Amany M. Shebl Professor Of Medical-surgical Nursing Dean. Nursing Faculty,

Impact Of Nursing Management Protocol On Radiotherapy Induced GIT Side Effects (Nausea, Vomiting, And Diarrhea) Amany M. Shebl Professor Of Medical-surgical Nursing Dean. Nursing Faculty, Mansoura University, Egypt

It has been estimated that 50%–60% of patients diagnosed with cancer will receive radiation therapy at some point in their treatment. Side effects of radiation therapy can interfere with patient quality of life and daily functioning. Severe side effects can lead to delays in treatment, potentially affecting the outcome of treatment. Dr.Amany M. Shebl

Health care providers must pay more attention to patient-centered information provision. So, This work is an attempt to move forward to prevent much radiation- induced gastrointestinal morbidity. Dr.Amany M. Shebl

Dr.Amany M. Shebl

Research Hypothesis Decrease incidence and severity of GIT side effect and improve of patients' knowledge after implementation of nursing management protocol on radiotherapy induced GIT side effect. Dr.Amany M. Shebl

Materials & Method Suzan El-saeed Mansour

Materials • Research Design Quasi-experimental research design was utilized in this study. Subjects: A purposive sample of patients who received radiotherapy post cancer, it comprised of 200 adult patients of both males and females who were diagnosed with cancer, and planned to receive radiotherapy.

Settings of the study The study was carried out in the inpatients ward and radiotherapy administration setting (out patients) of the Clinical Oncology and Nuclear Medicine Department at Mansoura University Main Hospital. Suzan El-saeed Mansour

Tools of the study • Tool I: Patient knowledge Structured Interview schedule: This tool included two parts: Part 1: Bio-socio-demographic data and medical data sheet. Part 2: Patient's knowledge related to side effects of radiotherapy. • Tool II: Nausea and vomiting assessment scale: Developed by American Society of Clinical oncology It was used to assess the incidence and the severity of nausea and vomiting in all phases of assessment for both groups Dr.Amany M. Shebl

Tool III: Diarrhea Assessment Scale Developed by American Society of Clinical oncology and adopted by the researchers for assessing the incidence and the severity of diarrhea. Dr.Amany M. Shebl

The field work was performed over a period of eleven months started from September 2010 to July2011. Assessment Phase: The researcher initiated data collection by interviewing each patient of both groups separately for assessing patient's and collect data used the study tools (Tool I , Tool II, and Tool III).The time taken for filling out questionnaire varied between 15-20 minutes and 5 minutes foe each one of the other tools..

Implementation phase: The nursing management protocol was applied for the patients. It included information related to effect of radiotherapy on different body systems and measures to control it. it included measures to apply for patients constituted oral care protocol, progressive relaxation technique, and nutritional modifications to control oral problems, nausea, vomiting, diarrhea and fatigue.

The nursing management protocol was conducted on 4 teaching sessions. Each session was conducted for 5 to10 patients sometimes for each patient individually according to his condition, one session per day; the time allowed varies between 20-30 minutes. All sessions were ended before second phase of assessment (post-test). Suzan El-saeed Mansour

Evaluation phase: tools were applied three times. The first evaluation was done immediately after conducting the teaching sessions of nursing management protocol for the study group (post test). The second evaluation was carried out after 16th session of radiotherapy (follow up I) while the last evaluation was done after 30th session of radiotherapy (follow up II). Suzan El-saeed Mansour

Results 52% of patients in the study group were in the age group of 50 years and over with mean age 46.92±8.64. Forty nine percent of patients in thecontrol group were in the same age group with a mean age (45.53±10.84). Most of study subjects were females. Suzan El-saeed Mansour

Suzan El-saeed Mansour

Regarding pre nursing management protocol, the differences between scores of the study and control groups were not statistically significant in all items of GIT radiotherapy side effects (p>0.05). on the other hand, differences between scores for all items of GIT radiotherapy side effects of the study and control groups post in the follow up1, and 2nd follow were highly statistically significant where (p≤ 0.001**) post protocol of radiotherapy implementation. Dr.Amany M. Shebl

Conclusions • The results of the current study revealed that, both incidence and severity of GIT symptoms were significantly decreased in the study group after implementation of nursing management protocol Dr.Amany M. Shebl

Recommendations • Patients with cancer should be given a written instruction about their radiotherapy and self- management measures to radiotherapy. • Nursing management protocol should be integrated within the plan of care for Patients with cancer going to radiotherapy Dr.Amany M. Shebl

Amany M. Shebl Professor Of Medical-surgical Nursing Dean. Nursing Faculty,