PROFORMA FOR REGISTRATION OF
SUBJECTS FOR DISSERTATION.
“A STUDY TO ASSESS THE EFFECTIVENESS OF SELF
INSTRUCTIONAL MODULE ON THE KNOWLEDGE
REGARDING CORD BLOOD BANKING AMONG STAFF NURSES
IN SELECTED HOSPITAL , TUMKUR.”
Miss. SHANEES E,
IST YEAR M.Sc. NURSING,
SHRIDEVI COLLEGE OF
2009 - 2010.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR
1. NAME OF THE MISS.SHANEES.E,
CANDIDATE AND 1ST YEAR M.Sc. NURSING,
ADDRESS SHRIDEVI COLLEGE OF
2. NAME OF THE SHRIDEVI COLLEGE OF
3. COURSE STUDY AND 1ST YEAR M.Sc. NURSING,
SUBJECT OBSTETRICS AND
4. DATE OF ADMISSION TO 01-06-2009
5. TITLE OF THE STUDY A STUDY TO ASSESS THE
EFFECTIVENESS OF SELF
INSTRUCTIONAL MODULE ON
THE KNOWLEDGE REGARDING
CORD BLOOD BANKING
AMONG STAFF NURSES IN
6. BRIEF RESUME OF INTENDED WORK.
“The only gift is a portion of thyself.” “Be a blood and organ
donor. All it costs is a little love,”
“Donate Cord Blood – You Can Save a Life”
What could be more precious than gifting an unborn child a way to fight
hematopoietic, genetic or immune system diseases for the rest of his or her life? The birth of a
child presents us a very unique opportunity along with the happiness, the occasion delivers us
that we have someone more, very important, to care about. The opportunity is nothing but
something that could be derived from the umbilical cord and placenta – Cord Blood.
The blood that remains in the blood vessels of the placenta and the portion of
the umbilical cord that remains attached to it, after a baby is born and the umbilical cord is cut, is
called cord blood or placental blood. Cord blood banking includes the collection, processing and
storage of umbilical cord blood for any future needs that are related to the family or others.6
During 1970’s researchers discovered that umbilical cord blood could supply
the same kinds of blood forming (hematopoietic) stem cells as a bone marrow donor. And so,
umbilical cord blood began to be collected and stored. The first successful stem cell
transplantation was performed by Gluckman and his colleagues in 1988, when they took
umbilical cord blood from a new born and gave it to a five year old sibling who had Fanconi’s
anemia, a severe type of anemia that causes skeletal defect. They opened a way for the
subsequent development of a blood bank at New York Blood Centre.10
In the last sixteen years, there has been a substantial increase in the use of cord
blood as an alternative stem cell source for the patients who cannot find matched bone marrow
donors. As the use of cord blood transplantation has become a common practice, the number of
cord blood banks continued to be increase in the world. Cord life is considered as the largest
network of stem cell banks.6
The first cord blood repository in India was established by reliance life sciences,
which incorporated in 2001. The first strictly private cord blood bank in India is Life cell and it
is located in Chennai.30
‘Cord life’ launched the most advanced umbilical cord banking technology ,
which has the ability to isolate two cell types that helps in hastening the healing process of
diabetic foot ulcers, on 04-11-09. In India ‘cryosave’ and ‘cryobanks’ were launched in
December 2008 with a view to provide a private cord blood storage program and public blood
donation program. Cryosave is the only company that offers a fully automated dual – storage
Constantly growing attempts are being made to spread awareness of the
phenomenon of umbilical cord blood banking that has created a sensation in the scientific
community. Research on stem cell therapy has shown that advanced stem cell therapy could be
used to treat more than 75 life threatening diseases. Currently research in the use of stem cells to
treat more than 85 diseases such as diabetes, heart attack, stroke, spinal cord injuries etc, is being
undertaken. There has been a completely new wave of research trials involving umbilical stem
research that has swept through the nation.30
Although a relatively new concept, cord blood storage is fast gaining
momentum as a less traumatic alternative to waiting lists, as a way to treat neurological illness,
and as an insurance for the family against a host diseases.
