RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA.
ANNEXURE –II
PROFORMA FOR THE REGISTRATION OF SUBJECT FOR DISSERTATION
1.
/NAME OF THE CANDIDATE
AND THE ADDRESS
/MISS SUNITA DEVI
K.L.E.S.’s INSTITUTE OF NURSING SCIENCES, NEHRU NAGAR,BELGAUM-10.
2.
/NAME OF THE INSTITUTE
/K.L.E.S.’s INSTITUTE OF NURSING SCIENCES,
NEHRU NAGAR,BELGAUM – 10.
3.
/COURSE OF THE STUDY
/M. Sc. NURSING 1st YEAR
MEDICAL SURGICAL NURSING.4.
/DATE OF ADMISSION TO THE COURSE
/JUNE 2007
5.
/TITLE OF THE TOPIC
/“EFECTIVENESS OF A LEARNING package on care of patients with permanent pacemaker (ppm) among staff nurses.”
6. / BRIEF RESUME OF THE INTENDED WORK:6.1 NEED FOR THE STUDY:
“To know all, it is necessary to know very little, but to know that very little, one must first know pretty much”. – GEORGE I. GURDJEFF.
The heart is one of the few truly vital organs. Disorders related to the heart are currently the leading cause of death through out the world. Cardiovascular diseases account for 12 millions deaths annually worldwide.1
Fortunately, heart disease as a cause of death has been gradually declining since the early 1970s. with continued advances in research and clinical practice, the coming decades may see additional break through in preventing and treating cardiovascular disorders especially dysrhythmias such as Bradyarrhythmia, Atrial fibrillation (AF), Ventricular Fibrillation (VF), Supra ventricular Tachycardia (SVT) etc.2
The most important treatment for dysrhythmias (i.e. Bradyarrhythmia, VF, AF) is pacemaker implantation to save the life of patient. Cardiac pacemakers are a proven treatment in the management of many cardiac dysrhythmias. As per statistical data over 2 million pacemakers have been implanted world wide since 1960. The first human implant of a totally implantable pacemaker was in 1960. Its battery life was approximately 12-18 months.2
World’s first “Demand” pacemaker was introduced in mid – 1960s, since the heart beats on its own and provides pacing only when necessary. All new pacemakers today are “demand” models.2
Cardiac dysrhythmias such as atrial fibrillation (AF) and ventricular fibrillation (VF) are the most prevalent and serious condition commonly found. In 2002, the estimated prevalence of AF was 2,200,000 in US adults. (MMWR. February 21, 2003).3
Sudden cardiac deaths – the number is estimated to be 3,35,000 per year, (American Heart Association, 2005) most likely deaths result from ventricular fibrillation.3
Through research, the understanding of cardiovascular disease continues to grow hourly. As a result the care of people with heart disease is currently one of the most progressive area in nursing. Nurses caring for clients with cardiac disorders and cardiac pacemakers must understand cardiac structure, functions and all about pacemaker. Special care, has to be taken before and after pacemaker implantation, and at the time of discharge. They must be able to identify life-threatening dysrhythmias, identify capture to sense and failure to sense about pacemaker. She should be ready to initiate appropriate emergency intervention whenever needed.1
Because permanent pacemaker (PPM) and cardiovascular disorders are long term. Another important component of nursing care is education of the clients about self management with PPM. Caring for individuals with PPM and cardiovascular disorders is not confined to the critical care unit but is common throughout the scope of nursing practice medical – surgical units. Caring for clients who have chronic illnesses can be very challenging for nurses. Nurses are called on to deliver many aspects of care to these clients, including helping ease, their pain of illness, listening to the client regarding feelings about his or her illness, assisting in the technological care of their disease process and perhaps in helping patients work through their decisions about treatment options. Clients who are in the chronic stages of their illness may come to rely on nurses for a care that may go beyond the realm of nursing practice. When decision becomes over whelming, clients might prefer that their health care providers make all the health care decisions for them. The role of the cardiological nurse is to perform an important part in treating medical emergencies. In order to treat these all emergencies and take care of patients with permanent pacemaker, nurses need to know in detail about the care of patients with pacemaker.2
Today in the 21st century, technology is fast growing and every individual from the school going child to an adult is expected to update his knowledge and skills to maintain a pace with this fast moving society. Nursing being a profession that deals with aspects of human life, every nurse is expected to meet the requirements what the time calls for. Few nurses are compelled and involuntarily practice the same old traditional methods and practices when the profession began.
