Effectiveness of Self -Instructional Module (SIM) on Knowledge Regarding recent Advancement in Infertility Treatment among Staff Nurses

Ravin Kumar Bishnoi

Nursing Tutor, College of Nursing, All India Institute of Medical Sciences, Rishikesh Virbhadra Road, Rishikesh, Uttarakhand-249201

*Corresponding Author Email: bishnoiravin@gmail.com

ABSTRACT:

Infertility has been relatively neglected as both a health problem and a subject for social science research in South Asia, as in the developing world more generally. The general thrust of both programmes and research has been on the correlates of high fertility and its regulation rather than on understanding the context of infertility, its causes and consequences. Yet, we know that infertility affects a relatively large number of couples at some point in their reproductive lives - globally, between 50 and 80 million couples.^[1] The incidence of infertility in men and women is almost identical. The role of the infertility nurse is continually expanding and changing to meet the demands of couples undergoing assisted reproduction. The present study was thus undertaken to assess the pre test knowledge score of staff nurses regarding recent advancement in infertility treatment, to assess the effectiveness of SIM (self instructional module) on knowledge of staff nurses regarding recent advancement in infertility treatment and to find out the association between pretest knowledge score with selected social demographic variables. Pre-experimental one group pre-test post test design, was used to find out the effectiveness of SIM on recent advancements in infertility treatment. The sample consisted of 60 staff nurses of selected maternity hospitals of Indore city. They were chosen by convenient sampling technique. The study was conducted at SAIMS Hospital, Life Line Hospital, Greater Kailas Hospital and Dolphin Hospital, Indore. The data was collected prior and after administration of self-instructional module by a structured questionnaire. The data was analyzed by descriptive and inferential statistics. The knowledge gained through self instructional module was good as it was evidence with a highly significant difference (t₍₅₉₎=22.669, P<0.001) between the mean post-test (X₂=30.85) and pre-test (X₁=16.25) knowledge score. There was a significant association of the pre-test knowledge score with demographic variable like age, education, experience and in-service education programme.

KEYWORDS: Infertility; staff nurses; self-instructional module; knowledge.

INTRODUCTION:

Background:

“A Nurse will always give us hope, an angel with a stethoscope.” - Carrie Latet.

The WHO has defined infertility as the inability to achieve a pregnancy after one year of unprotected intercourse. In approximately 1/3 of cases, male factors are responsible, in another third female factor; in the remainder, a combination of factors is involved the couple are evidently anxious about their apparent infertility but must be encourage to talk about whether they really want children and if they are both equally committed to their goal.^[2] New technologies are very helpful for couples. Better understanding of cause of infertility can be achieved with new techniques to evaluate the oocytes, spermatozoa and embryo on molecular and genetic level with improved understanding of the aetiology of infertility. Treatment will be more effective, with the advance of new drugs and advance technology.^[3]

In recent years nurse practitioner have expanded their repertoire of obstetric-gynaecological skills to include the provision of infertility care. To minimize the stresses educate them about the factors, testing and treatment involved in infertility. Nurse can support them emotionally through a sensitive aspect.^[4]

Couples who come to a fertility clinic have two needs, education and counselling. In infertility management nurses is key person. They should discuss on this topic or fertility Preservation with the patients and their families. They should improve the awareness of our community. Nurses as coordinators and counsellor, play an important role in infertility treatment.^[5]

Nurses should supply information on infertility treatment and assist couples to cope with their personal and family stress. Nurses should aware about cost of infertility treatment vary according to the technology used.^[6]

NEED FOR THE STUDY:

Education can help to increase knowledge. Education means translation of knowledge in to practice in simple words, it means practical training. Education helps in moulding a person for a particular purpose about which knowledge has been imparted.^[2]

A study conducted on trends in clinical practice and nurse’s attitude about fertility preservation evaluates their awareness of fertility preservation and evaluates their awareness of fertility preservation. Although nurses were more likely to discuss fertility preservation with patient who had at least one child or who had a poor prognosis. It may help to promote the fertility preservation concept and lead to improved dissemination.^[7]

