BRIEF RESUME OF THE INTENDED WORK



Rajiv Gandhi University of Health Sciences, Karnataka,

Bangalore.

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

DISSERTATION PROPOSAL

“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAM ON THE KNOWLEDGE REGARDING MALE CATHETERIZATION AMONG I YEAR BSC(N) STUDENTS IN SELECTED NURSING COLLEGES BANGALORE CITY”.

SUBMITTED BY,

Mr. SUNIL,

1ST YEAR M.Sc NURSING,

ROYAL COLLEGE OF NURSING,

# UTTARAHALLI HOBLI,

BANGALORE- 560061.

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

| 1 |Name of the Candidate and Address |Mr.SUNIL |

| | |1ST YEAR M.Sc NURSING, |

| | |ROYAL COLLEGE OF NURSING, |

| | |#60, UTTARAHALLI MAIN ROAD, |

| | |UTTARAHALLI HOBLI, BANGALORE: 560061. |

| | | |

| 2 |Name of the Institution |Royal College of Nursing. |

| 3 |Course of study and subject |1ST Year M.Sc Nursing, |

| | |Medical and surgical Nursing. |

| 4 |Date of admission to Course |01-06-2011 |

| 5 |Title of the Topic |

| |“A study to assess the effectiveness of structure teaching program on knowledge regarding male catheterization among I |

| |year BSC(N) in selected nursing colleges, Bangalore city.” |

| | | |

|6 |Brief resume of the intended work: | |

| |6:1 Need for the study |Enclosed |

| |6:2 Review of literature |Enclosed |

| |6:3 Objectives of the study |Enclosed |

| |6:4 Operational definitions |Enclosed |

| |6:5 Hypothesis of the study |Enclosed |

| |6:6 Assumptions |Enclosed |

| |6:7 Delimitations of the study |Enclosed |

| |6:8 Pilot study |Enclosed |

| |6:9 Variables |Enclosed |

| |Materials and Methods |

|7 |7:1 Source of data- Data will be collected from I year nursing students in selected nursing colleges,Bangalore city. |

| |7:2 Method of collection of data: Structured knowledge questionnaire. |

| |7:3 Does the study require any investigation or interventions? |

| |Yes. |

| |7:4 Has ethical clearance been obtained from our institutions? |

| |Yes, Ethical committee’s report is here with enclosed. |

|8 |List of references |Enclosed |

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

|1 |Name of the Candidate and Address |Mr. SUNIL, |

| | |1ST YEAR M.Sc NURSING, |

| | |ROYAL COLLEGE OF NURSING, |

| | |#60, UTTARAHALLI MAIN ROAD, |

| | |UTTARAHALLI HOBLI, BANGALORE: 560061. |

|2 |Name of the Institution |Royal College of Nursing. |

|3 |Course of Study and Subject | 1st Year M.Sc Nursing, |

| | |Medical- surgical nursing. |

|4 |Date of Admission to Course |01-06-2011 |

|5 |Title of the Topic |

| |“A study to assess the effectiveness of structured teaching program on knowledge regarding male catheterization among I |

| |year BSC (N) nursing students in selected nursing colleges, Bangalore city.” |

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“Never doubt that a small group of thoughtful, committed people can change the world. Indeed it is the only thing that ever has.”- Margaret Mead

An indwelling urinary catheter is one that is left in place in the bladder. Indwelling catheters may be needed for only a short time, or for a long time. These catheters attach to a drainage bag to collect urine. A newer type of catheter has a valve that can be opened to allow urine to flow out, when needed.1

A supra-pubic catheter is a type of indwelling catheter. Rather than being inserted through urethra, the catheter is inserted through a hole in abdomen, then directly into bladder.2

Nurses are the primary managers of all the routine care and problem solving associated with patients who have indwelling urinary catheters. Despite the key role nurses have, there is a lack of uniformity in the nature of documentation provided to guide practice.3

Catheterization, which is initiated in a hospital or nursing home setting, uses the same basic technique for insertion of the urinary tract catheter. The catheter is inserted by a nurse or other health care professional, and remains in the patient until bladder function can be maintained independently. When the catheter is removed, patients will experience a pulling sensation and may feel some minor discomfort. If the catheter is required for an extended period of time, a long-term, indwelling catheter, such as a Foley catheter, is used. To prevent infection, it should be regularly exchanged for a new catheter every three to six weeks.4

