Final Nursing Rsrch

7/30/2019 Final Nursing Rsrch

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Level of Knowledge and Skills inPerforming Breast Self-Examinationamong 4th year Female High School

Students of Beatriz D. DuranoMemorial National High School:

Health Teaching Program in

Breast Self Examination


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A Research Study Presented

To the Faculty of the College of NursingColegio de San Antonio de Padua

Guinsay, Danao City

In Partial Fulfilment of the Course

Requirements for the Degree

Bachelor of Science

in Nursing


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Lojel Denray M. Durano

Lois Stephanie L. GaradoEmmervon C. LaoDysebel H. Manto

Mary Lou A. Menchavez

Chen M. ManulatNichole Adrian Gomez

Lorianne Mer L. Torralba

Jeffrey C. Sato


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Kelly Thomas B. Tadena, RN, MANResearch Mentor


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Level of Knowledge and Skills inPerforming Breast Self-Examinationamong 4th year Female High School

Students of Beatriz D. DuranoMemorial National High School:

Health Teaching Program in Breast

Self Examination


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CHAPTER I

BACKGROUND AND ITS SETTING


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INTRODUCTION

Performing Breast Self-Examination

is one of the most important things awoman can do to herself. It is an actof self-awareness that can ease onesmind, soothe ones body and saveones breast. It could even save oneslife.


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Many women have suffered frombreast cancer because of insufficientknowledge on how to perform breast

self examination. This perhaps showsthe unending increased number ofcases of breast cancer. Majority of

these patients were diagnosed late dueto lack of knowledge on early detectionof breast cancer.


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Survival of breast cancer patients areincreased if early diagnosis is done.Breast cancer is the leading cause of

cancer death in women between ages15-54. Early detection of breastcancer, through monthly Breast Self-

Examination offers the best chance ofsurvival.


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According to WHO Womens health,Breast cancer is the leading cancer

killer among women aged 20-59 years.Cancers of the breast, lung and colonare among the top 10 causes of deathof older women globally.


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Breast cancer is No. 1 cause of cancerdeaths in the Philippines in a report

released recently by the Department ofHealth; breast cancer is now the mostcommon cancer in the Philippines,taking at least 16 percent of the

50,000 cases diagnosed with cancer.


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This is made even more alarming byanother report from the Philippine BreastCancer Network, which announced that

the Philippines has now the highestincidence rate of breast cancer in Asiaand is also considered to have the 9th

highest incidence rate in the worldtoday.


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And the incidence of breast cancercontinues to rise and whats moredistressing is the fact that all women

are at risk and anyone can be victimmothers, daughters, sisters, andfriends regardless of age, race, socialor economic status.


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The need for intensified efforts toeducate the public should be highlighted.By enlightening women and the public in

general of the importance of preventionand not only early detection, morewomen can be saved from this fatal

disease.


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Breast cancer is the leading cause ofcancer-related death among Cebuanowomen, based on the Cebu population-

based cancer registry of thefoundation. From 1993 to 2007, theEduardo J Aboitiz Cancer Center

(EJACC) of RAFI recorded a total of3,005 reported breast cancer cases inMetro Cebu.


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Based on the above premises, the studyis conducted to evaluate the Level ofKnowledge and Skills in Performing

Breast Self-Examination among 4thyear Female High School Students ofBeatriz D. Durano Memorial National

High school.


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The researchers also would like to know

the relationship of the Level ofKnowledge to the Level of Skills inperforming Breast Self-Examination.


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THEORITICAL BACKGROUNDThis study is anchored on

Bertrand Russells (1926) Theory of

Knowledge which states that knowledgeis a product of doubt. Knowledge refers

to learning concepts, principles andinformation regarding a particular

subject(s) by a person through books,media, encyclopedias, academicinstitutions and other sources.


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In the Tripartite Theory of Plato, thereare three types of knowledge: Personal

Knowledge, Procedural Knowledge andPropositional Knowledge. PersonalKnowledge is the knowledge of

acquaintance, knowledge in this senseis to do with being familiar with

something.


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While Procedural Knowledge is theknowledge concerned on how to do

something, it states that even learningthe theories behind task doesnt

necessarily mean that a person can do

the task proficiently.


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The last type of knowledge is thePropositional Knowledge that focuses

on the knowledge of facts or knownfacts of universal truth.

(http://www.marxists.org/reference/subject/philosophy/works/en/russell1.htm)
http://www.marxists.org/reference/subject/philosophy/works/en/russell1.htmhttp://www.marxists.org/reference/subject/philosophy/works/en/russell1.htmhttp://www.marxists.org/reference/subject/philosophy/works/en/russell1.htmhttp://www.marxists.org/reference/subject/philosophy/works/en/russell1.htmhttp://www.marxists.org/reference/subject/philosophy/works/en/russell1.htmhttp://www.marxists.org/reference/subject/philosophy/works/en/russell1.htmhttp://www.marxists.org/reference/subject/philosophy/works/en/russell1.htmhttp://www.marxists.org/reference/subject/philosophy/works/en/russell1.htmhttp://www.marxists.org/reference/subject/philosophy/works/en/russell1.htmhttp://www.marxists.org/reference/subject/philosophy/works/en/russell1.htmhttp://www.marxists.org/reference/subject/philosophy/works/en/russell1.htmhttp://www.marxists.org/reference/subject/philosophy/works/en/russell1.htmhttp://www.marxists.org/reference/subject/philosophy/works/en/russell1.htm


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Crossman (1959) stated that an earlyview on how practice leads toperformance improvements. He

suggested that, when faced with a newtask, they have many strategies thatcan potentially be used.


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Thus, Crossmans model qualifies as anexample of a theory that proposes that

practice leads to more efficientprocedures for performing a task.


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The theory does not suggest thatpractice modifies strategies to make

them more efficient. Instead, practiceleads to the selection of the mostefficient strategy among several.