6.1. Need for the Study
“Secure Any Child’s Future Today, Just After a Baby Is Born”
Every mother awaits for this for so long and it finally happens; a new life is
born into the world. This is the day the mother deliver her bundle of joy ,she is most likely to be
overwhelmed with visions of her baby’s first smile, first steps, first birthday party, first holiday
trip and life’s enormous milestones that has to be experienced. Even a single thought in which
her baby becomes seriously ill will probably be the last thing on any mothers mind. To an extent,
there lies a solution to alleviate such problems that occur to a baby even after he or she becomes
After a baby is delivered, the mothers’ body releases the placenta, the temporary
organ that transfers oxygen and nutrients to the baby while in the mothers uterus. Until recently,
in most cases the umbilical cord and placenta were discarded after birth without a second
thought. But during the 1970’s researchers discovered that umbilical cord blood could supply the
same kinds of hematopoietic stem cells as bone marrow donor. And so, umbilical cord blood
banking began by collecting and storing umbilical cord blood.12
In 1998, cord blood registry becomes first family bank and it is accredited by
American Association of Blood Banks. Cord blood registry preserves cord blood stem cells
samples from more than 190,000 newborns throughout the world.25
Today there are over 40 cord blood banks worldwide, both public and private.
The first ever cord blood bank in the world was started in New York’s Milstein National Cord
Blood Centre. It is a public cord blood bank. 1
New York Blood Centre & National Cord Blood Programme U.S.A., conducted
a survey. It is estimated that 7000-8000 unrelated donor cord blood transplants have been
performed worldwide since 1993. In this survey they identified that there were milder graft Vs
host diseases after mismatched cord blood transplantation.30
Recently, more than 300,000 frozen cord blood units have been established in
many parts of the world in order to ensure the safety, efficacy and facilitate cord blood
Pan J et al analyzed the data of 4000 umbilical cord blood units collected in
Shandong cord blood bank, China, from the end of 1999 to March 2001. The averages of
nucleated cells and CD34 cells were more than 1.2*10(9) and 3.9*10(6) per umbilical cord
blood, and more than 1.5*10(9) nucleated cells were obtained in 768 units. This study concluded
that these umbilical cord blood units are suitable for transplantation to patients with a body
weight greater than 40 kg.20
In India, to keep up with other countries, cord life launched the most advanced
cord banking technology in Kolkata and Cryobanks International India launched in Orissa to
expand its network by involving more families in the state for the storage of umbilical cord
blood. Around 300 families have stored umbilical cord blood in cryobank. Cryobank provides a
Private Cord Blood Storage Program and a Public Cord Blood Donation Program. Cryobanks
India has about 20 offices serving Pan India, Sri Lanka, Bangladesh, Nepal, and the Middle
Life Cell is the first private cord blood bank in India, which is located in
Chennai and began its operations in 2004. By April 2006 Rediff India Abroad reported that Life
Cell had 12 collection centers in India and intends to expand into Malaysia and Dubai.30
Jeevan stem cell bank, India’s only public bank for stem cells in the not-for-
profit sector launched in Chennai. 13
Histostem, a South Korean biotech company, plans to establish the world’s
largest cord blood bank in Mumbai. Histostem has an ambitious plan to collect 400,000 units of
cord blood in the next three years.30
As of Jan 2006, Reliance, Histostem, and Life Cell were the only three
companies licensed by the Indian Council of Medical Research, to store cord blood stem cells.30
Rotary-Narayana Tissue Bank and Stem Cell Research Centre were inaugurated
at Narayana health city campus, in order to provide treatment for different clinically recognized
hitherto incurable medical conditions. Such initiations from other organizations are needed to
upgrade our cord blood banking effectively and in a futuristic view.6
A private hospital for women and children at Ulloor in Trivandrum city has set
up a bank that enables parents to store umbilical cord blood, which is a potential source of stem
cells that can help treat genetic disorders.6
In 2006, a study conducted to assess the knowledge regarding cord blood
banking among mothers. This study reveals that only 1/3rd of expectant mothers are aware of