But the major inadequacy the investigator remarked during her clinical experience in coronary care units are the reality of insufficient knowledge and the ignorance of the staff nurses in patient care with permanent pacemaker (PPM).3 This inadequacy is reported to be the result of the following factors like lack of motivation, lack of interest, shortage of specialized nurses, lack of refresher courses and a busy schedule.
Today cardiovascular nursing has come to occupy an important place in this sphere of modern nursing. In recent years, there has been tremendous increase in the implantation of permanent cardiac pacemakers all over the world. Although these devices have proved to be life saving in he patients yet they are associated with a number of complications like skin necrosis and infection, haematoma formation, endocarditis, fracture of leads and malfunctioning of the device.
Therefore, to develop a generation of nurses that are efficient and skillful in their practice, the investigator concludes that the only means to achieve this goal is a learning package for the contemporary nurses on care of patients with permanent pacemaker.
In time to come the investigator hopes that a nurse be the one who not only follows the orders of the physician but will be confident to judge her care of the client. Quality care is the basic responsibility of every nurse.
It is therefore imperative that a study should be conducted in cardiac units on nurses caring for patients with permanent pacemaker.
6.2 REVIEW OF LITERATURE:
A descriptive study was conducted on risk factors analysis of permanent pacemaker infection in Chicago. The sample size of the study was all patients who had a permanent pacemaker implanted from January 1991 to December 2003 and were retrospectively reviewed. Univariate and multivariable analysis were performed to identify significant risk factors for PPM infection. The study revealed that 29 case patients and 58 control subjective met inclusion criteria. The majority (83%) of case patients presented with a pocket infection; a minority (10%) had PPM related endocarditis. Staphylococcus species (69% were the most common pathogens).4
A study was conducted on interference by cellular phones with permanent implanted pacemakers in Europe. The sample size was 100 patients. The study revealed in two pacing inhibition with the cellular phone positioned directly above pacemaker pocket. There was an increased sensibility in PPI from 0.5 mv setting to changed to 1.0 mv. 5
A cross-sectional study was conducted on self reported adjustment to implanted cardiac devices. The sample size was 174 subjects (46 woman and 128 men). The study revealed and concluded that they found 4 subscalers for implanted device adjusted scale (IDAS): fear, anxiety, attitude, preparation and body awareness. Perceived adjustment was “good” for 89% of persons. KIC 4 subscales of the IDAS correlated negatively with adjustment. Adjustment as measured by the overall IDAS, had a weak but significant relationship with measures of quality of life. 6
A qualitative (ethnographic) study was conducted on the interplay of knowledge and decision making between nurses and doctors in critical care. Sample size was six nurses who worked in the unit. This study concluded that the nurses with specialized knowledge of the critical care unit played a major role in influencing how they interacted during decision making.7
A study was conducted on the effect of metal detector gates on implanted permanent pacemaker. Metal detectors were used in airports, the sample size was 103 non selected pacemaker patients. The study revealed no ill effect was seen on any of the units tested pacemaker inhibition was not observed and programmability was not affected. Metal detector security gates have no effect on implanted permanent pacemakers. 8
A study was conducted on multiprogrammable pacemakers. The main objective of the study was to find out the complications and the role of nurse. The sample size was 927 patients of both sexes with multipprogrammable pacemaker implanted during 1987-1988 period, at the “commandante Manuel Fajardo” teaching Hospital and institute of cardiology and cardiovascular surgery. The study revealed sepsic of pocket (46.7%); hematoma, and in a lower percentage aseptic necrosis (5.7%). Emphasis is made in the role of the nurse in front of a patient with pacemaker.9