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Crossmans theory provides an accountof the power law of learning. Accordingto the theory, it is easier to find faster,

more efficient methods early inpractice, and so large gains inperformance time are more likely at

this stage.(http://books.google.com.ph/books?id=sSAHgnSBJ4sC

&pg=PA40&lpg=PA40&dq=Crosman)
http://books.google.com.ph/books?id=sSAHgnSBJ4sC&pg=PA40&lpg=PA40&dq=Crosmanhttp://books.google.com.ph/books?id=sSAHgnSBJ4sC&pg=PA40&lpg=PA40&dq=Crosmanhttp://books.google.com.ph/books?id=sSAHgnSBJ4sC&pg=PA40&lpg=PA40&dq=Crosmanhttp://books.google.com.ph/books?id=sSAHgnSBJ4sC&pg=PA40&lpg=PA40&dq=Crosmanhttp://books.google.com.ph/books?id=sSAHgnSBJ4sC&pg=PA40&lpg=PA40&dq=Crosmanhttp://books.google.com.ph/books?id=sSAHgnSBJ4sC&pg=PA40&lpg=PA40&dq=Crosmanhttp://books.google.com.ph/books?id=sSAHgnSBJ4sC&pg=PA40&lpg=PA40&dq=Crosmanhttp://books.google.com.ph/books?id=sSAHgnSBJ4sC&pg=PA40&lpg=PA40&dq=Crosmanhttp://books.google.com.ph/books?id=sSAHgnSBJ4sC&pg=PA40&lpg=PA40&dq=Crosmanhttp://books.google.com.ph/books?id=sSAHgnSBJ4sC&pg=PA40&lpg=PA40&dq=Crosmanhttp://books.google.com.ph/books?id=sSAHgnSBJ4sC&pg=PA40&lpg=PA40&dq=Crosmanhttp://books.google.com.ph/books?id=sSAHgnSBJ4sC&pg=PA40&lpg=PA40&dq=Crosmanhttp://books.google.com.ph/books?id=sSAHgnSBJ4sC&pg=PA40&lpg=PA40&dq=Crosmanhttp://books.google.com.ph/books?id=sSAHgnSBJ4sC&pg=PA40&lpg=PA40&dq=Crosmanhttp://books.google.com.ph/books?id=sSAHgnSBJ4sC&pg=PA40&lpg=PA40&dq=Crosmanhttp://books.google.com.ph/books?id=sSAHgnSBJ4sC&pg=PA40&lpg=PA40&dq=Crosmanhttp://books.google.com.ph/books?id=sSAHgnSBJ4sC&pg=PA40&lpg=PA40&dq=Crosmanhttp://books.google.com.ph/books?id=sSAHgnSBJ4sC&pg=PA40&lpg=PA40&dq=Crosman


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One of the leading causes of deathamong women is Breast Cancer. BreastCancer is a malignant tumor thattypically begins in the ductal-lobularepithelial cells of the breast and spreadvia the lymphatic system to the axillary

lymph nodes.


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The tumor may then mestastasize todistant regions of the body, including

lungs, liver, bone and brain. The findingof breast cancer in the axillary lymphnodes is not merely contiguous growthinto the adjacent region of the breast.


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Most primary breast cancers areadenocarcinomas located in the upper

outer quadrant of the breast (Black andHawks, 2005)


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Breast cancer is a typeof cancer originating

from breast tissue, most commonlyfrom the inner lining of milk ducts orthe lobules that supply the ducts withmilk. Cancers originating from ducts

are known as ductal carcinomas; thoseoriginating from lobules are known

as lobular carcinomas.


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Breast cancer is a disease of humans andother mammals; while the overwhelming

majority of cases in humans arewomen, men can sometimes also

develop breast cancer.


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The size, stage, rate of growth, andother characteristics of the tumordetermine the kinds of treatment.

Treatment may includesurgery, drugs (hormonal

therapy and chemotherapy), radiationand/or immunotherapy.

(http://en.wikipedia.org/wiki/Breast_cancer)
http://en.wikipedia.org/wiki/Breast_cancerhttp://en.wikipedia.org/wiki/Breast_cancer


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In order to detect easily theabnormalities of the breast, women are

encouraged to perform Breast Self-

Examination. Breast Self-Examination(BSE) is a screening method used in anattempt to detect early breast cancer.


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The method involves the woman herselflooking at and feeling each breast for

possible lumps, distortions or swelling.


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BSE was once promoted heavily as ameans of finding cancer at a morecurable stage, but large randomized

controlled studies found that it was noteffective in preventing death, andactually caused harm through needless

biopsies and surgery.

(http://en.wikipedia.org/wiki/Breast_self-examination)
http://en.wikipedia.org/wiki/Breast_self-examinationhttp://en.wikipedia.org/wiki/Breast_self-examinationhttp://en.wikipedia.org/wiki/Breast_self-examinationhttp://en.wikipedia.org/wiki/Breast_self-examinationhttp://en.wikipedia.org/wiki/Breast_self-examinationhttp://en.wikipedia.org/wiki/Breast_self-examinationhttp://en.wikipedia.org/wiki/Breast_self-examinationhttp://en.wikipedia.org/wiki/Breast_self-examinationhttp://en.wikipedia.org/wiki/Breast_self-examinationhttp://en.wikipedia.org/wiki/Breast_self-examination


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Figure 1. The normal and healthybreast compared to the breast with

cancer.


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Breast self Examination should beconducted once a month. A regulartime is best --- such as immediately

following menstruation, when breasttenderness and fullness caused by fluidretention have subsided, or on the first

day of the month.


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Women examine themselves regularlybecome familiar with the shape texture

of the breast. Any changes must bereported immediately to the physician foraccurate diagnosis (Kozeir, Erb, Blais and

Wilkinson 2002).


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Some facts that have been shared by thePhilippine Breast Cancer Network Allwomen are at risk. Approximately 70%

of breast cancers occur in women withnone of the known risk factors, onlyabout 5% of breast cancers are

inherited.


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About 80% of women diagnosed withbreast cancer will be the first to

be victims in their families.


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One out of four who are diagnosed withbreast cancer die within the first five

years, 1 out of 13 Filipino women willdevelop breast cancer in her lifetime.


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The Philippines has the highest incidencerate of breast cancer in Asia and

registered the highest increase of 589%among 187 countries over a 30 yearperiod from 1980 to 2010.

(http://www.pbcn.org/)
http://www.pbcn.org/http://www.pbcn.org/


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In 1989, Ngelangel et al. conducted aknowledgeattitudepractice survey,Fifty percent of women had heard/readabout breast examination, only 37% ofthe women had ever received a breastcheck-up from a physician.


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Medical personnel had only ever advised36% on the importance of BSE and only

about 67% knew the benefits of BSE.Only 37% of the women had everreceived a breast check-up from a

physician.


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Medical personnel had only everadvised 36% on the importance of BSEand only about 67% knew the benefits

of BSE. Only 54% had ever done aBSE, of whom only 27% are stillpracticing it.


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Reasons given for not doing the BSEincluded no symptoms, busy, dont know

how, dont like, dont think important,

always forget, afraid and not aware.