cord blood banking and 84% of patients expect health care providers to answer their questions
regarding cord blood banking.12
Dinc H Et al (2009) conducted a descriptive study to assess the pregnant
women’s knowledge and attitude about stem cells and cord blood banking. The sample size was
334 pregnant women. Data were collected by using interview forms. This study concluded that
the participants had lack of knowledge about cord blood banking and health care professionals
need to offer accurate and scientific counseling services on this subject to the parents.8
Perlow JH, (2007) conducted a study to determine the patient’s knowledge of
umbilical cord blood banking. The total sample size was 425 patients. The method used was
survey. The data were collected by using questionnaire. This study revealed that 37% of patients
had no knowledge regarding umbilical cord blood banking, 2.6% of patients had knowledge and
74% of patients were minimally informed about umbilical cord blood banking only 14% of
patients were educated about umbilical cord blood banking by their nurse, although 90% of
patients expected their obstetrician to answer their questions on umbilical cord blood banking.
This study concluded that patients are poorly informed about umbilical cord blood banking and
they are expecting information from the health care professionals.21
These studies have proved that mothers do not have enough knowledge about
cord blood banking and they expect their health professionals to give adequate information
regarding cord blood banking .therefore it’s a necessity to teach the nurses about cord blood
During the period while the investigator worked as a clinical instructor, she
observed that staff nurses and student nurses had very little knowledge regarding the concept of
cord blood banking and the advanced researches done in this program. As a post graduate
student, the researcher feels that extensive program should be conducted to improve the
knowledge regarding cord blood banking to the staff nurses, allied health personals and the
6.2. REVIEW OF LITERATURE
Kaimal A. J et al (2009) conducted a study to investigate the cost effectiveness
of private umbilical cord blood banking. The method used was decision analytical model. This
study reveals that private cord blood banking is not cost effective because it cost an additional
amount. In sensitivity analysis it reveals that if the cost of blood banking is less than $262,
private cord blood banking becomes cost effective. This study concluded that private umbilical
cord blood banking is cost effective only for children with a very likelihood of needing a stem
Lopez M et al. (2009) conducted a prospective study to analyze the umbilical
cord blood characteristics of umbilical cord blood units from preterm deliveries and compare
them to full term deliveries. A comparative study was conducted between preterm deliveries and
full term deliveries. The sample size was 194 patients. The study concluded that umbilical cord
blood from preterm deliveries contain higher CD34 cell content than umbilical cord blood units
from full term deliveries.19
Hassal O et al (2007) conducted a study to evaluate the attitude of women
towards cord blood donation and transfusion. Data were collected from 180 women who were
attended the maternity clinic in Mombasa, by using questionnaire. In this study, the donation and
transfusion of cord blood were acceptable to 81% and 78% of women, respectively. This study
concluded that the donation of umbilical cord blood and its transfusion are acceptable to the
majority of women.11
Albano M S et al. (2006) conducted a study with the aim to determine whether
human genomic DNA is also present in cord blood plasma in quality and quantity able to support
human genetic identification in New York Blood Centre. The method used was short tandem
repeat analysis. The study demonstrates that infant derived EC-DNA is present in cord blood
plasma and provides a useful tool for the unambiguous confirmation of plasma aliquote identity.1
Solves P et al (2006) conducted a study to evaluate the benefits and
disadvantages between the two different cord blood collection strategies, i.e., before and after
placental delivery, in caesarean deliveries. The method used was retrospective analytical
approach. The data of cord blood units collected from 253 caesarean deliveries for a 3 year
period. This study reveals that there was no significant difference between these two methods
and this study concluded that both methods produce comparable total nucleated cells &CD34
counts of cord blood units collected from caesarean section.
