Impact Of Teenage Pregnancy On Various Physical And Psychological Parameters

Background

Cancer is one of the main causes for the prevalence of morbidity and mortality throughout the world. It was estimated that each year nine million people get diagnosed with cancer, out of which five million people die of this disease (Sanson-Fisher et al. 2000, p. 226-237Colorectal cancer is one of the most common causes of death due to cancer (Cameron & Waterworth 2014, p. 218-24). Every year one million people are affected with colorectal cancer and among them 50,000 deaths occur each year (Deng et al. 2013, p. 445-53). For the treatment of cancer chemotherapy is mostly used with other forms of treatment options like radiotherapy and surgery thus, helping to increase the survival rate of cancer patients (Australian Government Cancer Australia, 2012).  Though the main aims of treatment are to extend the life of patient and decrease the death rate, it is very hard to ignore its side effects. This causes a huge problem to both patient and family members (Taylor, Richardson & Cowley 2011, p. 243-249). Apart from the physical symptoms, patients also have to face other psychological and social symptoms (Australian Government Cancer Australia, 2012). Siminoff, Thomson & Dumenci (2014, p. 981-988 in his study analyze the relationship between the patient symptoms with cognitive barrier whereas Cameron & Waterworth (2014, p. 218-24), explored the relation of communication with the sense of life of quality living of patient. Assessing these factors help to plan for the future care and heightened patient’s satisfaction level (Tasuya et al.1999, p.338-346) The use of chemotherapy treatment with key coping strategy had been able to help for patient living with colorectal cancer to live for extended period of time (Cameron & Waterworth 2014, p. 218-24).

Significance of the study

A review of literature enables the researcher in assessing and analyzing the depth and breadth of available information that are required for the research concerning the research problem. While reviewing the literature on the topic related to colorectal cancer patients, it came to known that the studies of such patients is limited only in the areas of symptomatic condition, medical trials, pain management, prognosis, quality of life and care. Limited research had been done to study contributing factors for patient’s satisfaction during chemotherapy. Though different factors contribute to the individual quality of life and patient’s satisfaction level, the importance of quality of nursing care in patient satisfaction cannot be ignored. The descriptive study done by Salin, Kounonen & Aalto(2012, p.592-597), showed that there is a patient’s satisfaction is related with the care provided by the health care settings.

Hence, this study will be beneficial for all health practitioners to explore the factor affecting the patient experience regarding the quality of care provided during chemotherapy. .  It will provide the chance to study important information regarding the need of cancer patient undergoing treatment.  It would be useful in future in caring of cancer patients. The result of the study findings will also help the health professionals to include different aspects of patient care while caring patient who are undergoing chemotherapy. Apart from that it can be a relevant reference to bring change in Australian health care policies and strategies regarding nursing care for people suffering with colorectal cancer undergoing chemotherapy treatment.

Aim and specific objectives

According to Polit & Beck, the aim and objective of the study illustrate the cause of doing the research. It is the central controlling idea for the whole study. To achieve the objectives of the research and to address the problem of the research qualitative research was used. According to (Polit & Beck 2004, p. 16), qualitative research lends itself to investigating process through analysis and understanding of the factual conversation and truthful reporting. 

The specific objective of this study is to explore the contributing factors that are affecting the patient satisfaction and care, during chemotherapy. This study explores the patient experience regarding the quality of care provided during chemotherapy. It also aims to find out the patient satisfaction undergoing treatment.

Research question

By analyzing the related answers to the subjective question one can know about the experience related to it through research question (Polit & Beck 2014, p.118). It shows that the research question is designed to address the answer and idea of the whole result of the study. Polit and Beck (2008, p. 105), describe research question as the statement of purpose which direct the researcher to collect the relevant data in the study by clarifying the research study. The question for this research study can be stated as follow

What are the contributing factors that affect the patient’s satisfaction during care of colorectal cancer patient undergoing chemotherapy?

Selection, Sampling and recruitment of the participants

The study was done by using purposive sampling technique to gather the information from patient living with colorectal cancer. This technique is a judgmental, selective and subjective sampling technique. The participants were chosen with this technique to enable most in answering the research question. Such technique is preferred to enable researcher in qualitative studies (Polit & Beck 2014, p. 285).

Polit and Beck (2004, p. 290) define population as the whole collection of cases that meet the designated criteria as designed by the research and target population as the population which is formed by the generalization of the researcher. Polit and Beck (2008, p.391) had explained ‘population’ as ‘the whole group of interest’ and ‘sample’ as ‘the subset of a population selected to participate in the study.’ For the purpose of the study the target populations were those cancer patients who are suffering from colorectal cancer and undergoing chemotherapy in any hospital or in out- patient department.