(http://jjco.oxfordjournals.org/content/32/suppl_1/S52.full)


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In a 1997 field trial of breast cancerscreening conducted by the DOHPCCPand IARCWHO in Metro Manila, therewas a large non-compliance rate

(79.1%) among women found to havebreast masses (2.8% positivity rate) interms of consulting referral hospitals

for re-evaluation and possibletreatment.


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Reasons such as fear, no money fortransport/treatment/medical expenses,indifference, no time, non-awareness

of gravity of the disease and spiritualfatalistic attitudes were commonlygiven,


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it continues to campaign for monthly BSEand annual physician breast

examinations until such time that

mammography becomes available andaffordable to most of the targetpopulation.

(http://www.doh.gov.ph/)
http://www.doh.gov.ph/http://www.doh.gov.ph/


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The Breast Cancer Control Program(BCCP) of the Philippines refers to theimplementation of a nationwide anti-

breast cancer scheme: publicinformation and health education, casefinding and treatment integrated intothe community health structure and

equipped to control breast cancer in asystematic sustained manner


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Studies have shown a one-thirdreduction in mortality attributed to

breast cancer screening, mainly due tomammography.


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However, the importance of annualclinical breast examination (by nurse,

midwife or public health physician) andmonthly breast self-examination(BSE)are to be emphasized, taking notethat:


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(a) sophisticated screening technology(mammography) is not easily availableor affordable,

(b) mammography is mainlyrecommended for women 50 yearsold,

(c) many breast cancers are foundamong 3550-year-old Filipino women


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(d) a relatively inexpensive strategy

(BSE) involving physicians as examinersor a referral depot would be cheaper and

more available than mammography andphysician time.

(http://jjco.oxfordjournals.org/content/3

2/suppl_1/S52.full.Prevention)
http://jjco.oxfordjournals.org/content/32/suppl_1/S52.fullhttp://jjco.oxfordjournals.org/content/32/suppl_1/S52.fullhttp://jjco.oxfordjournals.org/content/32/suppl_1/S52.fullhttp://jjco.oxfordjournals.org/content/32/suppl_1/S52.full


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Reproductive factors associated withprolonged exposure to endogenousestrogens, such as early menarche,

late menopause, late age at firstchildbirth are among the mostimportant risk factors for breastcancer.


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Exogenous hormones also exert a higherrisk for breast cancer. Oral contraceptiveand hormone replacement therapy users

are at higher risk than non-users.Breastfeeding has a protective effect(IARC, 2008, Lacey et al., 2009).

(http://www.who.int/cancer/detection/breastcancer/en/index2.html)
http://www.who.int/cancer/detection/breastcancer/en/index2.htmlhttp://www.who.int/cancer/detection/breastcancer/en/index2.htmlhttp://www.who.int/cancer/detection/breastcancer/en/index2.htmlhttp://www.who.int/cancer/detection/breastcancer/en/index2.html


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Breast cancer is the top cancer inwomen both in the developed and thedeveloping world. The incidence of

breast cancer is increasing in thedeveloping world due to increase lifeexpectancy, increase urbanization and

adoption of western lifestyles.


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Although some risk reduction might beachieved with prevention, these

strategies cannot eliminate the majority

of breast cancers that develop in low-and middle-income countries where

breast cancer is diagnosed in very late

stages.


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Therefore, early detection in order toimprove breast cancer outcome andsurvival remains the cornerstone of

breast cancer control.


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The recommended early detectionstrategies for low- and middle-incomecountries are awareness of early signs

and symptoms and screening by clinicalbreast examination in demonstrationareas.

(http://www.who.int/cancer/detection/br

eastcancer/en/index.html)


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Figure 3. Schema of Study


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Figure 3 shows the Schema of theStudy, in which it was anchored on theTheory of Knowledge, Tripartite Theory

and the Skill Acquisition Theory. Theinputs are the profile of therespondents in terms of the Age, Civil

Status and the Level of Knowledge and

Skills in Performing Breast Self-Examination.


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The researchers utilized the researcher-made questionnaire of Breast Self-Examination Checklist as the process.The output is the Health TeachingProgram in Breast Self-Examination.


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THE PROBLEM


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Statement of the ProblemThis study aimed to determine the

relationship between Level of Knowledge

and skills in performing breast self-examination among 4th year FemaleHigh School Students of Beatriz D.

Durano Memorial National High school inorder to propose an action plan.


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Specifically, the researcher seeks answerto the following questions:

1. What is the profile of therespondents in terms of:

1.1 Age;

1.2 Civil Status?


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2. What is the Level of knowledge in

performing Breast Self-Examination

among the 4th Year Female HighSchool Students of Beatriz D. DuranoMemorial National High School?


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3. What is the Level of Skills in

performing Breast Self-Examinationamong the 4th Year Female HighSchool Students of Beatriz D. DuranoMemorial National High School?


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4. Is there a significant relationshipbetween the Level of Knowledge andSkills in Performing Breast Self-Examination among 4th Year FemaleHigh School Students of Beatriz D.Durano Memorial National High

School?


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5. What Health Teaching Program inBreast Self-Examination can be

proposed based on the findings of thestudy?


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Statement of the Null Hypothesis

The hypothesis is tested at 0.05 alpha levelof significance.

Ho: There is no significant

relationship between the Level ofKnowledge and Skills in PerformingBreast Self-Examination among 4th

Year Female High School Students ofBeatriz D. Durano Memorial NationalHigh School.


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Significance of the Study

This study is important and beneficialto the following entities:

Student Nurses will enhance theirknowledge and skills in conductinghealth teachings on Breast Self-Examination and also to review their

knowledge and skills.


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Clinical Instructors will increasetheir knowledge and focus on onesrole modelling in moulding the

behaviour of students regarding BreastSelf Examination. Also, it enables themto focus on the weaknesses andstrengths of each student on theknowledge and skills of performingBreast Self Examination.


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High School Students will benefit fromthe health teaching program proposedby the researchers. In addition it willenhance their knowledge and skills inperforming Breast Self-Examinationand to correct errors and common

malpractices.


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The Researchers will be aware of theLevel of Knowledge and Skills of the 4th

Year High School Students in

Performing Breast Self-Examinationthat may help them to early diagnosesigns of breast cancer.


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Future Researcher will derive from thisstudy by other researchers, especiallythose who are interest in Breast Self-

Examination. It encourages them toenhance the current research toprovide more conductive data.