Potential complications of the procedure include damage to the lining of the urethra; bleeding from the urethra, prostate, or bladder; urinary tract infection; chronic irritation of the bladder; and obstruction of the catheter, causing backflow of urine and possible kidney damage. Some individuals may react to the latex material in the catheter. Individuals with known latex sensitivity should be provided with Teflon or silicon urethral catheters. Catheterization may be complicated by release of urinary bacteria into the bloodstream, which can result in an infection involving the heart, if the bacteria lodge on a damaged heart valve. For this reason, individuals with valve prolapsed or other heart valve conditions should receive prophylactic antibiotics before catheterization.5

Limited evidence suggests that the following interventions reduce the incidence of in patients managed by short-term indwelling catheterization: (1) staff education about catheter management, combined with regular monitoring of incidence, (2) a facility-wide program to ensure catheterization only when indicated and prompt removal of indwelling catheters, (3) daily cleansing of the urethral meatus using soap and water or perineal cleanser, and (4) maintenance of a closed urinary drainage system. Limited evidence suggests that routine catheter changes every 4 to 6 weeks reduce incidence in patients managed by long-term catheterization.6

The use of urinary catheters should be avoided whenever possible. Urethral catheterization should only be done when absolutely indicated. A quarter of all patients admitted to hospital are catheterized and Urethral catheterization is a simple procedure that can have devastating consequences when performed incorrectly with associated significant morbidity and occasional mortality. Too few students receive any instruction in this technique, despite attachment to urology firms.7

6.1 NEED FOR STUDY:

Urinary tract infections are the most common type of nosocomial infections, accounting for 40% of all infections in hospitals per year. In addition, several studies have reported that about 80% of nosocomial UTIs occur following instrumentation, primarily catheterization. Because nearly 10% of all hospitalized patients are catheterized, preventing UTIs is a major factor in decreasing nosocomial infections.8

A study was conducted on urinary cauterization in care homes for older people: self- reported questionnaire audit of catheter management by care home staff. Self-administered questionnaire was used to determine standards published by the National Institute for Clinical Excellence and the Association of Continence care. Seven hundred and fifty out of 1438 (52%) nursing staff from 37 randomly selected homes. Eighty-three percent of the nursing staff and 40% of the other staff received formal catheter care training.Only 45% of nursing staff and 40% of other care staff encouraged residents to empty their own catheter bags. Routine use of catheter maintenance solutions or bladder washouts was reported by 50% of all staff. Nursing staff (29%) and other staff (54%) took urine specimens from the bag tap. There is a need for ongoing local audit and formal training in urinary catheter-care, particularly for non-qualified care staff. Education is needed to ensure local implementation of NICE guidance.9

A study was conducted on impact of an interactive workshop on the management of urinary catheterization on nurses. The aim of this study was to determine whether a structured workshop for nurses promoting best practice technique for management of indwelling urinary catheters results in an improvement in knowledge on the subject. The research design of one-group pre-post test quasi-experimental design using a convenience sample was used. Participants completed a multiple choice question test prior to the intervention. There was a significant improvement in mean test scores after the workshop when compared with pre-workshop scores. It is concluded that interactive lecture workshops based on best practice techniques for the management of urinary catheterization help improve nurses' knowledge. Such educational initiatives also help to overcome deficiencies in initial nurse training where preparation for quality catheter care can be lacking.10

Approximately 4 million Americans undergo urinary catheterization annually, and more than 500,000 of these catheterizations involve indwelling catheters left in place for some period. Between 15% and 25% of patients may receive indwelling catheters during hospitalization, and the prevalence of catheter indwelling catheter. Although the indications for catheterization have been extensively outlined, reports of the inappropriate use of catheters range from 21% to more than 50%.use in residents of long-term care facilities is estimated between 7.5% and 10%. One study found that of 4,010 individuals receiving home care services.11

The physician orders the catheter and a registered nurse performs the procedure and provides patient education. Catheterization is a rather simple procedure, but female nurses are sometimes reluctant to perform urethral catheterization on male patients despite established patient care guidelines and advice on the male catheterization procedure. However, both intermittent and indwelling male catheterization is required to achieve optimum quality of life; therefore nurses should make the best possible practice and techniques available.12

6.2 REVIEW OF LITERATURE

Review of literature provides basis for future investigation, justifies the need for replication, throws light up on feasibility of the study and indicates constraints of data collection and help to relate findings of one another. The scope of literature review should be broad enough to allow the reader to become familiar with the research problems and narrow enough to include predominantly relevant sources.

