UNIVERSITY OF GHANA, LEGON DEPARTMENT OF PSYCHOLOGY MAIN CAMPUS. RESEARCH WORK TITLE OF STUDY ATTITUDE OF NURSES IN GOVERNMENT HEALTH INSTITUTIONS TOWARDS SICKLE CELL PERSONS PRESENTED BY : FRANCIS KOFI SOMUAH INDEX NUMBER : 10227103 SUPERVISOR : MRS. ANGELA ANARFI GYASI-GYAMERAH A DISSERTATION SUBMITTED TO THE DEPARTMENT OF PSYCHOLOGY, UNIVERSITY OF GHANA, LEGON, IN PARTIAL FULFILMENT OF THE 1
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Attitude of Nurses in Government Health Institutions Towards Sickle Cell Persons
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UNIVERSITY OF GHANA, LEGON
DEPARTMENT OF PSYCHOLOGY
MAIN CAMPUS.
RESEARCH WORK
TITLE OF STUDY
ATTITUDE OF NURSES IN GOVERNMENT HEALTH INSTITUTIONS TOWARDS
SICKLE CELL PERSONS
PRESENTED BY : FRANCIS KOFI SOMUAH
INDEX NUMBER : 10227103
SUPERVISOR : MRS. ANGELA ANARFI GYASI-GYAMERAH
A DISSERTATION SUBMITTED TO THE DEPARTMENT OF PSYCHOLOGY, UNIVERSITY OF GHANA, LEGON, IN PARTIAL FULFILMENT OF THE
REQUIREMENTS FOR THE AWARD OF THE BACHELOR OF ART DEGREE IN PSYCHOLOGY.
MAY, 2010
1
DECLARATION
I, Somuah Francis Kofi, hereby affirm that this work is my own unique work and has not
been submitted to any university in order to acquire an academic qualification.
Mrs. Angela Anarfi Gyasi-Gyamerah
(Supervisor)
Signature:……………………………………..
Date:………………………………………….
Somuah Francis Kofi
(Student)
Signature:……………………………………
Date:………………………………………...
2
DEDICATION
This work is dedicated to all Sickle Cell Persons
3
ACKNOWLEDGEMENT
It is amazing to me when I realize that I have made it to the point where I must thank all of
the individuals who have supported me to help me get to where I am. I would like to begin by
thanking the woman, who have truly believed that I chose the correct path for myself and
have encouraged me through it all, my project supervisor Mrs. Angela Anarfi Gyasi-
Gyamerah.
Thank you to Mrs. Doris Boadi of the Sickle cell unit at the Tema General Hospital, who
provided a superb example of enthusiasm even through the frustrating moments. Of course I
would like to also thank everyone who has helped to make this research a success through
their advising, participation and support; Roland Brown of Sickle Aid Ghana, the fabulous
management and staff of the Sickle Cell unit of the Tema General Hospital.
Without my family and friends behind me when I pushed myself too hard, this would have
been a very difficult journey. I would like to thank my parents Mr. Jacob Kofi Kissi Somuah
and Mrs. Dora Gyamfuah Somuah and my siblings Kesse, Osei and Kissiwaa. I would also
like to send my support and thanks to my coursemates who have made it all bearable as well
as my friends especially Anna, Comfort, Emelia, Esther, Fati, Bolaji who remind me that
there is more to life than work. This has been an exciting time and it is unreal that the time
has come for another journey. I will not step onto the next path without reminders of all the
steps I have already taken.
To the almighty God, I give you all.
4
ABSTRACT
This survey was conducted to determine the level of knowledge about Sickle cell Disease
(SCD) and the attitude towards sickle cell persons among nurses in local government health
institutions in Ghana. Thirty four nurses, comprising thirty-two females and two males were
randomly selected from the Tema General Hospital to fill a thirty-one item questionnaire to
measure their attitude toward Sickle cell persons and asses their level of knowledge about the
Sickle Cell Disease. The Chi square test was used to test for all four hypotheses. All four
hypotheses were rejected. Findings from the research showed that nurses have positive
attitude towards sickle cell persons as well as a good knowledge about the SCD.