RESEARCH MATERIALS AND


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RESEARCH MATERIALS AND

METHODS

Research Method

The researchers used the descriptive-correlational design to determine theLevel of Knowledge and Skills amongthe 4th Year Female High SchoolStudents of Beatriz D. Durano

Memorial National High School inPerforming Breast Self-Examination.


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Research Respondent

The respondents of this study were the4th year Female High school studentsof Beatriz D. Durano Memorial NationalHigh school. The researchers chose 30respondents utilizing the purposive

sampling.


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Inclusion criteria:

The respondents must be a bonafide 4thyear student at Beatriz D. Durano

Memorial National High School. Theymust be 15-20 years old.


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Exclusion criteria:Those who are below 15 and above 20

will be excluded from being one of theresearch respondents and those who are

not 4th year High School Students.


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Research Environment

The study were conducted at Beatriz D.Durano Memorial National High school located at P.G Almendras Street, Lapu-lapuSuba, Danao City. It has a 4-storey buildingand has 6 ground floor rooms and 1 annexbuilding that has classrooms and equippedlaboratories.


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It has 45 teachers headed by a principal.The total population is 1,539 students in

school year 2011-2012. It offerscomplete secondary education. They

started their operations in the year 1996.

Figure 4. Beatriz D. Durano Memorial


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Figure 4. Beatriz D. Durano Memorial

National High School Building.


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Scope and Limitations of the Study

This particular study mainlydetermined the Level of Knowledgeand Skills in Performing Breast Self-examination among 4th Year FemaleHigh School Students of Beatriz D.Durano Memorial National High school.


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The researchers are aware of thelimitations of the study, therefore these

limitations should be taken into

consideration in their interpretationanalysis of the findings and also in the

formulation of a conclusion:


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1. The research instruments are notstandardized.

2. The validity of the results lay on the

sincerity of the respondent in givinghonest responses.

3. Willingness and the cooperation of

the respondent with regards to theresearch study.


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The respondents who are involved inthis study are only representativesample from 4th year High School

Students of Beatriz D. DuranoMemorial High School in PerformingBreast Self-Examination.


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Research Instrument

The researchers utilized a researcher madequestionnaire and a Breast Self-Examination

checklist to determine the Level ofKnowledge and Skills in Performing BreastSelf-examination among 4th Year FemaleHigh School Students of Beatriz D. Durano

Memorial National High School .


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Part I of the questionnaire is theresearcher made questionnaire that

determines the Level of Knowledge in

Performing Breast Self-examinationamong 4th Year Female High School

Students of Beatriz D. Durano Memorial

National High school.


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It is a 10 item questionnaire whichanswers have corresponding value. 5=I have exceptional understanding; 4= I

have good understanding; 3= I havemoderate understanding; 2= I havebasic understanding; 1= I have nounderstanding.


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The following hypothetical measureswere utilized for interpretation of the

mean score:


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Part II of the questionnaire is the BreastSelf-Examination checklist to determinethe Level of Skills. A 16 items checklist,

which ratings have corresponding values5= Excellent; 4= Very Good; 3= Good;

2= Fair; 1= Poor.


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There were no numbers that are closerto 1 that would indicate that the

respondents got scores closer to 5. The

following interpretation of their meanscore is shown below.

DATA COLLECTION AND


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PROCEDURE

I. Preliminary Preparation

The Group presented the researchproposal manuscript to the Research

Committee for approval to conduct thestudy on Level of Knowledge and Skillsamong 4th year Female High SchoolStudents of Beatriz D. DuranoMemorial National High school inPerforming Breast Self-Examination.


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Upon approval, the group sent a letterto the Dean of the College of Nursingof Colegio de San Antonio de Padua to

inform her about the study. Anotherletter was addressed to the VicePresident for Academic Affairs andOperations.


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A letter was also addressed to Principalof Beatriz D. Durano Memorial NationalHigh school, asking for permission to

conduct the study at the Beatriz D.Durano Memorial National High School.

Upon the approval, the researchersinformed each of the class presidentsand asked for the assistance in thedissemination of the information.


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II.Actual Data Gathering

As soon that it was approved, theresearchers produced 20 copies for thepilot study and 30 copies for actualstudy. A pilot study was conducted bythe researchers in order to determine

the validity and reliability of theresearcher-made questionnaire.

The esea che s disseminated the


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The researchers disseminated thequestionnaires to the respondents with

the informed consent, instructionswere given upon starting, in answeringthe questionnaire the researchers were

present if in case there were questionsthat are needed to be addressed or ifthere were any clarifications. After

answering the 1st

part of thequestionnaire the papers werecollected.


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And for the 2nd part of the questionnairethe respondents were given 20-25minutes to perform Breast Self-

Examination and were observed by theFemale researchers to evaluate theprocedure done by the respondent.

After the examination the data were

rated, tabulated, analyzed andinterpreted.

STATISTICAL TREATMENT


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A. Percentage formulaTo determine the profile of therespondents via percentage;

percentage formula was utilized.r = P/N x 100%

Where: r- Percent Rate

P- pointsN- total number of respondents

STATISTICAL TREATMENT


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B. Weighted Mean

To determine the weights of the scores ofthe respondents, the weighted mean wasutilized.

x = fx/F


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Where: x= Weighted meanf= frequencyx= weight of each score

fx= Sum of all the products of f and xwhere f is frequency of knowledge, skilland x is the weight of each score of

knowledge, skill.F= Sum of all the respondents


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C. Pearson product-Moment Correlation

In order to determine the relationship betweenthe Level of Knowledge and skills in

performing breast self-examination among4th year Female High School Students ofBeatriz D. Durano Memorial National Highschool, the Pearson r product-Moment

Correlation has been utilized.

r= N(XY)(X)(Y)


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( ) ( ) ( )

(N[X2] - [X]2) (N[Y2] [Y]2)

Where: r= Pearson r

= summation

N= the total number of respondents

X= the Level of Knowledge among4th year Female High School Students

Y= the Level of Skills among 4thyear Female High School Students

To interpret the correlation value (r)bt i d th f ll i l ifi ti


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obtained, the following classificationsmay be applied:

An r from 0.00 to 0.20 denotesnegligible correlation

An r from 0.21 to 0.40 denotes

low or slight correlationAn r from 0.41 to 0.70 denotesmarked or moderate relationship


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An r from 0.71 to 0.90 denotes highrelationship

An r from 0.91 to 0.99 denotesvery high relationship

An r from 1.00 denotes perfectcorrelation


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D. The t-test

In order to determine if the studyparticipants are enough for the study as wellas to check if there is a significantrelationship between Level of Knowledgeand Skills in performing Breast Self-Examination among 4th year Female HighSchool Students of Beatriz D. DuranoMemorial National High, the t test wasutilized.