For the purpose of the study, the sample size was chosen one hundred patients suffering from colorectal cancer and undergoing chemotherapy.

Polit and Beck (2004, p.290) defined eligibility criteria as the preset and defined criteria that possess the specific the characteristics in the population that fits into the need of the study. The inclusion criteria comprises of patient living with colorectal cancer with the aged group above five year of age  and who are undergoing treatment of chemotherapy for at least more than two months. The exclusion criteria composed of the patient suffering from cancer other than colorectal cancer and who are less than five years of age. Those patients who have been under chemotherapy treatment for less than two months of duration were not included in the study.

Ethical consideration

According to the National Health and Medical Research Council (NHMRC, 20014), National Health and Research Council, Australian Research Council and Universities of Australia are the responsible bodies that are concerned to assess the issues and ethical issues regarding the study. They are responsible to study and assess all the research study involving the human rights and participation.

The ethical principles of research such as, principle of beneficence, equality, and respect for research participants, dignity, and justice were considered while doing the research. The Research ethics has been defined as the process in which the moral values are set concerning the participants of the research. It is the systematic procedure to study and assess the participants involved in the research which is all based upon the legal, professional and sociological rules and principles Polit and Beck (2014, p. 380). It is important to comply with the all ethical aspects of the research to protect the right and dignity of the participants involved in the study. The ethical issues can arise if the right of the study participants does not met with the study objective ( Polit and Beck 2014, p. 380).

According to Polit & Beck (2014, p. 88), informed consent is the process in which information regarding study is provided to the individual involved in the study to ensure that the participant get acquainted with the aim of the study. Thus it ensures voluntary interest and safety of the research participants. Confidentiality and Anonymity will be maintained throughout the research process while taking information. Anonymity is maintained in the research when the researcher cannot show any link or relationship with the information of the participants. Confidentiality occur when identities of the individuals involved in the research is protected and is not linked with any information with anyone (Polit & Beck 2004, p.712)

In this research study, ethical guidance will be complied as per the ethical rules, code and guidelines of University of Wollongong. The consent form and information will be made available to the participants regarding study and will used as a tool to inform participants of the study about the facts and information regarding the research. The consent will be taken through verbal and written means to ensure privacy and confidentially of the participants and to protect the right of respondent during the study. The participants involved in the study will be assured that the information received from them will be made confidential and will not be used in any other purpose other than for the research purpose. The consent form and required information sheets will be distributed to the patient undergoing chemotherapy with colorectal cancer after the approval from the University of Wollongong. The permission will be taken from university of Wollongong, Human Resource Ethics Committee, hospital administration and participants themselves to carry out the research. Required information and data will be collected through interview using questionnaire during the hospital visit.

Proposed research approach/design, philosophy

According to Polit & Beck (2004, p. 50), descriptive design is the design used in the research because of its high degree of representativeness and the ease of collecting participants’ opinion and experience by researcher. Descriptive study design helps to study the day to day experience and opinion of the event. For the purpose of the study, descriptive qualitative study design will be used. This will helps to find out the contributing factors associated with the breast cancer patients during chemotherapy. Apart from that it also aims to find out the relationship of contributing factors in relation to patient satisfaction level who are undergoing chemotherapy.

Research instrument

A research instrument is defined as the tool which is used in research to collect the required information for the study. In the research the researcher is responsible to encourage and involve them in questioning and answering process. They are allowed to answer without any burden and time constraints (Polit &Beck 2014, p. 292). He defined questionnaire as an instrument of gathering required information from respondents through self report and through self administration of formatted pattern of questions (Polit &Beck 2014, p. 292).

For the purpose of gathering the information from patient, a semi-structured questionnaire will be used as a research tools. Questionnaire will address different aspects of patient’s experience regarding chemotherapy and nursing care. Questionnaire will consist of both structured and open ended questions and face to face interview technique will be used to gather the required information from the participants regarding their experience, demographic component, events, chemotherapy regime and nursing care provided. The study will also tries to dig out to search the contributing factors that are hindering the optimal level of satisfaction among colorectal cancer patient during chemotherapy. The problems and questions regarding the research will be made answerable by the researcher. Since interview techniques are used researcher is responsible to guide the questionnaire but the whole process depends on the respondent themselves. The sole power of the research conclusion depend on the response of the respondent

