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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 5  |  Issue : 3  |  Page : 115-120

Impact of an educational module on the knowledge and attitude of nursing students toward eye donation


1 Department of Ophthalmology, Mahathma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Puducherry, India
2 Department of Child Health Nursing, Kasturba Gandhi Nursing College, Sri Balaji Vidyapeeth University, Puducherry, India

Date of Web Publication11-Oct-2017

Correspondence Address:
Nagarajan Swathi
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2320-3897.216428

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  Abstract 

Background: The only source of cornea for corneal transplantation is from timely harvested safe eyes of deceased donors. Nurses attending on terminally ill patients can, if trained, motivate the relatives for eye donation. Aims: The aim of this study is to determine impact of an educational lecture on knowledge and attitude of nursing students toward eye donation. Settings and Design: This was an interventional study. Subjects and Methods: Nursing students in their 1st year and 4th year of training were administered a prestructured questionnaire. A 30-min interactive session was conducted for them regarding eye donation and transplantation. After 4 months, the questionnaire was readministered and their responses were analyzed with regard to number of correct responses for each question. Statistical Analysis Used: The statistical analysis used in this study was MedCalc for Windows, version 13.3.1 (MedCalc Software, Ostend, Belgium). Student's t-test was used to analyze change in knowledge and attitude. P <0.05 was considered significant. Results: The difference in the level of knowledge and attitude between first year and final year students before the exposure to educational awareness video was not statistically significant (P = 0.2 and P = 0.9, respectively). Four months following the interactive video, change in knowledge levels was significant for both groups (P = 0.01 - first year and P = 0.006 - final year), but there was no significant change in their attitude toward eye donation. Conclusion: Inclusion of eye donation in nursing curriculum is likely to be effective in imparting knowledge to nursing students who may be potential counselors for eye donation. “The proof of the pudding lies in the eating” and whether this translates to action by actual increase in registration as donors and corneal harvests remains to be seen.

Keywords: Corneal blindness, corneal transplantation, eye banking, eye donation, nursing education


How to cite this article:
Swathi N, Venipriya S, Geetha C. Impact of an educational module on the knowledge and attitude of nursing students toward eye donation. J Clin Ophthalmol Res 2017;5:115-20

How to cite this URL:
Swathi N, Venipriya S, Geetha C. Impact of an educational module on the knowledge and attitude of nursing students toward eye donation. J Clin Ophthalmol Res [serial online] 2017 [cited 2017 Dec 14];5:115-20. Available from: http://www.jcor.in/text.asp?2017/5/3/115/216428



With 1.14 million bilaterally corneal blind persons, India holds the dubious distinction of the world's largest corneal blind population.[1] Important causes of corneal blindness include trachoma, ocular trauma, childhood corneal blindness, ulcerations, abuse of steroid eye drops, and use of traditional eye medications.[2] A corneal transplant is the only option available for visual rehabilitation of those afflicted with vision impairing corneal scarring. Even though corneal transplants continue to be the most common type of human transplant surgery, the eye donation trends are quite poor for a country the size of India.[3] According to the Eye Bank Association of India (EBAI), the huge gap of demand and supply of corneal grafts is further worsened by a significant proportion of donor corneas being unsuitable for corneal transplantation.

Poor knowledge of the procedure involved in eye donation and possible objections from family members are common reasons for low corneal donation rates.[4] A positive attitude of health-care workers can significantly influence public opinion, and nursing staffs, in lieu of proximity to patient and relatives, have an excellent opportunity to motivate them to donate eyes.[5]

The objective of this study was to assess the knowledge and attitude toward eye donation among a group of nursing students and observe whether the clinical exposure of such students, which gradually increases in the 4 years of nursing school, has any influence on it. Further, the impact of an educational module on eye donation and corneal transplantation toward any change in knowledge and attitude among these nursing students was also assessed.


  Subjects and Methods Top


Nursing students (BSc) of the first year (who would have had no special exposure to eye donation) and final year (who have been exposed to almost the entire nursing curriculum and a 2 weeks posting in Department of Ophthalmology in their 3rd year) in a large medical school in Southern India were requested to complete a previously validated anonymous questionnaire modified according to local circumstances.[6] Permission to administer, this questionnaire was obtained from the Institute Research and Ethics Committee. This study was performed as part of the National Eye Donation Fortnight in 2014. An introductory note was provided at the beginning of the questionnaire that informed participants about the nature of the study and the behavior under investigation. Participation was voluntary, without any form of compensation. Students were asked to respond based on their existing knowledge and views, and completed questionnaires were collected within 30 min.