5
TABLE OF CONTENTS PAGES
Declaration………………………………………………………………..i
Dedication………………………………………………………………..ii
Acknowledgement……………………………………………………….iii
Abstract…………………………………………………………………..iv
Table of contents…………………………………………………………v-vi
CHAPTER ONE - INTRODUCTION...................................................1-5
Statement of the problem
Aims and objectives
Relevance of the study
CHAPTER TWO - LITERATURE REVIEW………………………6-10
Theoretical framework
Related studies
Hypotheses
Operational definition
CHAPTER THREE - METHODOLOGY………………………….11-13
Research setting
Population /sample
Sampling techniques
Instruments
Scoring
Research design
Procedure for data collection
Data analysis
CHAPTER FOUR……………………………………………….14-33
6
Results
CHAPTER FIVE - DISCUSSION……………………………...34-39
Attitude of nurses with relatives with Sickle Cell Disease
Academic qualification and level of knowledge about the Sickle Cell Disease
Gender and attitude towards Sickle cell persons
Age and level of knowledge about Sickle Cell Disease
Summary
Conclusion
Implication of the finding
Limitation of the study
Suggestions and recommendations for further studies
REFERENCES…………………………………………………40-41
Appendix………………………………………………………..42-58
7
CHAPTER ONE
INTRODUCTION
Of all genetic disorders to which man is known to be liable, there is probably no other that
presents a collection of problems and challenges quite comparable to Sickle Cell Disease
(SCD) and related disorders, because of its extensive distribution, problem created by its
chronicity, and its resistance to therapy. It is a genetic abnormality whose control and cure
still elude clinicians, research workers, and social scientists. Despite major advances in our
understanding of the molecular pathology, pathophysiology, control and management of the
inherited disorders of the haemoglobin, thousands of infants and children with these diseases
are dying through lack of appropriate medical care (Feroze and Aravidan, 2001).
SCD is a term used for a group of conditions in which the pathology is due to the presence of
haemoglobin S. Sickle cell anemia, or homozygous SCD, results from the inheritance of a
sickle cell gene from both parents. Other genotypes of SCD result from the inheritance of
one haemoglobin S and another abnormal haemoglobin such as C, causing SC disease, or a
thalassemia gene causing Sß+ or Sß0 thalassemia. SCD is characterized by continuous red
blood cell hemolysis usually resulting in anemia. This varies from patient to patient from
inconsequential to severe; causing the variable presentation of painful vaso-occlusive crises;
the potential for serious infections in childhood; and acute complications involving any of the
major organ systems, with progressive, irreversible organ damage. In sickle cell trait (the
carrier state) there is always more normal (A) haemoglobin than S haemoglobin. Patients
with sickle cell trait do not have symptoms from their sickle haemoglobin except under
extraordinary conditions (Harris, 2002).
8
'Sickle Cell Anaemia' is also sickle cell disease ('SS Phenotype'). The reason why it is called
sickle cell anaemia is because anaemia (low haemoglobin level) is the most obvious feature
of the SS phenotype. Other haemoglobin genes can combine with sickle haemoglobin to
cause sickle cell disease of varying degrees of severity, namely Haemoglobins D, E, G, K, O,
Korle-Bu, Osu-Christiansborg, etc. Beta-Thalassaemia is not an abnormal haemoglobin gene
(it is a gene for producing an insufficient amount of Normal haemoglobin), nor is Foetal
Haemoglobin (which is Normal Haemoglobin for the baby in the womb, but which should
disappear in adulthood). If Foetal Haemoglobin persists into adulthood it is known as
Hereditary Persistence of Fetal Haemoglobin (HPFH) which can combine with sickle
haemoglobin gene to cause disease. Similarly, a beta-thalassaemia gene can combine with
Haemoglobin S to cause illness. So the sickle cell diseases can include the phenotypes SS
(sickle cell anaemia), SC, SD, SE, SG, SK, SO, S Korle-Bu, S Osu-Christiansborg, SBeta-
Thalassaemia, SFhereditary, etc. (www.sicklecell.md/faq)
The sickled cells in a person with SCD have a hard time moving through the blood vessels in
the body (Druggin, 2006).