6.2.1 Studies related to male catheterization

6.2.2 Studies related to complication of male catheterization

6.2.3 Studies related to importance of male catheterization

6.2.4 Studies related to knowledge of the health personnel regarding male catheterization of complication.

6.2.1 Studies related to male catheterization:

A study was conducted on evaluating the potential of removing long-term urinary catheters among home care recipients in Taiwan. The study aimed to the potential of removing long- term placed urinary catheters among home-care recipients. The result was, among 43 home care recipients participated in this study, and most of them were physically dependent and 69.8% were long-term catheterized. The mean residual-urine volume of the more dependent participants was significantly higher than the less dependent recipients. Comparing recipients with residual urine volume higher and lower than 160 cc, we found that recipients with higher residual-urine volume were more likely to be people with diabetes and higher dependent. They concluded that further prospective interventional study is needed to evaluate the possibility of removing long-term urinary catheters among home care recipients.13

A prospective study was conducted on urinary catheterization in medical ward. The study aimed to determine the frequency of inappropriate catheterization and the reasons for doing it. And various risk factors associated with inappropriate catheterization, catheter associated urinary tract infections. The One hundred and twenty five patients admitted, who underwent catheterization with a Foley's catheter, at admission, have been selected. The result Thirty-six out of 125 (28.8%) patients included was inappropriately catheterized. The most frequent indication for inappropriate catheterization was urinary incontinence without significant skin breakdown (27.8%) and catheterization in the emergency, non-ambulatory functional status, the risk factors for acquiring, impaired mental status, and duration of catheterization. They concluded that inappropriate catheterization is highly prevalent in medical wards, the patients catheterized in the medical emergency; Careful attention to these factors can reduce the frequency of inappropriate catheterization and unnecessary morbidity.14

6.2.2 Studies related to complication of male catheterization

A study was conducted on Factors associated with the frequency of self-intermittent catheterization after prostate brachy therapy .the study aimed to evaluate the factors associated with the probability of a patient performing self-intermittent catheterization after transperineal interstitial permanent prostate brachytherapy. They used the methods of 204 patients who underwent therapy at Mayo Clinic Scottsdale. The result was out Of the 204 patients, 22 patients (11%) received Pd seeds and 182 patients (89%) received I. Thirty-seven (18%) patients received external-beam radiotherapy in addition to the therapy. catheterization was performed by 69 (34%) of the 204 patients. Factors that were significantly associated with a lower frequency of self-intermittent catheterization .they concluded that significant associations were observed between the frequencies of SIC and the number of seeds implanted. These findings may aid in better patient selection and therapeutic decisions.15

A prospective study was conducted on risk factor for acute urinary retention requiring temporary intermittent catheterization after prostate brachy therapy. The study aimed to investigate prognostic factors for men undergoing transperineal radioactive seed implantation at the University of Washington. The method used was 62 consecutive unselected Patients were contacted by phone at one week postoperatively and at one-month intervals thereafter. Follow-up continued until all patients provided the date of last catheterization. The result was Urinary retention rate at one week was 34% (21 of 63 patients). At one month, 29%; at three months, 18%; and at six months, 10% Use of alpha blockers, hormonal therapy, type of seed, or external beam radiotherapy had no impact on risk of retention at any follow up point. They concluded that further investigation will be needed to clarify the risk of urinary retention for men undergoing brachytherapy.16

A prospective study was conducted on physical predictor of infection in patient treated with clean intermittent catheterization. The study aimed to study urinary tract complications in patients treated using long-term clean intermittent catheterization (CIC). The sample of 170 patients (84 men and 86 women, mean age 56.9 years) with a mean duration of use of CIC for 8.8 years were assessed for complications by using questionnaires and the analysis of urine samples. The result was 111 patients (65%) had no signs of clinical urinary tract infection, while 10 patients (6%) had pronounced symptoms. The remaining 29% had only minor signs of urinary tract infection. There were three predictive factors of clinical UTI was patient had the highest mean catheterization volume now, and the highest increase in mean catheterization volume. In urine sample Gram-positive cocci present. They concluded that confirms previous reports showing CIC to be an excellent procedure for minimizing urinary tract complications and supports the current recommendations.17