The questionnaire consisted largely of a range of self-explanatory closed questions that required the participant to respond using a dichotomous (yes/no) or polytomous response [Appendix 1]. The participants were also given the opportunity to write a free-text response where appropriate. Thirteen questions assessed knowledge and five questions assessed their attitude [Table 1] and [Table 2]. The students were then exposed to an interactive educational video/PowerPoint presentation by one of the authors (SN). This presentation over a 30 min period covered all relevant information on eye donation, corneal transplantation, and the standard operating procedure to be followed during the harvesting of a deceased donor cornea. After a period of 4 months (during which time none of the students had been posted in Ophthalmology), the students were readministered the same questionnaire without prior intimation. Those students who did not participate the first time were requested to indicate this and were excluded from the final analysis.
Table 1: Knowledge of nursing students before and after the video interactive session

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Table 2: Attitude of nursing students before and after the video interactive session

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Statistical analyses were performed using MedCalc for Windows, version 13.3.1 (MedCalc Software, Ostend, Belgium). Level of knowledge and attitude was determined by the number of correct responses for a given question.

Regarding free-text responses, reasons for willingness for eye donation included: (i) as those doing so out of perceived nobility of the act of giving vision to a blind person or (ii) being influenced by known persons receiving or donating eyes or (iii) influenced by articles on the subject. Reasons for hesitancy in donation were attributed to (i) a lack of awareness on the subject, (ii) possible objections of family members, (iii) a perceived sense of disrespect to the body, (iv) religious reasons, and (v) a fear of impending death.

Student's t-test was performed to analyze for change in knowledge and attitude following exposure to the educational program. P < 0.05 was considered as significant.


  Results Top


A total of 90 and 97 students from the first year nursing participated in the two questionnaires, respectively. The seven students who had not participated in the first session were excluded from the final analysis. With regard to the final year nursing, 85 and 83 students participated in the 1st and 2nd session, respectively. The level of knowledge was better in the final year students in both stages. A good percent of students of both years were aware that a hospital/eye bank could be approached for eye donation. Attitudes toward eye donation were positive among all students, and a high percentage of students expressed willingness to be donors themselves. Nobility of the act and helping a blind person were the most common reasons cited for their willingness to donate while only 1% were influenced by eye donation of a known person or an article on the subject. There was an improvement in awareness with almost all questions following the exposure to the interactive educational video/PowerPoint presentation. However, it was surprising that a vast majority of students of both years continued to remain unaware that the cornea is the tissue being harvested. While knowledge with regard to the non-influence of donor disease state had marginally improved, it still continued to be much below other parameters. Most common reason cited for hesitancy to donate eyes was a lack of awareness of eye donation and probable objections by family members while 11 students cited religious reasons. The difference in the level of knowledge between first year and final year students (before the exposure to educational awareness video) was not statistically significant (P = 0.2, t-test; 2-tailed). Similarly, no statistical difference was seen with regard to attitude toward eye donation among the two groups before the exposure to the interactive video (P = 0.9, t-test; 2-tailed). Following exposure to the interactive video, the change in knowledge levels was significant for both group of students (P = 0.01 - first year and P = 0.006 - final year, t-test; 2-tailed), but the attitude changes toward eye donation among both groups were not statistically significant. All responses are summarized in [Table 1] and [Table 2].


  Discussion Top


Earlier studies in the Indian subcontinent region appear to indicate high levels of awareness (70%) and willingness (55%) to donate eyes.[4],[7],[8] Despite such commendable numbers, the observed threefold increase in procurement has not been able to bridge the ever-widening mismatch between the corneal donations and demand.[9]

Specific reluctance has been noted toward eye donation when compared to other organ donations with reasons such as eyes “having distinctive characteristics,” being “window to the soul,” and “physically seen on another person,” being offered as reasons to explain the averseness to eye donation.[10],[11] Dispelling the myths regarding eye donation is essential to overcome this barrier. The mass-media campaign by the EBAI continues to be the most common source of information among medical and paramedical professionals, students, and public alike. The positive benefits of this media campaign can be realized in the steady threefold increase in the corneal donations over a 15 years period reaching to around 50,000 donations in a year.[12] However, the existing corneal procurement requirement gap exposes the inadequacy of these promotional advertisements in isolation.