Analysis

Data analysis is defined as the systematization and synthesis of required data collected during the research (Polit & Beck 2004, p.716). Since the research methodology was descriptive type, descriptive statistics will be used to calculate the data. Such statistics used in descriptive research will helps to summarize the qualitative date from evidence (Polit & Beck 2004, p.716). To reduce and summarize the data, the recorded data will be transcribed and analyzed well to gather the required information needed in the research. Lambert and Lambert (2012, p. 255), explained category grouping as the interactive process in which the sections are created nearly as much as similar to the response of the respondent. To enhance the data management, the response from the respondent will be categorized into sections like physical factors, psychological factors, social factors, care provision, quality of services. Such categorized data will be analyzed carefully and coded according to the response of the participants. Those coded data will be analyzed routinely. After collecting the data, reviewing and reorganizing by category grouping, summary and abstraction will be drawn to study the different aspects of the study. The collected and analyzed date will be thus presented to the research experts, professors, research department and committee of university for their approval and guidance.

Research Issues associated with the research approach 

Reliability is defined as the instrument that measures the accuracy of the data collection. If the measurement reflect the true score under the investigation, an instrument can be said reliable (Polit & Beck 2004 ,p.416).  In this study, the instrument will be submitted to university to test for reliability after completing the collection of data.

Validity is defined as the extent of measurement of the instrument, the degree to which it is supposed to measure (Polit & Beck 2004, p.422). In the study, the questionnaire will be assessed beforehand, prior to data collection and will be pretested to maintain its validity. Validity is important factor which determining the quality of research (Polit & Beck 2004, p.422).  Pretesting will be carried out in the some other health care settings with patients with colorectal cancer undergoing chemotherapy which will be similar to research population. To enhance validity, while collecting information, the interview will be recorded and will be transcribed.  According to Elliott and Timulak (2005, p.152), auditing, checking, recording and well organization of data is essential to maintain the quality of the research.  During data collection, it will be assured that adequate and required data get collected that are necessary to meet the need of the research. To ensure that the collected get analyzed well experts from the university will be advised to analyze and debrief the collected the data.

Conclusion

In conclusion, the research study thus conducted will provide an opportunity to collect the required information regarding the contributing factors affecting patient’s satisfaction in colorectal cancer undergoing chemotherapy. It will explore the different aspects of areas that are affecting patient’s experience and choice regarding care and practice. Apart from that it will also tries to find out the factors that are impacting the nursing care for cancer patients. In the study, the target population will be patient with the aged group above five years of age, who are suffering from colorectal cancer and are undergoing chemotherapy session in hospital or in outpatient department. The study will use purposive sampling technique to collect the necessary information required for the study. The sample size will be one hundred patients of Australia. For the purpose of gathering the information from patient, a semi-structured questionnaire will be used as a research tools. During research, ethical consideration will be adhered through participant respond sheet, consent form, and verbal consent. Validity and reliability will be maintained throughout the research. Confidentiality and anonymity of the respondent will be ensured. The collected data will be reviewed timely and analysis will be done with categorical process.

Background

Teenage pregnancy is defined as the condition of conception in human females under the age of twenty years. Pregnancy can be developed during the onset of puberty before the first menstrual cycle. However normal pregnancy occurs usually after the onset of the first menstrual cycle. Pregnant teenagers are exposed to various physical, physiological and psychological health hazards like other women. Moreover, these individuals are exposed to additional medical and psychological challenges that increase the incidences of mortality and morbidity in them (Yadav et al, 2000) (Moffit, 2002). 

The medical concerns become more evident when conception or pregnancy is established before the age of fifteen years. The well-studied risk involves the chances of increased anemia, lower birth weight and premature labor and eclampsia. It has been observed that in developed countries, teenage pregnancies are associated with social stigma and low economic issues due to early drop out from higher education. This becomes more pronounced if such pregnancy develops, without the act of marriage (Yadav et al, 2000) (Moffit, 2002).  

Adolescence marks the transition from nourishing stage to the stage of being grown up, in the life of an individual-namely nourishing transition. The World Health Organization (WHO) defines adolescence as a progression from the appearance of secondary sex characters to the stage of reproductive maturity which involves the development of mental processes and adult identity and transition from socio-economic dependence. Pregnancy in the adolescent period, whether in developed or developing countries, pose significant challenges on the physiological and psychological health of the affected individual (WHO, 1998). 

Malnourishment and sexually transmitted diseases are more pronounced in the adolescents of developing countries along with the earlier medical challenges. Although various studies have reported such conditions on physical, physiological and psychological variables, no studies have introspected the issue of psychological health (for example depression) and also the impact of physiological parameters on psychological health status (Yadav et al, 2000) (Moffit, 2002)