6.2.3 Studies related to importance of male catheterization

A study was conducted on urinary catheterization in acute stroke clients. The study aimed to determine what influences the decision to insert an indwelling urinary catheter in acute stroke clients with design of prospective case note review and semi-structured interview, conducted in three teaching hospitals. The sample of 70 stroke clients and 50 doctors and nurses and physiotherapist from acute stroke units. The result is continence and catheterization was considered less important than other aspects of acute stroke care. There was no catheterization policy or standardized continence assessment tool in use. Decision to catheterize belonged to doctors or nurses depending upon clinical indication. They concluded that clear corporate policy on catheterization is required to direct practice.18

A study was conducted on inserting catheter into a male patient in oxford medical schools. The study aimed to common practice of male catheterization during clinical practice of medical personnel. The study found that 6% (51/864) of urological consultation during study were related to male catheterization. In these 51 cases of catheter morbidity, 38(74%) from junior doctors performed urethral catheterization and nurses are performing male catheterization during their clinical practice. They concluded that major problem might be due to inexperience.19

6.2.4 Studies related to knowledge of the health personnel regarding male catheterization complication.

A study was conducted on bladder catheterization in greek nursing education: An audit of skills taught. This aimed to assess the current educational model regarding male bladder catheterization at a sole tertiary education in nursing establishment in a major greek city and to improve nurse undergraduate training by implementing appropriate recommendation for change to the current educational module and support these changes in the long term. The methods which were used were systematic search of international database for guidelines audit measures included direct observation of the teaching process and compilation of a checklist. The result was shortcoming of pre-preparation, textbook of educational resources, lack of national guidelines, setting of the educational experiences. They concluded that main problem with teaching process exposed by the audit was entrenched use of an outmoded textbook with little effort to enrich teaching with current evidence based practice.20

A study was conducted on reminder reduces urinary catheterization in hospitalized patient. The studies aimed to Physicians are often unaware that their patients have a urinary catheter, and these "forgotten" catheters are frequently unnecessary. The method used was controlled trial, using a pretest-posttest design, was conducted on four hospital wards at an academic medical center. A research nurse monitored the urethral catheter status of each patient daily. The result was total of 5,678 subjects after adjusting for age, sex, and length of stay, the average proportion of time patients were catheterized increased by 15.1% in the control group but decreased by 7.6% in the intervention group. There was no significant difference in urethral re-catheterizations between intervention and control groups. The hospital cost savings provided by the intervention offset the necessary costs of this nurse-based intervention. They concluded that approximately 90% of U.S. hospitals currently without computerized order-entry systems, a written reminder should be considered as one method for improving the safety of hospitalized patients.21

A study was conducted on visually guided male urinary catheterization; the study aimed to examine feasibility and safety of male urinary catheterization by nursing personnel using a visually guided device in clinical setting. The training was given to two nurses and 25 patients were used for study. The data regarding success of placement, total procedure time, and pain during procedure were collected. The result was all catheters were successfully placed. They concluded the success rate for placement of Foley catheter with visually guided device was 100%, indicating its safety and accuracy. But training should be needed to improve the knowledge.22

6.3 OBJECTIVES OF THE STUDY

1

1. To assess the pre-existing knowledge of first year student nurses regarding male catheterization by pre test.

2. To develop and conduct a structured teaching program among first year student nurses regarding male catheterization.

3. To evaluate the effectiveness of structured teaching program among first year student nurses regarding male catheterization.

4. To find out the association between knowledge level and selected demographic variables of student nurses.

6.4 OPERATIONAL DEFINITIONS

1. Effectiveness: it refers to the extent to which the structured teaching program has measured the desired outcomes in terms of knowledge scores.

2. Structured teaching program: It refers to systematically developed teaching module designed for educating the student nurses regarding male urinary catheterization.

3. Knowledge: it refers to appropriate response received from student nurses to the items elicited through a structured knowledge questionnaire.

4. Urinary catheterization: it refers to procedure by inserting tube into bladder through urethra.

5. Student nurses: it refers to first year Bsc., nursing students studying in a selected nursing colleges.

6.5 HYPOTHESIS OF THE STUDY

H1: There will be significant difference between pre-test and post-test knowledge scores of I year Bsc(N) students regarding male urinary catheterization.

