AN EXPERIMENTAL STUDY TO ASSESS THE EFFECT OF SELF INSTRUCTIONAL MODULE ON KNOWLEDGE AND PRACTICES REGARDING HANDLING OF CYTOTOXIC DRUGS AMONG THE STAFF NURSES WORKING IN THE PEDIATRIC UNITS OF SELECTED HOSPITALS IN PUNE CITY

Introduction: Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. Many treatment options exist for cancer and treatment with chemotherapy started in early 20 century. It involves one or more cytotoxic drugs. Nurses are the main groups that are exposed to these drugs in hospital setting. Hence an experimental study to assess the effect of self instructional module on Knowledge and Practices regarding handling of cytotoxic drugs among the staff nurses working in the Pediatric units of selected hospitals in Pune city was undertaken. The objectives of the study were to assess the Knowledge and Practices of the staff nurses regarding handling of cytotoxic drugs before and after the administration of self instructional module, to determine the effectiveness of Self Instructional Module on Knowledge and Practices among the staff nurses, to correlate the Knowledge and Practices of staff nurses and to find out the association between pre Knowledge and Practice scores with selected demographic variables. Material and methods: A pre experimental one group pre test post test design was used and carried out on 60 samples. The Non probability purposive sampling technique was used. Demographic Performa, structured questionnaire and observation checklist was used to collect the data. Results: The mean knowledge score was significantly increased from 14.3 to 17.4 (p value = 0.000) and the mean practice score was improved from 15.0 to 17.1 (p-value = 0.000) with significant positive correlation between knowledge and practice (r=0.6, t value= 6.2, p value = 0.000) depicting significant change in the knowledge and practice of the staff nurses after the administration of the self instructional module. Conclusion: The researcher is optimistic that the study has exposed some directions for further research that will influence a greater appreciation and awareness for safe handling awareness and practices among the staff nurses handling cytotoxic drugs.


INTRODUCTION
Cancer is a disease process that begins when an abnormal cell is transformed by the genetic mutation of the cellular DNA. Cancer is one of the second largest killer diseases next to the heart disease. There are many treatment strategies against cancer and chemotherapy being one of them. Cytotoxic drugs are therapeutic agents mainly used in chemotherapy for their actions on killing cancerous cells. Nurses play a pivotal role in the preparation, administration of cytotoxic drugs among patients suffering with cancer. There is an increasing trend of occupational exposure to cytotoxic hazards among the health care professionals as cancer patients are usually diagnosed at earliest stages and receiving multiple chemotherapy regimens for a longer period of time. Long term occupational exposures to cytotoxic drugs are associated with various carcinogenic, teratogenic and mutagenic effects. Nurses being the major role in the treatment, it is still a necessity and a need to continue assessing their knowledge, practices and help them with learning aids to keep them updated.

MATERIAL AND METHODS
A quantitative approach using pre experimental one group pre test post test design had been adopted for the present study. A total of 60 samples were selected by using non probability purposive sampling technique according to the inclusion criteria of the sample i.e. educational qualification (ANM, GNM, B.Sc staff nurses), staff nurses working in the Pediatric wards of selected hospitals, staff nurses who are involved in handling of cytotoxic drugs. Validity & reliability was done.
Available Online at http://www.recentscientific.com International Journal of Reliability was done by using test re-test method and inter rater method. Pilot study was conducted on 10 samples to determine the feasibility of the study and it was found feasible. Informed consent was taken prior to conduct the study. Structured questionnaire, consisting of 25 items and observation checklist, also consisting of 25 items was used to assess the pre knowledge and practices of the staff nurses. Followed with the administration of the self instructional module and similarly the post test on the 8 th day. Post results were analyzed to determine the effectiveness of the self instructional module. Paired "t" test was used to calculate the significance of the intervention. Practices regarding cytotoxic drugs were aimed in terms of prior to administration, administration and post administration. Among that, following were the areas where the staff nurses didn't follow all the guidelines-practices of locating spill kit, use of spill kit, selection of PPE, assessment of adverse effects. However they followed all the guidelines in areas of were calculating the weight prior to administration, gathering equipments, use of PPE and documentation.     found to be improved in areas of selection of PPE, use of spill kit for spill management, administration of cytotoxic drugs. Corresponding p-value was of order of 0.000, which was smaller than 0.05. Hence the null hypothesis was rejected. The self-instructional module was proved to be significantly effective in improving the practice of the staff nurses regarding handling of cytotoxic drugs Table No. 8 shows that correlation coefficient between knowledge and practices were 0.6, which indicates that there is positive correlation between knowledge and practices of staff nurses. The significance of this positive correlation was tested using t-test for significance of correlation coefficient. t-value for this t-test was found to be 6.2 with 58 degrees of freedom. Corresponding p-value was 0.000, which was smaller than 0.05. Hence there was a significant positive correlation between knowledge and practices of staff nurses.      Keeping in view the findings of the present study, the researcher identified some areas where the staff nurses where lacking in both their knowledge and practice regarding handling of the cytotoxic drugs. The areas which the researcher felt the need to be taken care of were identified as: exposure routes, adverse effects of handling cytotoxic drugs, following the standard operating procedure while administrating the drug, appropriate selection and use of personnel protective equipments right from the receiving till the after care of the drug.

RESULTS
These results further states that reinforcement and reeducation on new and current practice is still an important aspect to knowledge dissemination and retention among the staff nurses. It is also evident that self learning in the form of written material that is self instructional module serves as a ready reference as it is easier and convenient for the learners.
It can be concluded that SIM remains the preferred and accepted method of instruction, as it is handy and help clarify and further enquire into the areas of weakness and gaps in knowledge as well as practices by the nurses.

CONCLUSION
This study helps to maintain an awareness and up to date knowledge and skill regarding safe handling of cytotoxic drugs and also ensuring that staff nurses are adequately prepared to protect themselves in their workplace from unnecessary exposure. It also aimed in improving the knowledge and practices of the staff nurses handling the cytotoxic drugs. The findings of the present study indicates that participants when administered the self instructional module showed improved knowledge and practice score as compared to the knowledge and practices before the administration of the self instructional module. Learning aid i,e self instructional module was found to be effective in improving the knowledge and practices of the staff nurses regarding handling of cytotoxic drugs.