CHAPTER FOUR

RESULTS

Introduction

This chapter presents the findings from the study conducted on the knowledge and
practices of nurses at Machakos Level 5 Hospital Cancer Centre in the prevention of
breast cancer. The findings are organized based on the study objectives, including
the level of knowledge among nurses regarding breast cancer, their current practices
in prevention, and the challenges they face. These findings are supported by relevant
literature and discussed in the context of their implications for nursing practice and
healthcare delivery.

4.1 Questionnaire Response Rate

Out of the 10 questionnaires distributed, 9 were completed and returned,

representing a response rate of 90%. All 9 questionnaires were fully filled with no
errors.

4.2 Demographic Characteristics

The study involved 9 participants, with the majority being female, accounting for
66.7% (n=6), while males accounted for 33.3% (n=3). Most of the respondents had a
higher diploma as their level of education, representing 55.6% (n=5), followed by
bachelor’s degree 22.2% (n=2) and masters degree 22.2% (n=2). The findings
showed that the majority of nurses specialized in oncology nursing, represented by
88.9% (n=8), followed by palliative care nursing at 11.1% (n=1).

The study shows that the level of experience in the Cancer Center for 3-6 years was
66.7% (n=6) and less than 2 years 11.1% (n=1).The age distribution indicated that the
majority of the respondents were aged 41–45 years, representing 33.3% (n=3)
followed by 31-35 years representing 22.2% (n=2).
The study population comprised 10 nurses, 9 out of the 10 participated in the
research, representing a response rate of 90%.

Table 1: Demographic Characteristics of Respondents

Age(Years) N %

Age of Nurses in Cancer Center

31-35 2 22.2

36-40 3 33.3

40-45 3 33.3

Above 45 1 11.1

Sex of Nurses in Cancer Center

Male 3 33.3

Female 6 66.7

Level of education of nurses in

Cancer Center

Higher Diploma 5 55.6

Degree 2 22.2

Masters 2 22.2

Level of specialization

Oncology nurse 8 88.9

Palliative care 1 11.1

nurse

Level of experience in Cancer

Center

Less than 2 1 11.1

3-6 6 66.7

6-10 2 22.2

4.3 Knowledge of Respondents on Breast Cancer Prevention

4.3.1 Knowledge on Breast Cancer

The findings showed that the majority of respondents correctly defined breast
cancer as the uncontrolled growth of cells in breast tissue, while others identified it
as cancer originating in breast ducts or lobules. Most respondents were aware that
family history, genetic mutations, and age are risk factors for breast cancer. The
most commonly recognized symptoms were breast lumps, nipple discharge, and
changes in breast shape or size.

The study revealed that 88.9% of nurses could identify genetic predisposition (e.g.,
BRCA1/BRCA2 mutations) and prolonged estrogen exposure as significant risk factors
for breast cancer. However, only 77.8% recognized lifestyle factors such as alcohol
consumption, obesity, and physical inactivity as risks.

Table 2: Knowledge on Breast Cancer

Question Response

Definition of Breast cancer Uncontrolled growth of cells in breast

tissue
Cancer originating in the breast ducts or
lobules

Risk factors for breast cancer Family history, genetic factors, mutation,
age
Lifestyle Factors; alcohol, smoking,
obesity

Symptoms of Breast Cancer breast lumps, nipple discharge, and

changes in breast shape or size.

4.3.2 Knowledge on Breast Cancer Prevention

All respondents (100%, n=9) knew the importance of regular breast examinations.
Most participants, 77.8% (n=7), identified mammograms as the most effective
screening tool, while 88.9% (n=8) emphasized the importance of lifestyle
modifications in reducing risk.The study revealed encouraging levels of knowledge
among nurses concerning breast cancer risk factors, signs, symptoms, and preventive
measures. Key findings include:

Awareness of Risk Factors

77.8% demonstrated adequate knowledge of breast cancer risk factors, including

genetic predisposition, lifestyle factors (e.g., obesity, smoking), and hormonal
influences.

Signs and Symptoms

66.7% were proficient in recognizing early warning signs, such as breast lumps,
changes in size or shape, nipple discharge, and skin alterations.

Preventive Measures:

88.9% exhibited knowledge of breast cancer prevention strategies, including the

importance of regular self-examinations, clinical breast exams, and mammography
for early detection.