India's Transplant of Human Organs Act is a voluntary consent system depending on the surviving members to donate the eyes of their dead or dying relative. In the absence of consent from the person concerned, the relatives are unlikely to volunteer eye donation, despite awareness regarding the same. Often, the ceremonies surrounding death take precedence during the crucial narrow window of 6 hours when the eyes can be harvested. A “catalyst” who solicits eye donation, in such situations, has been found to improve the yield.[13] Unlike in the developed world, grief counselors are available in a very few hospitals in India. It is the nurse who is in close contact with the patient's relatives from admission and is most suitably positioned to suggest a corneal donation to the grieving relatives.[14],[15] Having gained their trust and respect, the suggestion for a corneal donation is likely to be met more positively.

For an effective Hospital Corneal Retrieval Program, these nurses should be armed with adequate knowledge regarding eye donation. In countries where nurses handle various aspects of organ donation including counseling and procurement, it has been found that they consider themselves lacking in adequate knowledge to counsel for eye donation.[16] Our study did not find a statistically significant difference in the knowledge of first and final year nursing students, reflecting the not very high priority given to organ donation in nurses' core curriculum. Following the education module, there was a significant increase in the knowledge of nursing students of both groups, more so in the 4th year group. A strong case may, therefore, be made to include the teaching of organ and tissue donation in the nursing education curriculum syllabus which could enable nurses to motivate the bereaved families for eye donation.

It is important to realize that merely providing knowledge is a very simplistic approach which is unlikely to yield expected results. Dhaliwal who recorded 80% willingness to donate eyes finally observed that only two students had actually registered for the same.[6] Radunz et al. recorded 42% of participants as being positively influenced by the lecture but observed no significant increase in actual number of voluntary donors.[17] A similar trend is also seen in this study.

Strangely, in our study, following the educational module, more number of students gave “lack of awareness” as their reason for not registering for eye donation than before the interactive video. We speculate that “lack of awareness” is often used as a convenient excuse to explain away the reluctance to register oneself as a corneal donor. Studies show that those nurses who have registered for organ donation were more confident in counseling prospective donor family for the same and are likely to exert a positive influence on the relatives.[18],[19]

The success of an eye donation program relies not only on governmental and infrastructural support but also on the awareness and favorable attitude of general public to organ donation and the cultural background of the family of potential donor. With religious institutions supporting eye donation as an act of merit/charity, an important cause of unwillingness to donate organs is gradually being overcome. Till organ donation at death becomes the norm in our society, counselors who solicit the same will play an important role. Nurses by virtue of their proximity to the near and dear ones of the deceased are best suited to play this critical role.

The results of the post intervention test conducted in a short time interval of 4 months are to be interpreted with caution. A 4-month period is probably too short a time to detect any change in attitudes toward corneal donation among these nursing students. Possible improvements in knowledge are likely to remain inconsistent with a single contact intervention as in this study. With passing time, it is to be expected that forgetfulness, and ennui may play a role in changing levels of knowledge.


  Conclusion Top


A short single contact education module in this study has been effective in improving knowledge regarding eye donation among nursing students. The absence of this topic in nursing curriculum can result in a low priority being accorded by the students. Eye donation does not have adequate prominence in the present nursing curriculum. We may then conclude that inclusion of organ donation (eye donation) in the nursing core curriculum would be of value when we consider nursing students to be potential counselors for eye donation. The inclusion of this topic in the nursing curriculum will compulsorily expose all students to the process of corneal donation and is more likely to be treated with seriousness in lieu of it being a part of their formal training. Improved knowledge is expected to change unfavorable attitudes among this group of medical personnel who are to play a critical role as a potential counselor for corneal donation. However, “The proof of the pudding lies in the eating” and whether this translates to action by actual increase in registration as donors and corneal harvests remains to be seen.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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