The scientific discovery of the disease was in 1910 when a Chicago Physician, Dr. James
Herrick, came into contact with a Grenadan dental student with severe anaemia and yellow
eyes (jaundice). He examined his blood under the microscope and saw sickle-shaped red cells
and immediately published his findings and called the disease sickle cell anaemia.
4. Do you personally know someone who is suffering from Sickle cell disease?
(1) Yes (2) No
5. If Yes, then indicate by circling in any of the boxes below, the exact relationship that exist between you and the sickle cell patient.
(1) Brother (2) Sister (3) Mother (4) Father (5) Son/ daughter (6) Friend (7) other
(please specify)…………………………………
Corresponding to each statement below is a numerical session that denotes the word/phrase that range from “strongly agree” to “strongly disagree”. Tick appropriately the number that most reflect the extent to which you agree or disagree with each statement in sections B, C and D.
SECTION B – (AFFECTION) (FEELINGS AND EMOTIONS TOWARDS SICKLE CELL PERSONS)
Statement Strongly Agree
Agree Undecided Disagree Strongly Disagree
1 2 3 4 5
1. Sickle cell persons should be treated like any other person
2. Sickle cell persons should be kept behind closed doors
3. Sickle cell persons should be treated in a separate hospital
4. Sickle cell persons should be allowed to mingle with others
5. I will feel bad if a sickle cell person dies in my hand
6. I will feel reluctant to administer treatment to sickle cell persons
49
7. I will prioritise treatment to sickle cell persons than other patients
8. I will manage sickle cell pain with dedication
9. Sickle cell persons are worthless
SECTION C – (BEHAVIOUR)(YOUR ACTIONS AND MANNERS TOWARDS SICKLE CELL PERSONS)
10. I will willingly agree to have him/her as a friend.
11. He or she can live normal life.
12. I will willingly allow my brother/sister/daughter/son to marry him/her.
13. I will willingly agree to be on duty with him/her.
14. I will willingly recommend him/her for a job.
15. I will willingly agree to him/her as a visitor in my house for a week.
16. I will willingly share my utensils with him/her
SECTION D(BELIEFS AND KNOWLEDGE ABOUT SICKLE CELL DISEASE)
17. Sickle cell is inherited from either father or mother, not both.
18. Sickle cell occurs when both parents pass on abnormal haemoglobin genes, at least one of which is the sickle gene.
19. Sickle cell confers immunity against malaria
20. Sickle cell cannot occur when only one parent has the sickle gene
50
21. Sickle cell is known as sickle cell anaemia only when both parents pass on a sickling gene i.e. S from father, S from mother, making "SS".
22. Sickle cell persons seldom go through life without regular blood transfusion
23. Sickle cell does not occur in white people
24. Sickle cell is so serious that no patient has attained 60 years of age
25. Sickle cell is a sexually transmitted disease
26. Sickle cell occurs only in black people
27. Sickle cell can be acquired through interaction with infected persons
28. Sickle Cell Trait is interchangeable with Sickle Cell Disease.
29. Sickle Cell Trait means the possession of one normal gene for haemoglobin formation (A) and the abnormal sickle gene (S), with the proportion of A always exceeding that of S.
30. Folic acid can help the body to replace damaged red blood cells
31. Lung, stroke, chest pains are major symptoms of the sickle cell crises
APPENDIX B
51
BUDGET
ITEM AMOUNTGH¢
PAYMENT TO RESEARCH ASSISTANTS 60.00
TRAVEL EXPENSES 55.00
TYPING & BINDING COST 35.00
PHOTOCOPYING 15.00
STATIONERY 45.00
MISCELLANEOUS 20.00
TOTAL 230.00
APPENDIX C52
TIME-TABLE
FIRST SEMESTER
( 2nd –4th ) week Reading around the research area.
( 5th ) week Present topic for supervisor’s approval.
( 6th - 8th ) week First draft of proposal.
( 9th ) week Proposal presentation.
(10th ) week Revise draft after supervisor’s comment.
( 11th —12th ) week Proof reading by researcher and others.
( 12th ) week Submission of proposal
SECOND SEMESTER
( 2nd _ 5th ) Week Data Analyses.
( 6th _ 8th ) Week First draft of report.