Knowledge Gaps:

A notable 33.3% demonstrated insufficient understanding of early detection

techniques and advanced diagnostic tools.

Table 3: Knowledge on Breast Cancer Prevention

Percentage Number of
Category Findings
(%) Respondents (n)

All respondents knew the

Regular Breast
importance of regular breast 100 9
Exams
examinations.

Identified as the most effective

Mammograms 77.8 7
screening tool by most participants.

Lifestyle Emphasized as important in

88.9 8
Modifications reducing risk.

Adequate knowledge of genetic

Awareness of Risk
predisposition, lifestyle factors, and 77.8 7
Factors
hormonal influences.

Proficient in recognizing breast

Signs and
lumps, size/shape changes, nipple 66.7 6
Symptoms
discharge, and skin changes.

Preventive Knowledge of prevention strategies 88.9 8

Measures like self-exams, clinical exams, and
 Percentage Number of
Category Findings
(%) Respondents (n)

mammography.

Insufficient understanding of early

Knowledge Gaps detection techniques and advanced 33.3 3
diagnostics.

4.4 Practices of Respondents in Breast Cancer Prevention

The study revealed that 66.7% (n=6) of nurses routinely educated patients about
self-breast examinations, while 33.3% (n=3) did not. Furthermore, 77.8% (n=7) of
respondents adhered to referring patients with suspicious findings for further
evaluation.Daily record-keeping of patients’ clinical findings was practiced by all
respondents (100%, n=9). However, only 55.5% (n=5) ensured continuous updates
on breast cancer prevention guidelines.

The study identified various practices nurses employed to promote breast cancer
prevention

Patient Education

77.8% regularly engaged in educating patients about breast cancer risk factors, self-
examination, and the importance of early screening.

Community Engagement

66.7% participated in awareness campaigns aimed at educating the public on breast

health and encouraging participation in routine screenings.

Clinical Practices

Nurses conducted breast exams during routine check-ups and encouraged referrals
for mammography among high-risk groups.Despite commendable efforts, limitations
in time, staffing, and resources constrained the scope and frequency of these
practices.

Implementation of Screening and Education Programs

The findings indicated that 77.8% of nurses routinely educated patients on self-
breast examination (SBE), and 66.7% actively encouraged participation in
mammography screenings. However, barriers such as limited time and insufficient
resources were noted by 55.6% of respondents, hindering the implementation of
these practices.

Counseling and Emotional Support

Approximately 77.8% of nurses reported regularly providing emotional support and

counseling to breast cancer patients, emphasizing the importance of early detection
and treatment adherence. Despite these efforts, some nurses highlighted challenges
in addressing the psychosocial needs of patients due to limited specialized training.

Knowledge of Breast Cancer Guidelines

While 77.8% of participants reported being aware of breast cancer prevention

guidelines, only 44.4% could correctly identify all components of the CDC breast
cancer prevention framework, including screening, education, and lifestyle
modification. These findings suggest a moderate level of knowledge, with gaps in
understanding specific aspects of evidence-based guidelines.

Table 4: Practices of Nurses in Breast Cancer Prevention

Category Practices Percentage (n) Significance

Educates patients about Focus on early

breast cancer risk factors, detection and the
Patient Education 77.8% (n=7)
self-examinations, and importance of self-
screening examinations.

Educates patients routinely Some nurses (33.3%,

about self-breast 66.7% (n=6) n=3) did not engage in
examinations (SBE) this practice.

Provides continuous Indicates a need for

updates on breast cancer 55.5% (n=5) improving guideline
prevention guidelines adherence.

Participates in breast Promotes routine

Community
health awareness 66.7% (n=6) screenings within the
Engagement
campaigns public.

Encourages referrals
Conducts breast exams
Clinical Practices 77.8%(n=7) for mammography for
during routine check-ups
high-risk patients.

Refers patients with Critical part of

suspicious findings for 77.8% (n=7) ensuring thorough
further evaluation diagnosis.

Maintains daily record-

Ensures organized
keeping of patients' clinical 100% (n=9)
patient tracking.
findings

Barriers include
Actively encourages
limited time and
participation in 66.7% (n=6)
resources (noted by
mammography screenings
55.6% of nurses).