H2: There will be significant association between pre-test and post-test knowledge scores of the student nurses regarding male urinary catheterization and selected demographic variables.

6.6 ASSUMPTIONS:

1. Student nurses may have some knowledge regarding the male urinary catheterization.

2. Student nurses may have interest to know more about male urinary catheterization.

3. Student nurse’s knowledge regarding male urinary catheterization can be improved by structured teaching programme.

6.7 DELIMITATIONS OF THE STUDY

1. The study is limited only to student nurses in selected nursing colleges, Bangalore.

2. The study is limited only to I year Bsc(N) students.

6.8 PILOT STUDY:

The study will be conducted with 6 samples. The purpose to conduct pilot study is to find out the feasibility for conducting the study and design on plan of statistical analysis.

6.9 VARIABLES:

Variables are qualities, properties or characteristics of persons, things or situations that change or vary and are manipulated or measured in research.

• Dependent variables: Knowledge level of student nurses regarding the male urinary catheterization.

• Independent variables: Structured Teaching Program regarding male urinary catheterization.

• Extraneous variable: Age, sex, sources of information, attendance of urinary catheterization demonstration, previous experience with urinary catheterization.

7 MATERIAL AND METHODS:

7.1 SOURCE OF DATA:

The data will be collected by using structured knowledge Questionnaire on male urinary catheterization whose content will be validated by the experts and will be pre-test and standardized through pilot study.

7.1.1 RESEARCH DESIGN

The research design adopted for this study is pre-experimental. One group pretest- posttest design.

7.1.2 RESEARCH APPROACH:

Evaluative research approach will be adopted.

7.1.3 SETTING OF THE STUDY:

The study will be conducted at selected nursing colleges, Bangalore city.

7.1.4 POPULATION:

All the student nurses who meet all the inclusion criteria and are studying in selected nursing colleges, Bangalore.

7.2 METHODS OF COLLECTION OF DATA (INCLUDING SAMPLING PROCEDURE):

The data collection procedure will be carried out for a period of one month. The study will be conducted after obtaining permission from the concerned authorities. The investigator collects data from student nurses by using a structured knowledge questionnaire regarding the male urinary catheterization.

The data collection instrument consists of following sections

Section A: Demographic Data

Section B: Questions related to the knowledge of student nurses regarding the male urinary catheterization.

7.2.1 SAMPLING TECHNIQUE:

Non-probability purposive sampling technique.

7.2.2 SAMPLE SIZE:

Sample consists of 60 student nurses who are studying in selected nursing colleges, Bangalore city.

SAMPLING CRITERIA:

7.2.3 INCLUSION CRITERIA:

1. Student nurses who are studying in selected nursing colleges, Bangalore city.

2. Student nurses those who are attending I year Bsc(N) course.

3. Student nurses who are available at the time of study.

4. Student nurses who are able to read and write Kannada or English.

5. Student nurses who are willing to participate in the study

7.2.4 EXCLUSION CRITERIA:

1. Student nurses with contagious diseases.

2. Student nurses who are selected for pilot study.

7.2.5 TOOLS FOR DATA COLLECTION:

A structured knowledge questionnaire is used to collect the data from the student nurses.

7.2.6 DATA ANALYSIS METHOD:

The data collected will be analyzed by using descriptive and inferential statistics

Descriptive statistics:

Frequency and percentage for analysis of demographic data and mean, mean percentage and standard deviation will be used for assessing the level of knowledge.

Inferential statistics:

Chi-square test will be used to find out the association between knowledge of student nurses and selected demographic variables. Paired‘t’ test will be used for evaluating the effectiveness of Structured Teaching Programme.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INVESTIGATIONS TO BE CONDUCTED ON PATIENTS OR HUMANS OR ANIMALS?

Since the study is pre- experimental in nature, investigation or interventions are required.

7.4 ETHICAL CLEARENCE:

Yes, ethical committee’s is here with enclosed. The main study will be conducted after the approval of research committee of the college. Permission will be obtained from the head of the institution. The purpose and details of the study will be explained to the study subjects and assurance will be given regarding the confidentiality of the data collected.

LIST OF REFERENCES (VANCOUVER METHOD FOLLOWED):

1. Artical related to urinary catheters – Overview [homepage on the Internet] 2011 [cited on 2011 Nov 28] Available from: URL: .