A study was done by Jam Acad et al (2006), Bostom College, USA. To provide an overview of impaired fertility in child bearing aged women, to review the current research on modifiable life style risk factor implicated in its development and to suggest strategies for nurse practitioner to assist women in behavioural changes that will allow them to protect their fertility. Research has shown that advancing age, a history of sexually transmitted infection and pelvic inflammatory disease. Extreme of body weight, tobacco and caffeine use are potentially modifiable risk factor in the development of impaired fertility.^[8]

Nurses must be aware of the link between this behaviour and the development of impaired fertility in order to assist women in preserving their fertility. Individual counselling, education and community wide education strategies are discussed.

Infertility in India is on the rise because of increased urbanization, stress, a competitive work environment and a fast-paced lifestyle, late marriages, more women opting to work, increased incidence of diabetes, pelvic inflammatory diseases etc. "Infertility affects about 15 per cent of all married couples, which means it is the commonest medical problem in the reproductive age group. And, given the fact that India has over one billion people, a conservative estimate would show that there are about 20 million infertile couples in India.

The recent advancement which researcher spoke about in the study are-

*Sequential Transfer

*Laser Hatching

*Cryo Preservation

*Therapeutic Donor Insemination

*Donor Oocyte programme (DOP)

*Donor embryo programme

*Surrogacy

*Blastocyte Transfer

*Tubal Transfer

- Gamete intra fallopian transfer (GIFT)

- Fallopian replacement of pre ovulatory Oocyte with timed intrauterine insemination (FROOTI)

- Pronuclear Stage Transfer (PST)

- Sperm attached Oocyte Fallopian Transfer (SOFT)

The many global advances in reproductive technology mean that infertile couples have many treatment options, since Indian clinics are providing cutting edge of reproductive medicine."

OBJECTIVE OF THE STUDY:

· To assess the pre test knowledge score of staff nurses regarding recent advancement in infertility treatment.

· To assess the effectiveness of SIM (self instructional module) on knowledge of staff nurses regarding recent advancement in infertility treatment.

· To find out the association of pre test knowledge score with selected social demographic variables.

HYPOTHESIS:

H1:

There is a significant increased in level of knowledge after implementation of Self-instructional module regarding recent advancement in infertility treatment among the staff nurses.

H2:

There is a significant association of the pre test knowledge score with selected social demographic variables.

CONCEPTUAL FRAMEWORK:

The conceptual framework adopted for the study is based on king’s goal attainment theory with the concepts of perception, goal setting, action, interaction and transaction first introduced by Imogene Kings in 1960s.

MATERIAL AND METHOD:

Research Approach:

Evaluative Approach

Research Design:

Pre experimental one group pre test post test design.

Setting:

Selected hospitals of Indore

Sample Size:60 Staff Nurses

Sampling Technique:

Non- probability convenient sampling technique.

The tools consisted of following 3 parts:

Section I:

Demographic Performa with 4 items for obtaining personal information about subjects such as age, education, experience of staff nurses and any in-service education programme on treatment of infertility.

Section II:

Structured questionnaire for assessing the knowledge of staff nurses regarding recent advancement in infertility treatment. Total numbers of items were 36.

Section III:

This part consists of self instructional module on recent advancements in infertility treatment.

RESULTS:

Section A:-Frequency and percentage distributions of samples according to selected demographic variables. (N=60)

Fig.A.1:- Distributions of samples according to Age

Fig.A.2:- Distribution of samples according to Qualification

Fig.A.3. Distribution of samples according to Experience.

Fig.A.4. Distribution of samples according to In-service education.