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t = r N-2

1 r2

t= t-value

N= number of respondents

r2= coefficient of correlation squared.

Definition of TermsT l l d t d th t th f ll i t


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To clearly understand the concept, the following termswere defined operationally.

Level of Knowledge: Theunderstanding of the 4th Year High

School Students in the facts aboutBreast Self Examination.

Skills: The ability of the 4th Year High

School Students to perform BreastSelf-Examination.

Breast Self-Examination: The procedured b h th l h S h l


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done by the 4th Year Female High SchoolStudents in this study.

4th Year Female High School Students:They are the researchers respondents inconducting the study ofLevel of Knowledgeand Skills among the 4th Year Female High

School Students of Beatriz D. DuranoMemorial National High School in PerformingBreast Self-Examination.

Health Teaching in Breast Self-

Examination: The propose action plan ofthe researchers regarding the results of thestudy.


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CHAPTER II

PRESENTATION, ANALYSIS ANDINTERPRETATION OF DATA


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This chapter presents the data that

answer the questions raised in thisstudy. There are six (6) tables madefor this study.

Tables 1 and 2 shows the profile of therespondents in terms of their Age andCivil Status respectively. Table 3presents the respondents Level ofKnowledge, Table 4 shows therespondentsLevel of Skills.


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Table 5 presents the relationshipbetween Level of Knowledge and skills in

performing breast self-examinationamong 4th year Female High School

Students of Beatriz D. Durano MemorialNational High school.


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AGE PROFILE

Table 1 shows that among 30 studyparticipants, 20 percent ages from 17-18

which comprises 6 study participants involvein the study, while the other 80 percent isfrom ages 15-16 which comprises 24 studyparticipants that were involve in the study,

while there were none for the age range of19-20.

AGE FREQUENCY PERCENTAGE


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AGE

CATEGORY

FREQUENCY PERCENTAGE

19-20 0 0

17-18 6 20

15-16 24 80

TOTAL: 30 100


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It is clearly shown in the study thatmajority of the respondents is from theage-range of 15-16; that comprises 24

students. Being a high school studentspecially in the 4th year level age fits inthe range ages 15-16, minimal only in

ages 17 and above for a 4th year highschool level.


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According to Erikson (1963) thepsychosocial task of an adolescent isestablishing the identity versus roleconfusion. The inability to settle onoccupational identity commonlydisturbs the adolescents. Eriksonstated that adolescents help one

another through this identity crisis byforming cliques and a separate youthculture.


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These cliques often exclude all thosewho are different in skin colour, culturalbackground, aspects of dress or fashion,

gestures and taste in music.


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During adolescents, peer groupsassume great importance. The peergroup has a number of functions. It

provides a sense of belongingness,pride, social learning, and sexual roles.(Erikson, 1963 as cited by Kozier et. al.

2007)


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Erikson notes the healthy resolution ofearlier conflicts can now serve as afoundation for the search for an

identity. If the child overcomes earlierconflicts they are prepared to searchfor an identity. He also said that the

adolescent must make a conscioussearch for identity.


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This is built on the outcome andresolution to conflict earlier stages, if the

adolescent cannot make deliberate

decisions and choices, especially aboutvocation, sexual orientation, and life in

general, role confusion becomes a

threat. ( Labiste, 2008)


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CIVIL STATUS PROFILE

Table 2 shows that among the 30

students, 100 percent of therespondents are single.

Table 2: The profile of the respondents as to their


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civil status

Civil l Status Frequency Percentage

Single 30 100

Married 0 0

Total: 30 100


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It is clearly shown in the study that allof the 30 respondents and being ahigh school student are single. Erik

Erikson said that in the adolescentperiod Teens need to develop a senseof self and personal identity. Duringadolescence, children are exploring

their independence and developing asense of self.


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As they make the transition from childhood

to adulthood, teens may begin to feelconfused or insecure about themselves andhow they fit in to society. As they seek toestablish a sense of self, teens may

experiment with different roles, activitiesand behaviors. According to Erikson, this isimportant to the process of forming a strongidentity and developing a sense of direction

in life.(http://psychology.about.com/od/psychosocialtheories/a/identity-versus-confusion.htm)
http://psychology.about.com/od/psychosocialtheories/a/identity-versus-confusion.htmhttp://psychology.about.com/od/psychosocialtheories/a/identity-versus-confusion.htmhttp://psychology.about.com/od/psychosocialtheories/a/identity-versus-confusion.htmhttp://psychology.about.com/od/psychosocialtheories/a/identity-versus-confusion.htmhttp://psychology.about.com/od/psychosocialtheories/a/identity-versus-confusion.htmhttp://psychology.about.com/od/psychosocialtheories/a/identity-versus-confusion.htmhttp://psychology.about.com/od/psychosocialtheories/a/identity-versus-confusion.htmhttp://psychology.about.com/od/psychosocialtheories/a/identity-versus-confusion.htmhttp://psychology.about.com/od/psychosocialtheories/a/identity-versus-confusion.htmhttp://psychology.about.com/od/psychosocialtheories/a/identity-versus-confusion.htmhttp://psychology.about.com/od/psychosocialtheories/a/identity-versus-confusion.htmhttp://psychology.about.com/od/psychosocialtheories/a/identity-versus-confusion.htmhttp://psychology.about.com/od/psychosocialtheories/a/identity-versus-confusion.htmhttp://psychology.about.com/od/psychosocialtheories/a/identity-versus-confusion.htmhttp://psychology.about.com/od/psychosocialtheories/a/identity-versus-confusion.htmhttp://psychology.about.com/od/psychosocialtheories/a/identity-versus-confusion.htm


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while 1 question are rated Goodunderstandingwhich falls within the rangescore of 3.41 4.20. There are no questions

that fall on theexceptionalunderstanding.The total weighted mean is 2.8 and isinterpreted asmoderateunderstanding.


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The result shows that most of the time,the respondents graded low in the

questions have a replacement character.

Table 3: The level of knowledge among the

respondents


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pQuestions Mean Interpretation

1. Do you know Breast Self-Examination? 2.93 ModerateUnderstanding

2. Do you know that Breast Self

Examination should be performed 7-10

days after your period or on the same date

each month if you are having irregularcycle?

