RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE KARNATAKA

PERFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1 / NAME OF THE
CANDIDATE
AND ADDRESS / MR.RAVI KUMAR.H.B
1st YEAR M. SC. NURSING
THE OXFORD COLLEGE OF NURSING
1st PHASE, J.P.NAGAR
BANGALORE- 560078.
2 / NAME OF THE INSTITUTION / THE OXFORD COLLEGE OF NURSING
1st PHASE, J. P. NAGAR
BANGALORE- 560078
3 / COURSE OF STUDY AND SUBJECT / DEGREE OF MASTER OF SCIENCE IN NURSING
MEDICAL SURGICAL NURSING
4 / DATE OF ADMISSION TO COURSE / 01. 06. 2007
5 / TITLE OF THE TOPIC / EFFECTIVENESS OF STRUCTURED TEACHING PROGAMME ON MANAGEMENT OF PATIENTS WITH ELECTROLYTE IMBALANCES AMONG STAFF NURSES IN SELECTED HOSPITAL BANGALORE

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

For every human being one of the very precious things to maintain is Health. Health is very important for every individual to perform both physical and mental activity; any alteration in the physiology and anatomy of the body of individual may lead to various illness and abnormalities, which it may be due to various reasons. In general there are many cause of illness, such as biological, psychological and environmental causes. The various factors which lead to cause diseases and abnormalities of various systems, such as cardiovascular, renal, central nervous system and other important systems of our body1.

Fluid electrolyte of the body are the essential components of the body, it maintains the normal functions of the other important systems of the body particularly cardiovascular, renal, gastrointestinal, nervous system etc.

Alterations in distribution of body electrolytes in terms of excess or deficit

amount to any of the systems will lead to major abnormalities. Fluid electrolytes are the vital components and maintain acid base balance, homeostatic mechanism, hydrostatic pressure, regulation of body compartments through osmosis, osmoiality, tonicity, diffusion and filtration. Imbalances in fluid electrolyte also serve as major tool for diagnostic purposes of various systemic diseases2.

As a normal adult body weight consists of 60 percent of fluid electrolyte, which are present in appropriate amount and distributed into the entire body in a well balanced quantity, any alteration in these body electrolyte will lead to health problems and emergency situation. The condition in which there is alteration of normal body electrolyte is called as fluid electrolyte imbalance and is one of the abnormality for which high numbers of morbidity and mortality are evidenced. Some of the common abnormalities due to electrolyte imbalances which are responsible for hospital admissions and are in more frequency are Hypernatremia, Hypernatremia, Hyperkelemia, Hypomagnesaemia, Hypomagnesemia, acid

base disturbances etc and these conditions may result due to medications, diet, heat stroke, hemorrhage, diahorrea, burns, major surgeries etc3.

According to WHO (2002) world wide incidence of diarrhea disease is estimated to be 62,451,000, between 4 to 6 million deaths occur per year globally as a result of acute diarrhea related dehydration and loss of body electrolytes. The fluid volume deficit is found in 15% to 25% of the hospital admission and approximately 1 to 2% of the death per year in Africa4.

In USA 3.5 lakh peoples are admitted to hospital as victims of electrolyte related to burns, among which 10,000 victims lost their life5 .In India admissions due to loss of body electrolytes as a result of burns is 7 lakh to 1.2 lakhs victims lost their life. Admissions due to burns are approximately 1% of hospital clients and carries high mortality rate6. According to National center for sports injury England research indicates 103 deaths due to heat stroke between 1960 to 2000.According to the statistics from the Central Disease control and prevention Chicago an average of 354 deaths reported due to sever loss of electrolytes as a result of heat every year7.

Department of Gerontology Italy, conducted a study to find the incidence and prognosis of postoperative electrolyte imbalances among 180 elderly patients of aged between 70 to 96 years, the incidence of electrolyte imbalances related to surgery. The study findings revealed that the incidence of postoperative electrolyte imbalances and fatality was 15% and 8.8%, and concluded that post operative electrolyte imbalances is risk factors for death among elderly orthopedic patients12.

As the incidences of fluid electrolytes imbalances are many more which may lead to many life threatening conditions, for a nurse it is very important to manage conditions related to fluid electrolyte imbalances.

6.1  NEED FOR THE STUDY

For all kind of illness and abnormalities which are acute or chronic in nature and to minimize rate of mortality, it is very essential for a nurse to manage including condition related to fluid electrolyte imbalance. Nurses are the only persons who provides compressive care compared to other health practioners and dedicate themselves to a maximum extent to the patients by giving complete care from the day of admission till the day of discharge.