Provides emotional Emphasizes early

Counseling and
support and counseling to detection, treatment
Emotional 77.8% (n=7)
breast cancer patients adherence, and
Support
patient-centered care.

Some nurses cite

Addresses psychosocial challenges due to
N/A
needs limited specialized
training.
4.5 Challenges in Implementing Breast Cancer Prevention Strategies

The nurses highlighted several challenges in executing prevention measures:

Resource Constraints

Limited access to upto date diagnostic tools such as mammography machines and
laboratory facilities impeded early detection efforts.

Knowledge Gaps

Despite high levels of overall knowledge, some nurses reported insufficient training
in advanced diagnostic techniques and emerging breast cancer management
strategies.

Patient-Related Barriers

Cultural beliefs and lack of awareness among patients hindered their acceptance of
preventive measures and screenings.These challenges underscore the need for
targeted interventions to equip nurses with resources, time, and enhanced
knowledge to effectively fulfill their roles.
CHAPTER FIVE
DISCUSSION,CONCLUSIONS AND RECOMMENDATIONS.

5.1 Introduction

This chapter provides an analysis and interpretation of the research findings

concerning the knowledge and practices of nurses at Machakos Level 5 Hospital
Cancer Centre in the prevention of breast cancer. The findings are discussed in
relation to the objectives, and conclusions are drawn based on the evidence. Finally,
practical recommendations are proposed to enhance nurses' capabilities in breast
cancer prevention.

5.2 Discussion

The study found out that majority of the nurses in the Cancer Centre are female. The

study also found out that the level of education of most of the nurses was higher

diploma followed by nurses with a Bachelor’s degree and then Master’s degree. This

study is study is similar to a study done in Egypt by Karima F Elshamy (2013) which

shows that majority of the nurses in the Cancer Centre are female. It also shows that

of all the nurses in the Cancer Centre, majority of the nurses had A1 Diplomas

followed by Bachelors degree and Master’s degree.

The research identified that most nurses possessed substantial knowledge of breast
cancer risk factors, including genetic predispositions, lifestyle influences, and
hormonal dynamics. Awareness of early signs and symptoms such as palpable lumps,
skin changes, and nipple discharge was also notable. However, gaps were evident
among a minority of nurses, particularly in advanced diagnostic techniques and risk
stratification. This study is similar to a study done by Abu Sharour, L.(2019) that
indicated nurses had limited knowledge regarding breast cancer prevention,

Findings of this research indicated that majority of nurses were actively involved in
promoting breast self-examinations, educating patients about risk factors, and
advocating for regular clinical breast screenings. Community outreach programs
further illustrated their dedication to raising awareness. Practices such as performing
clinical breast exams and encouraging mammography were reported as
standard.However, systemic issues like insufficient resources and time constraints
impeded these practices. High patient-to-nurse ratios limited the depth and
frequency of patient education. This finding resonates with Wurjine, T. H., Bogale,
N., & Menji, Z. (2019) assertion that structural barriers often hinder optimal nursing
practice. Addressing these issues is critical for enhancing preventive healthcare
delivery.

The findings of this research highlight a significant correlation between nurses'

knowledge, evidence-based practices, and positive patient outcomes, as well as
adherence to breast cancer prevention strategies. Nurses who demonstrated a
strong understanding of breast cancer prevention based on CDC guidelines and
actively implemented these practices achieved more favorable outcomes for their
patients and made a positive impact on the community. These results contrast with a
study by El-Sakhawy, M. A. (2024), which suggested that positive patient outcomes
were primarily influenced by nurses’ attitudes and practices rather than their
knowledge of breast cancer prevention or adherence to CDC guidelines.

The study revealed that all nurses acknowledged the significance of regular breast
examinations, highlighted mammograms as the most effective screening tool, and
stressed the importance of lifestyle modifications in reducing risk. They also
consistently educated patients on self-breast examinations and promptly referred
those with suspicious findings for further evaluation. These findings align with a
study by Oluwatosin, O. (2012), which similarly reported that the majority of
oncology nurses recognized the importance of breast examinations, endorsed
mammograms as the best screening method, and emphasized lifestyle changes to
mitigate risk.