3.03 ModerateUnderstanding

3. Do you know that you have anincreased risk of having Breast Cancerif you have a first-degree relative

(parent, brother, sister or child) thathas cancer?

3 ModerateUnderstanding

4. Do you know that smoking canincrease the risk of having breastcancer?


5. Do you know that Breast Self-Examination is the most convenient



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Examination is the most convenientand simple diagnostic tool againstBreast Cancer?

Understanding

6. Do you know thatmaintaining a Healthy Lifestylecan help reduce the risk ofhaving Breast Cancer?

3.63 GoodUnderstanding

7. Do you know that you haveincreased risk of having BreastCancer if you are overweight?

2.33 BasicUnderstanding

8. Do you know that you have

increased chance of havingBreast Cancer if you had neverhad child?

2.1 Basic

Understanding

9 Do you know that you 2 36 Basic


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9. Do you know that youhave increased risk of

having Breast Cancer if thebeginning of menstruationhappens before age 12?

2.36 Basic

Understanding

10. Do you know that youhave increased risk of

having Breast cancer if you

are drinking alcohol (more

than one drink a day)?


Total Mean: 2.8 Moderate

Understanding

Knowledge is a familiarity with someoneor something which can include facts


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or something, which can include facts,information, descriptions, or skillsacquired through experience oreducation. It can refer to thetheoretical or practical understanding

of a subject. It can be implicit (as withpractical skill or expertise) or explicit(as with the theoretical understandingof a subject); it can be more or less

formal or systematic.

(http://oxforddictionaries.com/view/entry/m_en_us1261368#m_en_us1261368)
http://oxforddictionaries.com/view/entry/m_en_us1261368http://oxforddictionaries.com/view/entry/m_en_us1261368http://oxforddictionaries.com/view/entry/m_en_us1261368http://oxforddictionaries.com/view/entry/m_en_us1261368http://oxforddictionaries.com/view/entry/m_en_us1261368http://oxforddictionaries.com/view/entry/m_en_us1261368http://oxforddictionaries.com/view/entry/m_en_us1261368http://oxforddictionaries.com/view/entry/m_en_us1261368http://oxforddictionaries.com/view/entry/m_en_us1261368http://oxforddictionaries.com/view/entry/m_en_us1261368http://oxforddictionaries.com/view/entry/m_en_us1261368


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Knowledge acquisition involves complexcognitive processes: perception,communication, association and

reasoning; while knowledge is also saidto be related to the capacity ofacknowledgment in human beings.

(Stanley Cavell, "Knowing and Acknowledging,"Must We Mean What We Say? (CambridgeUniversity Press, 2002), 238266.)

THE LEVEL OF SKILLS AMONG THE

RESPONDENTS


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RESPONDENTS

Table 4 shows the respondents Level of Skillsin performing Breast Self-Examination. In 16questions of the Breast Self-Examination

checklist, No procedure has been rated asPoor which falls on range score of 1.00-1.80 and there are no procedure rated as

Fairwhich falls on the range score of 1.81-

2.60, while there are procedure rated asGood which falls in the range score of2.61-3.40,

hil th 11 d th t h


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while there are 11 procedures that has

been ratedVeryGoodwhich falls onthe range score of 3.41-4.20 and thereis only 1 procedure that has been rated

Excellent which falls on the rangescore of 4.21-5.00. The total weightedmean is 3.61 and interpreted asVeryGoodin the level of skills.


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The finding of this study shows that therespondents have a very good rating in

terms of performing Breast Self-

Examination.

Table 4: The Level Of Skills among therespondents


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respondents

Questions Mean Interpretation

1. Examine your breast during

bath or shower.3.26 Good

2. Fingers flat, move gently

over part of each breast.3.76 Very Good

3. Use right hand to examine

left breast, left hand for the

right breast.4.06 Very Good

4. Check for any lump, hard

knot of thickening.3.6 Very Good

5. Inspect your breast

with arms at your sides

3.53 Very Good


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with arms at your sides.6. Raise your arms high

overhead.4.3 Excellent

7. Look for any changes in

contour of each breast, a

swelling, dimpling of skin or

changes in the nipple.

3.43 Very Good

8. Rest palms on hips and

press down firmly to flex

your chest muscles. Left andright breast will not, exactly

match.

3.16 Good

9. Regular inspection

shows what is normal for

3 Good


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you and will give you

confidence.10. To examine your right

breast put a pillow of

folded towel under yourright shoulder.

3.23 Good

11. Place right hand behind

your head.4.13 Very Good

12. With left hand, fingers flat,

press gently in small circular

3.66Very Good


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press gently in small circular

motion around an imaginary clock

face.13. Begin at outermost top of

your breast for 12 oclock, then

move to 1 oclock, and so on

around the circle back to 12.

3.63Very Good

14. Then move an inch, toward

nipple, keep circling to examine

every part of your breast,including nipple. This requires at

least 3 more circles.

3.6 Very Good

15. Now slowly repeat

procedure on your left

3.9 Very Good


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p y

breast with pillow under

your left shoulder and lefthand behind head.16. Finally, squeeze the

nipple of each breast gently

between thumb and index

finger. Any discharge, clear

or should be reported.

3.6 Very Good

Total Mean: 3.61 Very Good


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There are factors that might affect thepersons skills like practice that couldlead to increase proficiency on thegiven task. This was stated by

Crossman (1959) that practice can leadto performance improvements

He also stated that faced with a new


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He also stated that faced with a new

task, a person will have many strategiesthat can potentially be used. Withpractice at the task, they monitor the

outcomes they produce as a result of thevarious strategies used and also practice

leads to the selection of the mostefficient strategy among several.


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Steinaker and Bell (1979) stated thatconceptualized experiential learning asa sequence of progressive stages:exposure, participation, identification,

internalization, and dissemination.Exposure represents a consciousnessof the event and anticipation towardsinvolvement in it. Participation is actual

involvement in the experience.

