectiveness: In this study, effectivenss refers to the extent to which the structured teaching programme on placental stem cell banking among staff nurses has achieved the desired effects in terms of gain in post test knowledge scores. Knowledge: In this study, knowledge refers to the right response given by the staff nurses to the questions on placental stem cell banking.

Structured teaching programme: In this study, structured teaching programme refers to a planned teaching and a learning process between the investigator and study subjects that helps the study subjects to change his/her knowledge regarding placental stem cell banking. Staff nurses: In this study, staff nurses refers to registered nurses (b.sc, gnm) working in selected maternity hospitals, Mangalore. Placental stem cell banking: In this study, placental stem cell banking refers to the placental stem cells that are found only in placenta and are collected after the blood from umbilical cord is drawn and is stored in for future use. 6.6 Assumptions The study assumes that; 1. 2. Staff nurses may have the basic knowledge regarding placental stem cell banking. Structured teaching programme may help the staff nurses to improve their knowledge regarding placental stem cell banking. 6.7 Delimitations The study is limited to , 1. 2. 6.8 Staff nurses who are working in selected maternity hospitals, Mangalore. Registered nurses (B.Sc., P.B.B.Sc.(N), GNM). Hypotheses

H1: The mean post test knowledge scores of the staff nurses will be significantly higher than the mean pre test knowledge scores. H2: There will be significant association between the pre test and post test scores with their related demographic variables. knowledge

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Material and Methods

7.1 Source of data Staff nurses working in selected maternity hospitals, Mangalore. 7.1.1 Research design Pre experimental One group pre test post test design. pre test O1 O1: treatment X post test O2

Assessment of knowledge level of staff nurses regarding placental stem cell banking before admininistration of structured teaching programme.

X:

Structured teaching programme on placental stem cell banking.

O2 : Post test knowledge of staff nurses on placental stem cell banking. 7.1.2 Setting The study will be conducted in selected maternity hospitals, Mangalore. 7.1.3 Population Staff nurses working in selected maternity hospitals, Mangalore. 7.2 7.2.1

Methods of data collection

Sampling procedure Convenient sampling will be used to select the samples.

7.2.2

Sample size Sample consists of 60 staff nurses working in selected maternity hospitals, Mangalore.

7.2.3

Inclusion criteria for sampling

Staff nurses working in selected maternity hospitals. Who are willing to participate in the study.

7.2.4

Exclusion criteria for sampling Staff nurses who are already exposed to planned teaching programme on placental stem cell banking.

7.2.5 1. 2. 7.2.6 1. 2. 3. 4. 5.

Instruments intended to be used Baseline Performa Structured knowledge questionnaire on placental stem cell banking. Data collection method The investigator would get the permission prior to data collection from concerned authority. The investigator will introduce herself to the participants and obtain consent from them. Structured knowledge questionnaire is used to assess the knowledge of staff nurses regarding placental stem cell banking. A structured teaching programme will be administered to the staff nurses on placental stem cell banking. Post test assessment of knowledge is done using the same questionnaire on the eighth day.

7.2.7 Plan for data analysis Descriptive and inferential statistics will be used to analyze the data. 1. 2. 3. Demographic data will be analysed using frequency, percentage, mean and standard deviation. Effectiveness of structured teaching programme on placental stem cell banking will be analysed using paired t test. Chi-square test will be used to find out the association between pre test knowledge score with their selected demographic variables.

7.3

Does the study require any investigations or interventions to be conducted on patients, or other animals? If so please describe briefly. Yes. The investigator administers structured teaching programme on placental stem cell banking among staff nurses working in selected maternity hospitals. 9

7.4

Has ethical clearance been obtained from your institution in case of 7.3? Yes. Ethical clearance will be obtained from the concerned authority.

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References:
1. Kurtzburg. J. & Laughlin, M.(1996). Placental blood as a source of hematopoietic stem cells for transplantation into unrelated recipients. The new England journal of medicine, 335(5),157-66 2. Marvin, A.S., (2005, December 4). Isolation of stem cells of foetal or maternal origin from human placenta.retreived January 23, 2007, from http://pimm.wordpress.com/how-to-isolate-amniotic-stem-cells.html. 3. Wagner.(2002,September1).Placenta cord banking. Retreived February 15, 2003, from http://en.wikipedia.org/wiki/placenta-cord-banking. 4. Science daily. (2009, June 23). Placenta:new source for harvesting stem cells. Retreived may 29, 2011, from http://www.sciencedaily.com/releases/2005/445156.html. 5. Science daily. (2009, March 25). Placenta is a rich source of blood stem cells. Retreived may 29, 2011, from http://www.sciencedaily.com/releases/2005/1119.html. 6. Erin, A.(2009, July 18).placenta found to be rich in stemcells. Retreived November 9, 2009, from http://articles.sfgt.com/2009/bay-area-stem-cells. 7. Alicia B & Marcusu M.(2009). Placental stem cells in embryonic and foetal development. Reproductive sciences, 16(2):178-187. 8. Dello, D.M.(2006, August6). Amniotuic fluid and placental stem cells. Retreived November 20, 2007, from http://www.ncbi.nih.gov/pubmed/1714065. 9. Dinc. H.(2009). Knowledge of antenatal mothers on placental stem cell banking. Reteived November 22, 2010, from http//journals.apa.org/p.s.c/volume9/pre0030.html 10. Shini S.A study to assess the effectiveness of self instructional module on knowledge regarding placental stem cell banking among staff nurses. Unpublished M.Sc.(N) thesis. 11. Elizebeth L.(2005). A study to assess the knowledge and attitude of various health professionals regarding placental stem cell and its utilization. Unpublished M.Sc.(N) thesis. 12. Marvin, A(2000, March 7) Placenta stem cells. Retreived July 10, 2000, from http:/emergency medical paramedic.com/placental-stem-cells.S 13. Mishan K. (2004).Amniotic fluid and placental cells. Best practice and research clinical obstetrics and gynaecology, 18(6):283-293.

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9. 10.

Signature of the candidate Remarks of the guide

11.

Name and designation of (in block letters) 11.2 Guide

MRS. RENJINI DEVI S. ASSOCIATE PROFESSOR MASOOD COLLEGE OF NURSING MANGALORE

11.2 Signature 11.3 Co-guide (if any)

MRS. SYLVIA SEVERINE NORONHA PROFESSOR MASOOD COLLEGE OF NURSING, MANGALORE

Signature 12. 12.1 Head of the department

MRS. SYLVIA SEVERINE NORONHA

12.2 Signature 13. 13.1 Remarks of the Chairman and Principal

13.2

Signature

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