Aufderhaar U et al. (2003) conducted a study to determine whether
intrapartum factors have an influence on the hematopoietic cell compartment of cord blood. Cord
blood samples were obtained from 102 normal full term deliveries for the banking of stem cells.
The method used was analytical method. This study concluded that some intrapartum factors
such as higher birth weight, larger blood volume, lower arterial PH, have an impact on the
characteristics of collected cord blood cells. This knowledge may facilitate the selection of
optimal cord blood samples for unrelated banking and early discarding of suboptimal cord blood
samples thus resulting in the saving of costs.3
Danzer E et al. (2003) conducted a prospective study to evaluate the attitude of
mothers towards unrelated donation of umbilical cord blood for transplantation six months after
giving birth in the university hospital of Basel. The data were collected by using questionnaire
from 131 women. In this study 96.1% of the mothers stated that they would donate umbilical
cord blood again, and all respondents were certain that their decision to have donated umbilical
cord blood was ethical. This study shows a high degree of satisfaction of unrelated umbilical
cord blood donation for banking in women six months after delivery.7
Fernandez C. V et al (2003) conducted a study to examine the pregnant
women’s knowledge and attitude regarding cord blood banking. The study was conducted among
650 women attending antenatal clinic at regional women’s hospital. Data were collected by using
questionnaire. In this study about 68% of women were responded. In this more than half of the
women reported poor knowledge about cord blood banking. This study concluded that many of
the respondents wanted to receive information about cord blood banking from health care
professionals and most of the women supported the donation of cord blood to the public cord
blood bank for potential transplantation and research.9
Surbek D .V et al (1998) conducted a prospective study to evaluate the
knowledge of the possible medical use of cord blood and acceptance of cord blood banking
among pregnant women at the University of Basel Women’s Hospital pregnancy OP clinic. The
data were collected by using questionnaire from 300 pregnant women. In this study 95% of
women supported the idea of cord blood banking and from this 93% of women stated that they
would agree to donate cord blood from their own child. This study shows the high acceptance of
umbilical cord blood donation for banking and stem cell transplantation.28
Barton-burke. M, an author of a textbook ‘Cancer Chemotherapy -a nursing
process approach’ has explained that, umbilical cord blood is rich in hematopoietic stem cells
and can be used successfully for engraftment. The author has also described about the various
advantages like umbilical cord stem cells are superior to bone marrow or peripheral blood stem
cells in terms of proliferative potential and umbilical stem cells are likely to cause Graft Versus
Host Disease. Now a days, individuals have been transplanted successfully with cord blood stem
STATEMENT OF THE PROBLEM
“A STUDY TO ASSESS THE EFFECTIVENESS OF SELF
INSTRUCTIONAL MODULE ON THE KNOWLEDGE REGARDING CORD BLOOD
BANKING AMONG STAFF NURSES IN SELECTED HOSPITALS, TUMKUR .
6.3. OBJECTIVES OF THE STUDY
1. To assess the preexisting knowledge regarding cord blood banking among the staff nurses.
2. To prepare and distribute self instructional module.
3. To determine the effectiveness of self instructional module on cord blood banking among staff
nurses in terms of gain in knowledge score.
4. To find out the association between the knowledge score of staff nurses with selected
6.4. OPERATIONAL DEFINITIONS
1. ASSESSMENT : It refers to the organized systematic process of
collecting information about pretest and post test knowledge from staff nurses regarding cord
2. EFFECTIVENESS : It refers to the extent to which the self instructional
module on cord blood banking achieves desired effect in improving the knowledge of staff
nurses as evidence from gain in knowledge score.
3. SELF INSTRUCTIONAL MODULE : It refers to the written material designed for staff
nurses in order to provide information regarding cord blood banking.
4. KNOWLEDGE : It is the staff nurses cognitive ability to interpret
the information regarding cord blood banking and to answer the questions regarding it
reasonably and correctly.