2. Artical related to urinary catheterization [homepage on the Internet] 2011 [cited on 2011 Nov 28] Available from: URL:

3. A Andrew Fleming Rn Gnc BAppSc(Nsg) MHlthSc(Ger)1, Jenny Day Rn ADCH(OccHealth), BHlthSc(Nsg), MEd(AdultEd)2, Linda Glanfield Rn Grad Dip(hlthSc) Mn3[online].2009; Available from: URL:

4. Hunt, Gillian M., Pippa Oakeshott, and Robert Whitaker. Intermittent Catheterization: Simple, Safe, and Effective but Underused. British Medical Journal 1996 Jan; 312(7023): 103-7 Available from: URL:

5. Artical related to urethral Catheterization[online] 2011 [Cited on 2011 Dec 1]Availablefrom:URL:

6. J Wound Ostomy Continence Nurs. 2009 Mar-Apr;36(2):137-54. Available from: URL:

7. 7. A.K. Eziyi1, S.O. Ademuyiwa1, J.A.E. Eziyi 2, A.A. Salako 2, A.O.A. Aderounmu2, A.S.A. Oyedeji2(online) East and Central African Journal of Surgery, Vol. 14, No. 2, July-Aug, 2009, pp. 18-24 Available from: URL:

8. Artical related on Manual to control urinary infection [online] 2011 (cited on 2011 Dec 2) Available from: URL: .

9. McNulty, Bowen J, Foy C, Gunn K, Freeman E, Tompkins D, et al. Urinary catheterization in care homes for older people. Journal of hospital infection 2006 Jan: 62(1):29-6



10. Insaf Altun, Alikarakoc. Impact of an interactive workshop. International Journal of urological Nursing 2010 Nov: 4(3):125-32. Available from: URL:

11. Rebecca Herter BS, Meredith Wallace Kazer. Best practices in urinary care (cited on 2011 Dec 3) Available from: URL: http:// prodevvv/ce_article.asp?tid=1027118.

12. Artical related to Male catheterization [homepage on the Internet] 2011(cited on 2011 Dec 3) Available from: URL:

13. A journal Evaluate the potential of removing long-term urinary catheters among home care recipients 2011[homepage on the Internet]( cited on 2011 Nov29)Availablefrom:URL:. com/science/article/pi i/S2210833511000323.

14. A study related to Urinary catheterization 2011.[homepage on the Internet] (Cited on 2011 Nov 25) Available from:URL: .

15. David J, Schwartz, William, Wong W, Sujay. Factor associated with frequency of self- intermittent catheterization after prostateeeee brachy therapy. International Journal of radiation, oncology, biology 2005 Jan: 61(1): 60-3. Available from: URL: http:// science/article/pii/S036030160400759X.

16. Jacob Locker, William Ellis, Kent wallner, William Cavanagh, John Blasko. Risk factor for acute urinary retention requiring temporary intermittent catheterization after prostate brachy therapy. International Journal of radiation oncology, biology 2002 Mar:52(3) Available from: URL:

17. Digranes A, Hoisoeter PA. physical predictor of infection in patient treated with clean intermittent catheterization. British Journal of urology 1997 Jan: 79(1); 85-90. Available from: URL: .

18. Cowey E, Smith LN, Booth J, Weir CJ. Urinary Catheterization in acute stroke: clinical realities.( Cited on 2011 Nov 26 ) Available from : URL:

19. Tim Briggs. Inserting catheter into male patient. British medical journal 2011 Apr 19: Available from: URL: .

20. Dimitrios Theofanidis, Antigoni Fountouki. Bladder catheterization in greek Nursing education. An Audit of skills taught. Available from: URL: .

21. Saint, Sanjay, Kaufman, Samuel R, Thompson, Maureen; Rogers, Mary, et al. Reminder reduces urinary catheterization in hospitalized patient. Availablefrom:URL:.

22. Article related to Visually guided Male urinary catheterization 2011 ( Cited on 2011 Dec 26) A feasibility study. Available from: URL: .

|Signature of the Candidate | |

|Remarks of the Guide | |

|Name and Designation of | |

|11.1 Guide | |

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|11.2 Signature | |

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|11.3 Co-Guide | |

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|11.4 Signature | |

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|11.5 Head of Department | |

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|11.6 Signature | |

| 12.1 Remarks of the Chairman & Principal | |

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|12.2 Signature | |

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