( 9th _ 10th ) Week Submission of draft for supervisor’s comment.
( 11th _12th ) Week Revise draft after supervisor’s comment.
( 13th) Week Proof reading by researcher and competent others.
( 14th ) Week Submission of report for examination.
APPENDIX D
53
Inter –Semester Break - Data collection
FREQUENCY TABLES
Sex
Frequency Percent Valid Percent
Cumulative
Percent
Valid male 2 5.9 5.9 5.9
female 32 94.1 94.1 100.0
Total 34 100.0 100.0
Age
Frequency Percent Valid Percent
Cumulative
Percent
Valid 20-30 11 32.4 32.4 32.4
31-40 6 17.6 17.6 50.0
41-50 8 23.5 23.5 73.5
51-60 9 26.5 26.5 100.0
Total 34 100.0 100.0
academic qualification
Frequency Percent Valid Percent
Cumulative
Percent
Valid BECE 1 2.9 2.9 2.9
SSSCE/WASSCE 9 26.5 26.5 29.4
HND 4 11.8 11.8 41.2
DEGREE AND ABOVE 6 17.6 17.6 58.8
OTHER 14 41.2 41.2 100.0
Total 34 100.0 100.0
54
do you personally know someone who is suffering from sickle cell
disease?
Frequency Percent Valid Percent
Cumulative
Percent
Valid yes 24 70.6 70.6 70.6
no 10 29.4 29.4 100.0
Total 34 100.0 100.0
If yes, then indicate by ticking in the boxes below, the exact relationship that
exist between you and the sickle cell patient
Frequency Percent Valid Percent
Cumulative
Percent
Valid 10 29.4 29.4 29.4
brother 1 2.9 2.9 32.4
sister 1 2.9 2.9 35.3
son/daughter 1 2.9 2.9 38.2
friend 16 47.1 47.1 85.3
other 5 14.7 14.7 100.0
Total 34 100.0 100.0
sickle cell person should be treated like any other person
Frequency Percent Valid Percent
Cumulative
Percent
Valid strongly agree 13 38.2 38.2 38.2
agree 8 23.5 23.5 61.8
disagree 10 29.4 29.4 91.2
strongly disagree 3 8.8 8.8 100.0
Total 34 100.0 100.0
55
Sickle cell persons should be kept behind closed doors
Frequency Percent Valid Percent
Cumulative
Percent
Valid strongly agree 1 2.9 2.9 2.9
disagree 6 17.6 17.6 20.6
strongly disagree 27 79.4 79.4 100.0
Total 34 100.0 100.0
Sickle cell persons should be treated in a separate hospital
Frequency Percent Valid Percent
Cumulative
Percent
Valid strongly agree 3 8.8 8.8 8.8
undecided 1 2.9 2.9 11.8
disagree 16 47.1 47.1 58.8
strongly disagree 14 41.2 41.2 100.0
Total 34 100.0 100.0
Sickle cell persons should be allowed to mingle with others
Frequency Percent Valid Percent
Cumulative
Percent
Valid strongly agree 18 52.9 52.9 52.9
agree 14 41.2 41.2 94.1
undecided 1 2.9 2.9 97.1
strongly disagree 1 2.9 2.9 100.0
Total 34 100.0 100.0
Sickle cell persons are cooperative
Frequency Percent Valid Percent
Cumulative
Percent
Valid strongly agree 7 20.6 20.6 20.6
agree 17 50.0 50.0 70.6
undecided 6 17.6 17.6 88.2
disagree 4 11.8 11.8 100.0
Total 34 100.0 100.0
56
Sickle cell persons are brilliant
Frequency Percent Valid Percent
Cumulative
Percent
Valid strongly agree 11 32.4 32.4 32.4
agree 16 47.1 47.1 79.4
undecided 3 8.8 8.8 88.2
disagree 3 8.8 8.8 97.1
strongly disagree 1 2.9 2.9 100.0
Total 34 100.0 100.0
Sickle cell persons are dangerous
Frequency Percent Valid Percent
Cumulative
Percent
Valid strongly agree 1 2.9 2.9 2.9
undecided 2 5.9 5.9 8.8
disagree 6 17.6 17.6 26.5
strongly disagree 24 70.6 70.6 97.1
7 1 2.9 2.9 100.0
Total 34 100.0 100.0
Sickle cell persons are active
Frequency Percent Valid Percent
Cumulative
Percent
Valid strongly agree 2 5.9 5.9 5.9
agree 17 50.0 50.0 55.9
undecided 2 5.9 5.9 61.8
disagree 13 38.2 38.2 100.0
Total 34 100.0 100.0
57
Sickle cell persons are worthless
Frequency Percent Valid Percent
Cumulative
Percent
Valid agree 2 5.9 5.9 5.9
undecided 1 2.9 2.9 8.8
disagree 9 26.5 26.5 35.3
strongly disagree 22 64.7 64.7 100.0
Total 34 100.0 100.0
I will willingly agree to have him/her as a friend.