The study highlighted several challenges affecting effective breast cancer prevention
practices:

· Resource Constraints: Limited access to essential diagnostic tools, such as

mammography machines, posed a significant obstacle to early detection efforts.

· Cultural Barriers: Patient resistance stemming from cultural beliefs and limited
awareness hindered participation in early detection and screening initiatives.

· Knowledge Gaps: Despite a solid foundation of general knowledge, deficiencies in

specialized areas underscored the critical need for ongoing professional
development.

5.3 Conclusions

Nurses at Machakos Level 5 Hospital demonstrated strong knowledge and practices

in breast cancer prevention. All respondents recognized the importance of regular
breast examinations, with most identifying mammograms as the most effective
screening tool (77.8%) and emphasizing lifestyle modifications to reduce risk
(88.9%). Adequate knowledge of risk factors, such as genetic predisposition, lifestyle
influences, and hormonal factors, was also evident among 77.8% of the participants.
In practice, 77.8% routinely educated patients on breast cancer risk factors, self-
examinations, and screening, while 66.7% conducted breast exams during routine
check-ups and encouraged mammography participation. Additionally, all nurses
maintained detailed records of patients’ clinical findings, demonstrating well-
organized practices.

However, several areas for improvement were identified. Only 66.7% of nurses
consistently educated patients about self-breast examinations, and just 55.5%
regularly updated their knowledge of breast cancer prevention guidelines.
Furthermore, 33.3% exhibited gaps in understanding advanced diagnostic tools and
early detection techniques, underscoring the need for targeted training.

5.4 Recommendations

5.4.1 For Nurses

Continuous Education: Engage in ongoing training programs to enhance knowledge

of emerging breast cancer prevention strategies and advanced diagnostic
techniques.

Adherence to Evidence-Based Practices: Incorporate up-to-date guidelines from

reputable bodies such as WHO and CDC into daily practice.

5.4.2 For Healthcare Institutions

Improved Resource Allocation: Prioritize investments in diagnostic tools, such as

mammography machines and screening equipment, to support nurses.

Support for Training: Facilitate regular professional development opportunities

focused on cancer prevention and early detection.

5.5 Areas for Further Research

Investigate the effect of structured training on improving nurses' practices in other

health facilities.

Explore patient perspectives on nurse-led breast cancer prevention initiatives to

identify gaps and opportunities for improvement.
References:

Wurjine, T. H., Bogale, N., & Menji, Z. (2019). Assessment of knowledge, attitude and
practice towards breast cancer early detection methods among female health
professionals at public health centers of Addis Ababa, Ethiopia, 2017. MOJ Womens
Health, 8(3), 201-9.

Prolla, C. M. D., Silva, P. S. D., Netto, C. B. O., Goldim, J. R., & Ashton-Prolla, P. (2015).
Knowledge about breast cancer and hereditary breast cancer among nurses in a
public hospital. Revista latino-americana de enfermagem, 23(1), 90-97.

Ibrahim, A. M., Zaghamir, D. E. F., Elsehrawey, M. G., & El-Sakhawy, M. A. (2024).

Knowledge and attitudes of male nursing students concerning male breast cancer
and ways of prevention. International Journal of Africa Nursing Sciences, 20, 100662.

Andegiorgish, A. K., Kidane, E. A., & Gebrezgi, M. T. (2018). Knowledge, attitude, and
practice of breast Cancer among nurses in hospitals in Asmara, Eritrea. BMC
nursing, 17, 1-7.

Abu Sharour, L. (2019). Oncology nurses' knowledge about lymphedema assessment,

prevention, and management among women with breast cancer. Breast
Disease, 38(3-4), 103-108.

Okobia, M. N., Bunker, C. H., Okonofua, F. E., & Osime, U. (2006). Knowledge,
attitude and practice of Nigerian women towards breast cancer: a cross-sectional
study. World journal of surgical oncology, 4, 1-9.

Santhanakrishnan, N., Prabakaran, S., & Singh, Z. (2016). Knowledge, attitude, and
practice regarding breast cancer and its screening methods among nursing staff
working in a tertiary-care hospital located in South India. Int J Med Sci Public
Health, 5(8), 1650.