Identification occurs when theparticipant starts to apply earlier-


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participant starts to apply earlier-learned experiences and knowledge tothe situation. Internalization hasoccurred when the participant is ableto apply learned concepts to other

situations. Last, the disseminationstage is achieved when the participantcan advise/teach others about theexperience and manage their

involvement.(http://www.umdnj.edu/idsweb/idst5340/models_skills_acquisition.htm)
http://www.umdnj.edu/idsweb/idst5340/models_skills_acquisition.htmhttp://www.umdnj.edu/idsweb/idst5340/models_skills_acquisition.htmhttp://www.umdnj.edu/idsweb/idst5340/models_skills_acquisition.htmhttp://www.umdnj.edu/idsweb/idst5340/models_skills_acquisition.htmhttp://www.umdnj.edu/idsweb/idst5340/models_skills_acquisition.htmhttp://www.umdnj.edu/idsweb/idst5340/models_skills_acquisition.htmhttp://www.umdnj.edu/idsweb/idst5340/models_skills_acquisition.htmhttp://www.umdnj.edu/idsweb/idst5340/models_skills_acquisition.htmhttp://www.umdnj.edu/idsweb/idst5340/models_skills_acquisition.htmhttp://www.umdnj.edu/idsweb/idst5340/models_skills_acquisition.htmhttp://www.umdnj.edu/idsweb/idst5340/models_skills_acquisition.htmhttp://www.umdnj.edu/idsweb/idst5340/models_skills_acquisition.htmhttp://www.umdnj.edu/idsweb/idst5340/models_skills_acquisition.htmhttp://www.umdnj.edu/idsweb/idst5340/models_skills_acquisition.htm


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Fitts and Posner (1967) stated that thelearning process is sequential and thatwe move through specific phases as

we learn. There are three stages tolearning a new skill:


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Cognitive phase - Identification anddevelopment of the component partsof the skill - involves formation of a

mental picture of the skill,


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Autonomous phase - Developing thelearned skill so that it becomesautomatic - involves little or no

conscious thought or attention whilstperforming the skill - not all performersreach this stage.

The learning of physical skills requires


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The learning of physical skills requires

the relevant movements to beassembled, component by component,using feedback to shape and polishthem into a smooth action. Rehearsalof the skill must be done regularly andcorrectly.

(FITTS, P.M. and POSNER, M.I. (1967)Human performance. Oxford, England:Brooks and Cole)

There are factors that might affect the kill lik ti th t ld


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persons skills like practice that could

lead to increase proficiency on thegiven task. This was stated byCrossman (1959) that practice can lead

to performance improvements. He alsostated that faced with a new task, aperson will have many strategies thatcan potentially be used.


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With practice at the task, they monitorthe outcomes they produce as a result of

the various strategies used and alsopractice leads to the selection of the

most efficient strategy among several.

RELATIONSHIP BETWEEN LEVEL OF

KNOWLEDGE AND SKILLS


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KNOWLEDGE AND SKILLS

Table 5 shows the relationship betweenlevel of knowledge and skills inperforming breast self- examination

among 4th year female high schoolstudent of Beatriz D. Durano MemorialNational High School.

It shows that by obtained value of r is0 025 utilizing Pearson r product


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0.025, utilizing Pearson r product-

Moment Correlation, and the criticalvalue of r is 0.3494, the obtained valueof r is less than the critical value of r,which means that there is nosignificant relationship between Levelof Knowledge and Skills in PerformingBreast Self-Examination among 4th

year Female High School Student ofBeatriz D. Durano Memorial NationalHigh School.

To check if the respondents in the study


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To check if the respondents in the study

was enough to determine thesignificance between Level ofKnowledge and Skills in Performing

Breast Self-Examination the t test wasutilized. The result shows that theobtained t value is 0.132 while thecritical t is 2.048.

Since the obtained t value is less than


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Since the obtained t value is less than

the critical t value, it conveys to theresearcher that the respondents areenough and there is no significantrelationship between Level of

Knowledge and Skills in PerformingBreast Self-Examination. The result ofthe study clearly shows to theresearcher that they need to acceptthe null hypothesis.

Table5: The relationship between level of knowledgeand skills in performing Breast Self- Examination

among 4th year female high School Student of Beatriz


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g y gD. Durano Memorial National High School.

Obtained

r valueCritical r

valueObtained

t valueCritical t

valueSignificance Decision

on Ho

0.025 0.3494 0.132 2.048 NoSignificance

Accept


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For the thinking to be productive, ratherthan aimless daydreaming, there is

focusing on a problem or on perceivedelements of environment.


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Once the problem is intellectualized,thinking is directed to the solution.

After a solution is tentatively accepted,

it is tested or evaluated.

The present information and the method


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The present information and the method

one has, his hypothesis about thesolution, and the particular social orother context of the efforts are all

related to the testing or evaluatingaspect of thinking.

(General Psychology 4th EditionCustodiosa A.Sanchez, Paz F. Abad,

Loreto V. Jao pg. 155)


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In 1989, Ngelangel et al. conducted aknowledgeattitudepractice survey,Fifty percent of women had heard/readabout breast examination, only 37% of

the women had ever received a breastcheck-up from a physician


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Medical personnel had only ever advised36% on the importance of BSE and onlyabout 67% knew the benefits of BSE.

Only 37% of the women had everreceived a breast check-up from a

physician.


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Medical personnel had only everadvised 36% on the importance of BSEand only about 67% knew the benefits

of BSE. Only 54% had ever done aBSE, of whom only 27% are stillpracticing it.


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Reasons given for not doing the BSEincluded no symptoms, busy, dont know

how, dont like, dont think important,always forget, afraid and not aware.

(http://jjco.oxfordjournals.org/content/32/suppl_1/S52.full)


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Reasons such as fear, no money fortransport/treatment/medical expenses,


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transport/treatment/medical expenses,

indifference, no time, non-awarenessof gravity of the disease and spiritualfatalistic attitudes were commonlygiven, it continues to campaign formonthly BSE and annual physicianbreast examinations until such timethat mammography becomes available

and affordable to most of the targetpopulation. (http://www.doh.gov.ph/)

The Breast Cancer Control Program(BCCP) f th Phili i f t th
http://www.doh.gov.ph/http://www.doh.gov.ph/


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(BCCP) of the Philippines refers to the

implementation of a nationwide anti-breast cancer scheme: publicinformation and health education, casefinding and treatment integrated intothe community health structure andequipped to control breast cancer in asystematic sustained manner


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However, the importance of annualclinical breast examination (by nurse,midwife or public health physician) and

monthly breast self-examination (BSE)are to be emphasized, taking notethat:


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(d) a relatively inexpensive strategy(BSE) involving physicians as examinersor a referral depot would be cheaper andmore available than mammography and

physician time.(http://jjco.oxfordjournals.org/content/3

2/suppl_1/S52.full.Prevention)

Bugelski (1986) describes learning as the
http://jjco.oxfordjournals.org/content/32/suppl_1/S52.fullhttp://jjco.oxfordjournals.org/content/32/suppl_1/S52.fullhttp://jjco.oxfordjournals.org/content/32/suppl_1/S52.fullhttp://jjco.oxfordjournals.org/content/32/suppl_1/S52.full


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Bugelski (1986) describes learning as the

mental activities by means of whichknowledge and skills, habits, attitudesand ideals are acquired, retained, and

utilized resulting in the progressiveadaptation and modification ofbehaviour.