Frequency Percent Valid Percent
Cumulative
Percent
Valid strongly agree 15 44.1 44.1 44.1
agree 18 52.9 52.9 97.1
disagree 1 2.9 2.9 100.0
Total 34 100.0 100.0
He or she can live normal life.
Frequency Percent Valid Percent
Cumulative
Percent
Valid strongly agree 19 55.9 55.9 55.9
agree 14 41.2 41.2 97.1
undecided 1 2.9 2.9 100.0
Total 34 100.0 100.0
I will willingly allow my brother/sister/daughter/son to marry him/her.
Frequency Percent Valid Percent
Cumulative
Percent
Valid strongly agree 5 14.7 14.7 14.7
agree 13 38.2 38.2 52.9
undecided 12 35.3 35.3 88.2
disagree 4 11.8 11.8 100.0
Total 34 100.0 100.0
58
I will willingly agree to be on duty with him/her.
Frequency Percent Valid Percent
Cumulative
Percent
Valid strongly agree 11 32.4 32.4 32.4
agree 21 61.8 61.8 94.1
undecided 1 2.9 2.9 97.1
disagree 1 2.9 2.9 100.0
Total 34 100.0 100.0
I will willingly recommend him/her for a job.
Frequency Percent Valid Percent
Cumulative
Percent
Valid strongly agree 10 29.4 29.4 29.4
agree 19 55.9 55.9 85.3
undecided 5 14.7 14.7 100.0
Total 34 100.0 100.0
I will willingly agree to him/her as a visitor in my house for a week.
Frequency Percent Valid Percent
Cumulative
Percent
Valid strongly agree 10 29.4 29.4 29.4
agree 21 61.8 61.8 91.2
undecided 3 8.8 8.8 100.0
Total 34 100.0 100.0
I will willingly share my utensils with him/her
Frequency Percent Valid Percent
Cumulative
Percent
Valid strongly agree 16 47.1 47.1 47.1
agree 18 52.9 52.9 100.0
Total 34 100.0 100.0
59
Sickle cell is inherited from either father or mother, not both.
Frequency Percent Valid Percent
Cumulative
Percent
Valid strongly agree 2 5.9 5.9 5.9
agree 4 11.8 11.8 17.6
disagree 8 23.5 23.5 41.2
strongly disagree 20 58.8 58.8 100.0
Total 34 100.0 100.0
Sickle cell occurs when both parents pass on abnormal hemoglobin genes, at least
one of which is the sickle gene.
Frequency Percent Valid Percent
Cumulative
Percent
Valid strongly agree 16 47.1 47.1 47.1
agree 14 41.2 41.2 88.2
disagree 1 2.9 2.9 91.2
strongly disagree 3 8.8 8.8 100.0
Total 34 100.0 100.0
Sickle cell confers immunity against malaria
Frequency Percent Valid Percent
Cumulative
Percent
Valid strongly agree 4 11.8 11.8 11.8
agree 5 14.7 14.7 26.5
undecided 4 11.8 11.8 38.2
disagree 14 41.2 41.2 79.4
strongly disagree 7 20.6 20.6 100.0
Total 34 100.0 100.0
60
Sickle cell cannot occur when only one parent has the sickle gene
Frequency Percent Valid Percent
Cumulative
Percent
Valid strongly agree 9 26.5 26.5 26.5
agree 9 26.5 26.5 52.9
undecided 1 2.9 2.9 55.9
disagree 8 23.5 23.5 79.4
strongly disagree 7 20.6 20.6 100.0
Total 34 100.0 100.0
Sickle cell is known as sickle cell anemia only when both parents pass on a sickling
gene i.e. S from father, S from mother, making "SS".