Oluwatosin, O. (2012). Primary health care nurses’ knowledge practice and client
teaching of early detection measures of breast cancer in Ibadan. BMC nursing, 11, 1-
8.
Karadag, M., Iseri, O., & Etikan, I. (2014). Determining nursing student knowledge,
behavior and beliefs for breast cancer and breast self-examination receiving courses
with two different approaches. Asian Pacific Journal of Cancer Prevention, 15(9).

Othman, A., Ahram, M., Al-Tarawneh, M. R., & Shahrouri, M. (2015). Knowledge,
attitudes and practices of breast cancer screening among women in Jordan. Health
care for women international, 36(5), 578-592.

Atuhairwe, C., Amongin, D., Agaba, E., Mugarura, S., & Taremwa, I. M. (2018). The
effect of knowledge on uptake of breast cancer prevention modalities among
women in Kyadondo County, Uganda. BMC Public Health, 18, 1-8.

Azubuike, S. O., & Okwuokei, S. O. (2013). Knowledge, attitude and practices of

women towards breast cancer in Benin City, Nigeria. Annals of medical and health
sciences research, 3(2), 155-160.

Prolla, C. M. D., Silva, P. S. D., Netto, C. B. O., Goldim, J. R., & Ashton-Prolla, P. (2015).
Knowledge about breast cancer and hereditary breast cancer among nurses in a
public hospital. Revista latino-americana de enfermagem, 23(1), 90-97.

Yousuf, S. A., Al Amoudi, S. M., Nicolas, W., Banjar, H. E., & Salem, S. M. (2012). Do
Saudi nurses in primary health care centres have breast cancer knowledge to
promote breast cancer awareness?. Asian Pacific Journal of Cancer Prevention, 13(9),
4459-4464.

Heena, H., Durrani, S., Riaz, M., AlFayyad, I., Tabasim, R., Parvez, G., & Abu-Shaheen,
A. (2019). Knowledge, attitudes, and practices related to breast cancer screening
among female health care professionals: a cross sectional study. BMC women's
health, 19, 1-11.

Appendix I
Information and Consent
My name is Joseph Mugi Macharia, a final year student at Umma University pursuing

a degree in Bachelor of Science in Nursing. I am undertaking a study on knowledge

and practice of nurses in prevention of Breast Cancer in Machakos level 5 hospital

Cancer Centre.

Participant’s consent

I have read the information and understood, the risks and benefits of the study have

been explained to me. I understand that my participation in this study is voluntary

and that I may choose to withdraw at any time. I freely agree to participate in this

research study.

I understand that all efforts will be made to keep information regarding my identity

confidential.

Signature……………………………… Date……………………………

Appendix II

Structured questionnaire

CLIENT NO………….

DATE…………………..
A STUDY OF KNOWLEDGE AND PRACTICE OF NURSES IN PREVENTION OF BREAST

CANCER IN MACHAKOS LEVEL 5 HOSPITAL

Instruction: Tick where appropriate

SECTION 1:

Socio demographic Characteristic of respondents

Instruction: This part contains 5 questions which are related to socio-demographic

characteristics of the respondents. Read each questions and write the response(s)

of the respondent under the response column

1. What is your

sex?.........................................................................................................................

2. What is your

age?.........................................................................................................................

3. What is your level of

education?................................................................................................

4. What is your specialization

training?...........................................................................................
5. How long have you worked in the Cancer

Centre?.............................................................

SECTION 2:

Knowledge of Breast Cancer and Prevention:

Please read each question listed below and write your answer, encircle or tick your
answer where necessary.

1. How would you define breast cancer?

...................................................................................................................................

...................................................................................................................................

...................................................................................................................................

........................

2. Which of the following are risk factors for breast cancer? (Select all that
apply)
3. Family history of breast cancer
4. Genetic mutations (e.g., BRCA1/BRCA2)
5. Obesity
6. Alcohol consumption
7. Smoking
8. Hormonal influences

9. What are the common symptoms of breast cancer? (Select all that apply)
 10. Breast lumps
11. Nipple discharge
12. Changes in breast shape or size
13. Skin dimpling

14. What preventive measures for breast cancer are you aware of? (Select all
that apply)
15. Regular self-breast exams (SBE)
16. Clinical breast exams
17. Mammograms
18. Lifestyle modifications (e.g., exercise, healthy diet)