The role of nurse is not only to provide nursing care but also emphasizes to achieve knowledge and skill in managing critical situations Nurses through their highly skilled quality care can over come emergency conditions and also can identify, minimize complications in early stage by effective managing skills. Nurses are in need of complete knowledge about electrolyte imbalances, to anticipate, identify and understand possible electrolytes abnormalities immediately8.

According to WHO (2004) estimated that in every eight second a child dies of fluid electrolytes related disease, and in developing countries 50% of the admissions are related to fluid electrolytes9. According to the studies of the Institute of health science Nepal (April 2005 to March 2006) study on bases of hospital admissions 57 cases on diarrhea and dehydration findings predicted that 70% male and 30% females electrolyte imbalance where detected. The study concluded that hypernatremia, hpokelimia and metabolic acidosis are common electrolyte abnormalities found in the patients10.

According to the study conducted by University of Colombo, Srilanka (2007) to determine prognostic factors associated with high mortality in dengue encephalopathy in 15 patients, the findings reveled that contributing factors where acute liver failure (73%), electrolyte imbalances (80%) and shock (40%), the study concluded that out of 15 patients, 10 patients where contributing factors for mortality with dengue encephalopathy related to electrolyte imbalances11.

As the incidences of electrolyte imbalances are more in number, the investigator found a large number of morbidity and mortality due to various fluid and electrolytes imbalances in his clinical experiences. Hence it is very essential for staff nurses to have enough competencies in dealing with patients with electrolyte imbalances. To develop competency skills in managing conditions related to fluid electrolyte imbalances structured teaching programme is very essential tool to achieve nurses knowledge in depth about management of patients with electrolyte imbalances and to reduce incidence of mortality related to fluid electrolyte imbalances.

6.2 REVIEW OF LITERATURE

6.2.1 Studies related to general information about electrolyte imbalances

6.2.2 Studies related to the knowledge of staff nurses on management of patients with electrolyte imbalances.

6.2.3 Studies related to the effectiveness of structured teaching programme.

6.2.2 Studies related to general information about electrolytes imbalances

Devengenes KG ( 2006) conducted a study with an aim to show that during hyperkinesias electrolyte imbalances increase more in trained than untrained subjects. Groups were divided into four trained controlled subjects, trained hypo kinetic subject untrained controlled-uncontrolled hypo kinetic subjects. Results showed that plasma potassium, calcium and magnesium level increases more significantly during urine and fecal electrolyte exertion and concluded electrolyte decreases more in higher physical activity13.

Zhoghua Yi Xuea (2006) conducted a study with a aim to investigate acid base balance in patients with chronic severe hepatitis patients, and the findings revealed that majority of the patients has acid base disturbances and concluded that acid base disturbance (ABD) found in 115 of 126 patients14.

Jclin Nurs (2001) conducted a study to determine the relative frequency of hypomagnesium among patients with air flow limitations treated as out patients at referral center to determine hypomagnesium correlates with other electrolyte imbalances. The findings revealed that prevalence of hypomegnesia was 27.8%.The study concluded that more study should be conducted in order to determine cause of prevalence of hypomagnesia15 .

Yong Hyung (2005) conducted a study to examine whether fluid and electrolyte levels are significantly altered after eternal tube feeding in acute brain infraction patients .The study concluded that there was alteration of fluid imbalance and over hydration due to internal tube feeding 16.

6.2.2 Studies related to knowledge of staff nurses on electrolyte imbalances

Redden,Maurine ( 2001) conducted a study to assess nurses knowledge on fluid loss related to gastric surgery’s, collected sample of critical nurses (n=5) and gastrointestinal surgical nurses (n=5). The findings demonstrated that gastrointestinal nurses able to identify the problem but could not name the problem, on the other hand critical care nurses can identify problem and also name the problem. Ultimately the study recommended that practice guidelines and continuing nurses education enhances nurses knowledge on body fluid loss17.

Cook. Deeny. Thompson (2004) conducted a study to identify management of fluid and dehydration in patient with acute subarachnoid hemorrhage, and also to identify the nurse role on potential care of patients , findings reveled that nurses are knowledgeable about fluid and hydration in subarachnoid hemorrhage. The study concluded that the nurse role is pivotal and further needs education and collaboration with interdisciplinary nursing team18 .