Section B:- Comparison of Pre-test and Post test Knowledge Scores

Table.B.1. Comparison of pre-test and post test knowledge scores (N=60)

Pre-test knowledge Score	Frequency (N)	Frequency Percentage %	Post-test knowledge Score	Frequency(N)	Frequency Percentage %
Poor (0-12)	4	6.7%	Poor (0-12)	0	0%
Average (13-24)	53	88.3%	Average (13-24)	3	5.0%
Good (25-36)	3	5.0%	Good (25-36)	57	95.0%
TOTAL	60	100%	TOTAL	60	100%

Fig.B.1. Comparison between pre test and post test knowledge score.

Fig.B.2. Comparison of mean score of pre and post test

Table.B.2. Mean and standard deviation of knowledge score

Knowledge	Mean Score	Mean %	Standard Deviation (S)
Pre test	16.25	34.50%	3.869 69
Post test	30.85	65.50%	3.695

Table.B.3. Mean score, standard error of mean and paired t- test

Knowledge score

Mean score

Standard Error of Mean

Degree of freedom

‘t’ value

Level of Significance

Pre test

16.25

0.644

22.67

0.001

(Highly significant)

Post test

30.85

Section-C. Analysis and interpretation of data in order to find the Association of Pre test knowledge score of staff nurses with selected demographic variable.

Table.C.1. Association of pre-test knowledge with Selected demographic variables.

Groups	Poor	Average	Good	D.F	χ²value
Age in years
· 21- 25	3	33	0	6	48.981 P<0.001 (highly significant)
· 26-30	0	18	0
· 31-35	0	1	4
· 36-40	0	1	0
Education
GNM	4	14	0	4	12.511 P<0.02 Significant
Post Basic B.Sc.	0	14	2
Basic B.Sc.	0	25	1
Experience
· < 2 years	0	27	3	6	41.434 P<0.001* (highly significant)
· 2-4 years	0	9	0
· 4-6 years	0	15	0
· >6 years	4	2	0
In service education
· Attended	0	40	3	2	11.682 P<0.01 (Significant)
· Not attended	4	13	0	2	11.682 P<0.01 (Significant)

Interpretation:

H1:

This study shows that there is a significant increase in knowledge of staff nurses after the implementation of SIM (self-instructional module). Where the t-value is 22.669 (P<0.001)* (*-highly significant)

H2:

There is a significant association of the pre test knowledge score with selected demographic variables.

CONCLUSION:

The research study was conducted with the purpose of implementing the Self Instructional Module to increase the knowledge regarding Recent Advancements in Infertility Treatment among staff nurses working in obstetrics and gynaecological department in selected hospitals. The finding suggested that there was a significant increase in the level of staff nurses after the intervention and there was a significant association between pre test knowledge level and selected demographic variables.

REFERENCES:

1. World Health Organization: Challenges in reproductive health research: Biennial report 1992-1993, Geneva, World Health Organization (1994).

2. Mc. Gupta., B.K Mehajan, “ Textbook Of Preventive And Social Medicine”; J B Publication, 3^rd Edition; 306.

3. Manipalviratn S, et al “Future 0f Infertility Treatment” Int Surg 2006 Sep - Oct; 91 (5): 53-54.

4. Olliveir S et al, “Providing Infertility Care” JOGN Nurse 1984 Mar - Apr; 13 (2): 855-908.

5. Toback B M, “Recent Advances In Female Infertility Care” Journal of Clinical Nurse 1992; 3 (2): 313-319.

6. Chang S N, et al, “Infertile Couples Experience of Family Stress” Journal of Clinical Nurse 08, Feb; 17 (4): 531-538.

7. Claytonh et al, “Trends in Clinical Practice and Nurses” Oncology Nurse Forum 2008 March; 35 (2): 249-255.

8. Sam Acad, et all, “Impaired Fertility In Child Bearing Aged Women” 2006 Jan; 18 (6):268-276.

Received on 25.12.2016 Modified on 10.05.2017

Asian J. Nur. Edu. and Research.2017; 7(3): 284-288.

DOI: 10.5958/2349-2996.2017.00059.3