19. Are you aware of any advanced diagnostic tools for early detection of breast
cancer?
20. Yes
21. No

Section 3:

Practices in Breast Cancer Prevention

22. Do you routinely educate patients about self-breast examination (SBE)?

23. Yes
24. No

25. How often do you engage in community awareness campaigns about breast
cancer?
26. Regularly
27. Occasionally
28. Never

29. Do you follow guidelines for referring patients for mammograms?

30. Yes
31. No

32. Do you ensure patients are updated on breast cancer prevention guidelines?
33. Always
 34. Sometimes
35. Rarely

36. Do you maintain daily records of patients’ clinical findings regarding breast
cancer?
37. Yes
38. No
39.

40. Section 4:

Challenges in Implementing Prevention Strategies

41. What challenges do you face in breast cancer prevention practices? (Select all
that apply)
42. Limited access to resources (e.g., mammography machines)
43. Insufficient time for patient education
44. Knowledge gaps in advanced diagnostic techniques
45. Cultural beliefs among patients
46. Others (Please specify): __________

47. What support do you think is needed to improve your practice in breast
cancer prevention?

Consent Declaration

 I consent to participate in this study and understand that I can withdraw at any time.

 Yes
 No

CONSENT FORM
Title:

A Study on the Knowledge and Practices of Nurses in Breast Cancer Prevention in

Machakos Level 5 Hospital Cancer Centre.

Principal Investigator:

Joseph Mugi Macharia

Introduction:

You are invited to participate in a research study aimed at assessing the knowledge
and practices of nurses regarding breast cancer prevention in Machakos Level 5
Hospital Cancer Centre. This study is being conducted as part of a research project by
Joseph Mugi Macharia a final year student at Umma University.

Purpose of the Study:

The purpose of this study is to evaluate the current level of knowledge and the
practical approaches employed by nurses in the prevention of breast cancer. The
results of this study aim to identify knowledge gaps and improve preventative
practices in nursing care, thereby enhancing early detection and treatment
outcomes.

Procedures:

If you agree to participate in this study, you will be asked to complete a structured
questionnaire that explores your demographic details, your knowledge about breast
cancer risk factors, signs and symptoms, and prevention strategies, as well as your
current nursing practices related to breast cancer prevention. The questionnaire will
take approximately 20-30 minutes to complete.

Additionally, direct observation of nursing practices will be conducted to evaluate

adherence to recommended breast cancer prevention guidelines and methods.

Risks and Benefits:

There are no known risks associated with your participation in this study. Your input
will help improve understanding and practices regarding breast cancer prevention in
nursing care. The findings will contribute to enhancing patient outcomes and nursing
education in this area.

Confidentiality:

All information gathered in this study will remain strictly confidential. Data will be
securely stored and only accessible to the research team. Personal identifying
information will not be included in any reports or publications to ensure anonymity.
Voluntary Participation:

Participation in this study is entirely voluntary. You are free to withdraw at any stage
of the research without any repercussions.

If you have any questions or concerns regarding the study, please contact the
principal investigator, Joseph Mugi Macharia.

By signing this consent form, you confirm that you have read and understood the
information provided above and that you willingly agree to participate in this
research study.

Participants Signature: ______________________

Date: ___________________

Researcher's Signature: ______________________

Date: ___________________

Appendix III

Budget

Item Unit Quantity Total

cost(shillings)
a) Stationery Pen 10 20 200
Pencil 10 10 100
Staple pins 145 1 box 145
Stapler 500 1 500
 Plain papers 500 1 ream 500

b) Printing Draft proposal 10 per page 20 200

Final copy proposal 10 per page 20 200
Questionnaires 10 per page 90 900

c)binding Draft proposal 50 1 50

Final copy proposal 50 1 50
Final project 1000 2 2000
d)Fieldwork

Research assistant 100 per day 3 300

Internet and 50 per day 3 150
communication
Grand Total 5,295
Appendix IV: Work plan
YEAR 20 20 20 20 20 20 2024 2024 2024 2024
24 24 24 24 24 24

MONTH Apr Apr Ma Ju Ju Jun Septe Octob Novem Novem

il il y ne ne e mber er ber ber

Problem
Identification

Literature
Review

Proposal
Writing

Data
Collection

Data Analysis
and Report
Writing

Submission
of the
dissertation