Necker J G (2000) conducted a study on accuracy of fluid infusion of parental nutrition and fluid electrolytes, and to find fluid infusion varies for prescribed amount. Findings revealed that there is increase in accuracy of infusion of fluid electrolytes, the study concluded that rate of infusion matches with prescribed rate from 38% to84% for infusion delivered at 115ml per hour and from 67% to75% for infusion delivered at 100ml per hour19.

6.2.4 Studies related to the effectiveness of structured teaching programme on staff nurses:

Hung et al (2002) conducted study to evaluate the effect of an educational training for hospital nurses on universal precautions in china. Questionnaires where administered to 100 nurses prior to and 4 months after.The study concluded educational training improved Chinese nurses knowledge and practice of universal precautions20.

Anice George, et al (1998) conducted a study to assess the need based preparation and evaluation of SIM for staff nurses on the care of child recurring oxygen therapy. The study was conducted into two phases. The total sample of the study was 30 staff nurses of 6 months experienced in pediatric ward. The finding of the study showed high learning need statue in most of the areas and the staff nurses also expressed the desirable need for learning in detail. SIM was effective in term of gain in knowledge score as well as acceptability and utility of staff nurses21.

STATEMENT OF THE PROBLEM

A study to assess the Effectiveness of Structured Teaching programme on management of patients with electrolyte imbalances among staff nurses in selected hospital in Bangalore.

6.3 OBJECTIVES OF THE STUDY

1.  To assess the knowledge of staff nurses regarding management of patient with electrolyte imbalances by pre pest scores.

2.  To administer structure teaching programme on care of patients with electrolyte imbalances.

3.  To assess the effectiveness of structure teaching programme by pre and post test knowledge scores.

4.  To find out the association between knowledge scores with selected demographic variables.

6.4 HYPOTHESES OF THE STUDY

6.4.1 RESEARCH HYPOTHESES

H1: There will be significant difference between pre and post test knowledge scores of nurses in management of patient with electrolyte imbalances. H2: There will be significant association between pre and post test knowledge scores and demographic variables

6.4.2 VARIABLE UNDER THE STUDY

Independent Variables: Structured Teaching Programme on management of patients with electrolyte imbalances.

Dependent variables: knowledge of staff nurses related to management of patient with electrolytes imbalances.

6.5 OPERATIONAL DEFINITIONS

6.5.1 Effectiveness: refers to the extent to which the structured teaching programme on management of electrolytes imbalance produce effect in staff nurses knowledge evident from gain in knowledge scores.

6.5.2 Structured teaching programme: refers to the systematically developed instructional method and teaching aids designed for staff nurses to provide information on management of patients with electrolytes imbalances

6.5.2 Electrolytes imbalance: refers alteration in major body fluid component such as sodium, potassium, calcium and magnesium.

6.5.3 Staff nurse: refers to an individual who is qualified as a registered nurse and giving care for patient.

6.5.4 Knowledge: refers to correct response elicited through knowledge scores.

6.6 ASSUMPTION

1.  Staff nurses may have some knowledge in management of patients with electrolytes imbalance

2. Staff nurses may have interest to gain knowledge in depth about management of patient with electrolytes imbalances.

6.7 MATERIAL AND METHOD

6.7.1 SOURCE OF DATA

Staff nurses working in selected hospital in Bangalore.

6.7.2 METHOD OF COLLECTION OF DATA

Structured self reporting technique on management of patient with electrolyte imbalances.

6.7.3 RESEARCH APPROCH

An evaluative approach will be used to conduct the study.

6.7.4 RESEARCH DESIGN

Quasi experimental one group pre post test design will be adapted for the study.

6.7.5 SETTING OF THE STUDIES

Study will be conducted in the selected hospitals of Bangalore.

6.7.6 POPULATION

The population of the present study comprises of staff nurses who are working in selected hospital Bangalore.

6.7.7 SAMPLE SIZE

The sample size of present study will be 40 staff nurses.

6.7.8 SAMPLING TECHNIQUE

Purposive sampling technique will be used select the samples for the present studies.

6.7.9 SAMPLING CRITERIA

1 Staff nurses who are willing to participate in the study

2. Staff nurses who are available during the period of data collection.

3. Staff nurses who are providing care to the patients

6.8 EXCLUSION CRITERIA

1. Staff nurses who are on long leave during study

6.9 TOOL FOR THE DATA COLLECTION

Structure knowledge questionnaire. It consists of two sections.

Section A: Items on demographic variables like age, sex, educational

qualification total year of experience, in service education, special training

courses.