5. CORD BLOOD BANKING : It is the process of collecting, processing, and
storing the baby’s umbilical cord blood for family’s future medical need.
6. STAFF NURSE : A staff nurse is a person who is prepared in the
scientific basis of nursing and who has completed the general nursing and midwifery course
or bachelor of science in nursing and meets certain prescribed standards by getting registered
in the state nursing council and Indian nursing council and is practicing in the clinical aspect
of nursing to provide services that is essential for the promotion, maintenance, and
restoration of health.
6.5. RESEARCH HYPOTHESIS
H1: The mean post test knowledge score on cord blood banking among
the staff nurses, who have learned through self instructional module, will
be significantly higher than their mean pretest score at 0.05 level of
H2: There will be a statistically significant association between
knowledge score regarding cord blood banking and the demographic
variables among the staff nurses.
The staff nurses working in selected hospital may not have adequate knowledge regarding
cord blood banking.
Nurses have potential to learn about cord blood banking.
SIM will improve the knowledge level of staff nurses regarding cord blood banking and will
help to gain necessary knowledge in implementing the practice in various health care
6.7. DELIMITATIONS OF THE STUDY
The study is delimited to only staff nurses who have completed general nursing and
midwifery & BSc nursing course.
The study is delimited to staff nurses who are working in selected hospitals, tumkur.
The study delimited to the staff nurses who are not attended the continuing nursing education
program regarding cord blood banking.
Variables are an attribute of a person or objects that varies, that takes different
Independent variable : self instructional module on cord blood
Dependent variable : knowledge level of staff nursesregarding
cord blood banking.
6.9. PILOT STUDY
The pilot study will be conducted on 5 samples. The purpose of pilot study is to find out the
feasibility of conducting study and design on plan of statistical analysis. This also will help to
assess the practicability of carrying out the main study. The findings of the pilot study samples
will not be included in main study.
7. MATERIALS AND METHODS
7.1. SOURCE OF DATA
The data will be collected from staff nurses working in selected hospital,
7.1.2. RESEARCH DESIGN
The research design selected for this study is one group pretest –post test design
which is a sub type of pre experimental design.
7.1.3. RESEARCH APPROACH
An evaluative approach is considered appropriate for this study .
7.1.4. RESEARCH SETTING
The study will be conducted in selected hospitals, Tumkur.
The population of the study will be
Staff nurses who have passed G.N.M. or B.Sc. nursing course from a
recognized school of nursing and working in selected hospitals , Tumkur,
with state board registration.
7.2. METHODS OF DATA COLLECTION
The data collection procedure will be carried out for a period of three months.
The study will be initiated only after obtaining permission from concerned
The data will be collected from the staff nurses by using structured
questionnaire to assess the preexisting knowledge regarding cord blood banking. After
distributing the self instructional module, the data will be collected 7 days later from the
staff nurses by using structured questionnaire to assess the improvement in the
7.2.1. SAMPLING PROCEDURE
Non probability convenient sampling will be used to select the sample.
7.2.2. SAMPLING SIZE
The total study sample consists of 50 staff nurses in selected hospitals, Tumkur.
7.2.3. INCLUSIVE CRITERIA
Nurses who have passed general nursing and B.Sc. nursing course, who are
working in selected hospitals at Tumkur.
Nurses who are available during the period of data collection.
Both male and female nurses are included in the study.
7.2.4. EXCLUSIVE CRITERIA
Nurses who are not willing to participate in the study.
Nurses who have undergone ANM course.
Nurses who have completed post graduate course in nursing.
7.2.5. TOOLS FOR DATA COLLECTION
The structured questionnaire is used to collect the data from the staff nurses.
Content validity will be established by requesting the experts to go through the developed
tool and give their valuable suggestions.
The structured questionnaire should consists of the following sections.
SECTION–A : Questions that are included to collect demographic data .