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It is a process that needs to bestimulated and guided toward desirable

outcomes. (General Psychology 4thEdition Custodiosa A.Sanchez, Paz F.

Abad, Loreto V. Jao)


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CHAPTER III

SUMMARY, FINDINGS,

CONCLUSIONS ANDRECOMMENDATIONS


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This chapter presents the summary,findings, conclusions, and

recommendations of the study. This was

done to provide a concise and clear

presentation of the study.


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SUMMARY

This study aimed to determine theprofile as to the age and civil status of

the respondents in Performing BreastSelf-Examination among 4th Year HighSchool Students in Beatriz D. Durano

Memorial National High School.

Specifically, this study sought to answerthe following questions:


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the following questions:

1. What is the profile of therespondents in terms of

1.1 Age;

1.2 Civil Status?

2. What is the Level of knowledge and


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g

Skills in Performing Breast Self-Examination among 4th Year FemaleHigh School Students?

3. Is there a significant relationshipbetween the Level of Knowledge andSkills in Performing Breast Self-Examination among 4th Year FemaleHigh School Students?


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4. What Health Teaching Program inBreast Self-Examination can beproposed based on the findings of the

study?


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Moreover, this study employed the


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, y p y

descriptive research design todetermine the relationship betweenLevel of Knowledge and Skills inPerforming Breast Self-Examinationamong 4th Year High School Studentsutilizing the researcher-madequestionnaire of Breast Self-

Examination Checklist as the maininstrument for data gathering.


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There were (30) respondents involved inthe study. The study was conducted inBeatriz D. Durano Memorial NationalHigh School, P.G Almendras St. Lapu-

Lapu Suba Danao, City.

Two standardized tools were utilized inthis study.


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this study.

Part I was a 10 items researcher madequestionnaire that determines theLevel of Knowledge in PerformingBreast Self-Examination, whichanswers have corresponding value: 5=Exceptional Understanding; 4= GoodUnderstanding; 3= Moderate

Understanding; 2= BasicUnderstanding; 1= No Understanding.

Part II of the questionnaire is the Breast


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Self-Examination Checklist todetermine the Level of Skills. A 16items checklist, which ratings havecorresponding values 5= Excellent; 4=

Very Good; 3= Good; 2= Fair; 1=Poor. There were no numbers that arecloser to 1 that would indicate that therespondents got scores closer to 5.

FINDINGS


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Among thirty (30) study participants80 percent ages 15-16 whichcomprises 24 study participants, 20percent ages 17-18 which comprises 6study participants, while there werenone for the age range of 19-20. And100 percent or (30) all of the

respondents are single.


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The average mean of Level of Knowledgeis 2.8 and interpreted as Moderate

Understanding, while in the Level of

Skills is 3.61 and interpreted as VeryGood.

The Level of Knowledge and Skillsth


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among the 4th

year Female High SchoolStudents with an obtained r value of0.025 and the critical r value was0.3494, the obtained t value of 0.132

and a critical t value of 2.048 whichmade the researchers to accept thehypothetical statement of null

hypothesis.


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This indicates that the computed valueis less than the tabular value therefore

the researchers accepted the nullhypothesis in which states that there is

no significant relationship between Levelof Knowledge and Skills in Performing

Breast Self-Examination.

CONCLUSIONS

In the findings of the study the


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In the findings of the study, the

researcher here aimed to concludethat:

There is no significant relationship

between Level of Knowledge and Skillsin Performing Breast Self-Examinationamong 4th Year Female High School

Students of Beatriz D. DuranoMemorial National High School.


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Therefore, the students knowledge doesnot affect her skills in performing Breast

Self-Examination.


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This Health Teaching Program in BreastSelf-Examination consists of information

on how to properly perform the BreastSelf-Examination with exact knowledge.


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Further studies recommended by theresearchers to the following:

1. The Level of Knowledge, Skills andPractice in Performing Breast SelfExamination.


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2. The Knowledge, Attitude andPractice in Performing Breast SelfExamination.

3. The Compliance to regimen in

Breast Cancer Patients.


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4. The Effectiveness of Breast Self-Examination in Detecting Early Signs ofBreast Cancer.

5. The Effectiveness of Breast CancerControl Program of the Philippines.


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This research would not have been


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possible without the guidance and thehelp of several individuals who in one

way or another contributed and

extended their valuable assistance in thepreparation and the completion of thisstudy.

First and foremost, to God Almighty,


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who has generously provided knowledgeand heavenly wisdom to the researchersfor further understanding of the

research study and for his guidance and

blessings he showered upon us all. Theresearchers brings back the glory and

honor to our God.

To the loving parents and family, of


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the researchers whose encouragement,supervision, prayers, moral and financialsupport in formulating the study aided

the researchers in the completion of thestudy. Without their support, theresearchers cannot hurdle all the

obstacles and challenges in the making

of this research.

To Mr. Kelly Thomas B. Tadena, RN,


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MAN, adviser of their research study forhis invaluable assistance, comments and

suggestions that helped improve thisresearch and for the motivation andencouragement which enable the

researchers to pursue in making thisresearch.


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To Dr. Herminia O. Fernandez, RN,RM, MAN, Dean College of Nursing forher concerns, comments, suggestions

and for her approval in conducting thisresearch.


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To Dr. Alberto A. Jumao-as Jr., VicePresident for Academics for his

concerns, for the additional knowledge

regarding the research topic andapproval that made this research

possible.


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To Dr. Don Roel G. Arias, panelist, forhis assistance and suggestions which

aided the researchers in the completion

of this study.


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To Mr. Dennis T. Perez, for hisassistance in the statistical treatment

and the completion of this study.


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To Mr. Emardy Barbecho, for thesupport and for helping check the

grammar used in this study.

To the understanding and cooperative


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Level 4 Female High SchoolStudents of Beatriz D. DuranoMemorial National High School, for

their cooperation and honesty inanswering the questionnaire which

serves as the data for the success of thisstudy.


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To their classmates and friends forthe words of encouragement and formaking this research study a helpful

material that could be used for future

endeavours.

Final Nursing Rsrch

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