Frequency Percent Valid Percent
Cumulative
Percent
Valid strongly agree 14 41.2 41.2 41.2
agree 6 17.6 17.6 58.8
undecided 3 8.8 8.8 67.6
disagree 8 23.5 23.5 91.2
strongly disagree 3 8.8 8.8 100.0
Total 34 100.0 100.0
61
Sickle cell persons seldom go through life without regular blood transfusion
Frequency Percent Valid Percent
Cumulative
Percent
Valid strongly agree 1 2.9 2.9 2.9
agree 17 50.0 50.0 52.9
undecided 1 2.9 2.9 55.9
disagree 11 32.4 32.4 88.2
strongly disagree 4 11.8 11.8 100.0
Total 34 100.0 100.0
Sickle cell does not occur in white people
Frequency Percent Valid Percent
Cumulative
Percent
Valid strongly agree 5 14.7 14.7 14.7
agree 5 14.7 14.7 29.4
undecided 4 11.8 11.8 41.2
disagree 11 32.4 32.4 73.5
strongly disagree 9 26.5 26.5 100.0
Total 34 100.0 100.0
Sickle cell is so serious that no patient has attained 60 years of age
Frequency Percent Valid Percent
Cumulative
Percent
Valid strongly agree 3 8.8 8.8 8.8
agree 1 2.9 2.9 11.8
undecided 1 2.9 2.9 14.7
disagree 12 35.3 35.3 50.0
strongly disagree 17 50.0 50.0 100.0
Total 34 100.0 100.0
62
Sickle cell is a sexually transmitted disease
Frequency Percent Valid Percent
Cumulative
Percent
Valid agree 1 2.9 2.9 2.9
undecided 2 5.9 5.9 8.8
disagree 2 5.9 5.9 14.7
strongly disagree 29 85.3 85.3 100.0
Total 34 100.0 100.0
Sickle cell occurs only in black people
Frequency Percent Valid Percent
Cumulative
Percent
Valid strongly agree 5 14.7 14.7 14.7
agree 8 23.5 23.5 38.2
undecided 3 8.8 8.8 47.1
disagree 8 23.5 23.5 70.6
strongly disagree 10 29.4 29.4 100.0
Total 34 100.0 100.0
Sickle cell can be acquired through interaction with infected persons
Frequency Percent Valid Percent
Cumulative
Percent
Valid undecided 2 5.9 5.9 5.9
disagree 2 5.9 5.9 11.8
strongly disagree 30 88.2 88.2 100.0
Total 34 100.0 100.0
63
Sickle Cell Trait is interchangeable with Sickle Cell Disease.
Frequency Percent Valid Percent
Cumulative
Percent
Valid 1 2.9 2.9 2.9
strongly disagree 1 2.9 2.9 5.9
agree 2 5.9 5.9 11.8
undecided 4 11.8 11.8 23.5
disagree 14 41.2 41.2 64.7
strongly disagree 12 35.3 35.3 100.0
Total 34 100.0 100.0
Sickle Cell Trait means the possession of one normal gene for hemoglobin
formation (A) and the abnormal sickle gene (S), with the proportion of A always
exceeding that of S.
Frequency Percent Valid Percent
Cumulative
Percent
Valid strongly agree 13 38.2 38.2 38.2
agree 10 29.4 29.4 67.6
undecided 8 23.5 23.5 91.2
disagree 3 8.8 8.8 100.0
Total 34 100.0 100.0
Folic acid can help the body to replace damaged red blood cells
Frequency Percent Valid Percent
Cumulative
Percent
Valid strongly agree 26 76.5 76.5 76.5
agree 6 17.6 17.6 94.1
undecided 1 2.9 2.9 97.1
disagree 1 2.9 2.9 100.0
Total 34 100.0 100.0
64
Lung, stroke, chest pains are major symptoms of the sickle cell crises