SECTION–B : Questions that are formulated to assess the preexisting
knowledge regarding cord blood banking and the knowledge after giving
self instructional module.
7.2.6. DATA ANALYSIS METHOD
The data collected will be organized, tabulated and analyzed by using
descriptive and inferential statistics. The data will be planned to present in the form of
tables and figures.
DESCRIPTIVE STATISTICS: Frequency and percentage for analysis of demographic
data and mean percentage and standard deviation will be used for assessing the level of
INFERENTIAL STATISTICS: Chi – square test will be used to find out the association
between knowledge and selected demographic variables.
7.2.7. TIME AND DURATION
The time and duration of the study will be limited to three months or as per the
guidelines of university.
7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION OR
INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER
HUMANS OR ANIMALS? IF SO , PLEASE DESCRIBE BRIEFLY.
Yes, SIM is the intervention that is going to be given to the staff nurses.
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR
The pilot study and the main study will be conducted after the approval of the
research committee. Permission will be obtained from the concerned head of the
institution. The purpose and details of the study will be explained to the study subjects
and an informed consent will be obtained from them. Assurance will be given to the
study subjects regarding the confidentiality and anonymity of the data collected from
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blood banking for sample identification, Transfusion; 2009 April 17.
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2. Armson B A, umbilical cord blood banking: implication for perinatal care
providers, Journal Of Obstetrics and Gynecology Canada;2005July;
27(7):673; www.ncbi.nlm.nih.gov/pub med/ 15943003
3. Aufderhaar U the impact of intra partum factors on umbilical cord blood
stem cell banking; 2003; 31(4):317-22; www.ncbi.nlm.nih.gov/pub
4. Barton - Burke M , " Cancer chemotherapy- a nursing process approach ",
3rd edition , Jones and barlet publishers , Boston , 2001, P 49
5. City gets new cord blood banking, www.hinduonnet.com, 2009/03/19,
6. Cryo banks India.www.cryobanksindia.com/what_are_stem_cells.
7. Danzer E, attitude of Swiss mothers towards unrelated umbilical cord blood
banking six months after donation; Transfusion; 2003 May; 43(5): 604-8;
8. Dinc H, pregnant women’s knowledge and attitudes about stem cells and cord
blood banking;International Nursing Review;2009 June ; 56(2):250-6,
www.ncbi.nlm.nih.gov/pub med /19646176.
9. Fernandez C V, knowledge and attitude of pregnant women with regard to
collection, testing, and banking of cord blood stem cells; Canadian Medical
Association Journal; 2003 March 18 ; 168(6): 695-8;
10. Gluck man F, peripheral stem cell in bone marrow transplantation, cord blood
stem cell transplantation; Baillieres Best Practice and Research Clinical
Haematology; 1999 March-June;12(1-2):279-92; www.ncbi.nlm.nih.gov/pub
11. Hassal, the acceptability to women in Mombasa, Kenya, of the donation
and transfusion of umbilical cord blood for severe anemia in young
children, www.ncbi.nlm.nih.gov/pub med/2607521..
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2, Elseveir, New Delhi, 2418.
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of India; 2005;outcomes among 562 recipients of Nov / Dec; volume 55;
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Nursing Times 2008; May ; 24-26.
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deliveries; Gynecological and Obstetrical Investigations; 2009;68(3):181-5,
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23. Ram Sharan Mehta, Oncology Nursing, Jaypee Publication, 160.
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E pub 2009 Aug 6
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9. Signature of the candidate.
10. Remarks of the guide.
11. Name and designation of (in block letters )
11.1. Guide Prof. DANASU, M.Sc. (N), M.Phil
HOD, OBSTETRICS AND
SHRIDEVI COLLEGE OF
11.3. Co-guide (if any)
11.5. Head of the department. Prof. DANASU, M.Sc. (N), M.Phil
HOD, OBSTETRICS AND
SHRIDEVI COLLEGE OF
12. 12.1. Remarks of the chairman and principal.