An experimental, multicentre, randomized study with a nurse – led intervention was conducted on effects of self care program on the health related quality of life of pacemaker patients. The main objective of study was evaluation the effects on health related quality of life (HRQoL) of a 10-month self-care program for pacemaker patients. In the present study, there were no significant differences in HRQoL when comparisons were made between the experimental group and the control group. The study revealed two main findings for patients in the self-care program (n=97; mean age 71 years): a significantly better HRQoL in terms of experiencing the symptoms that were the reason for pacemaker implantation as having decreased or disappeared and higher level of perceived exertion in a ½ /1½ - minute stair test compared with patients who had standard checkups (n=115; mean age 73 years). 10
A prospective study was conducted on quality of life (QoL) and exercise capacity in patients with prolonged PQ interval and dual chamber pacemakers: A randomized comparison of permanent ventricular simulation (PVS) Vs intrinsic AV conduction, in patients with dual chamber pacemakers (PMS) and an intrinsic PQ interval > 210 ms. Dual chamber PMS in patients with AV block are usually programmed to PVS in VDD or DDD mode although long periods of 1AVC may occurs. The study revealed 14 consecutive patients (age 76 +/- 6 years; intermittent. 11
6.3 STATEMENT OF PROBLEM:
“ A study to evaluate the effectiveness of a learning package on care of patients with permanent pacemaker among staff nurses working in Heart Foundation, KLES Prabhakar Kore Hospital and MRC, Belgaum.”
6.4 OBJECTIVES OF THE STUDY :
1. To assess the knowledge of nurses on care of patients with permanent Pacemaker (PPM).
2. To find out the effectiveness of a learning package on care of patients with PPM among staff nurses through knowledge scores.
3. To determine an association between pretest knowledge scores and selected demographic variables.
6.5 OPERATIONAL DEFINITIONS :
1. Effectiveness:
Refers to determining the extent to which the information in the learning package has achieved the desired outcome as experienced by gain in knowledge score.
2. Learning Package:
Refers to a set of units forming a course of an educational scheme, prepared by the investigator on care of patients with PPM for staff nurses.
The content includes –
Ø Meaning
Ø Types
Ø Models
Ø Indications
Ø Functions
Ø Complications
Ø Identify capture to sense
Ø Identify failure to sense
Ø Guidelines to patients on discharge
Ø Prevention of infection
3. Knowledge:
Refers to the correct response from the nurses to items of cognitive (knowledge) aspects on care of patient with PPM as measured by structured questionnaire.
4. Pacemaker:
Refers to an electronic device used for pacing the heart in stead of the non-functional sino-atrial (SA) node, the natural cardiac pacemaker.
5. Permanent Pacemaker:
Refers to the power source implanted totally with in the body, subcutaneously either in the chest or abdomen, attached to pacer electrodes, which are threaded transvenously to the right ventricle or right atrium for pacing of the heart
6. Nurses:
Refers to a registered nurse with a B.Sc. (N), or GNM qualification, working in Heart foundation, KLES Prabhakar Kore Hospital and MRC, Belgaum.
7. Selected Areas:
Refers to Intensive Coronary Care unit, General Cardiology ward, Cath Lab, Private and Semi-private ward, of Heart foundation, KLES Prabhakar Kore Hospital and MRC, Belgaum.
8. Selected Demographic Variables:
Refers to demographic factors of nurses such as age, gender, professional qualification, total years of experience and exposure to in-service education programme.
6.6 HYPOTHESES :
H1 : The mean post test knowledge score will be significantly higher than the mean pretest knowledge scores at 0.05 level of significance.
H2 : There will be a significant association between pretest knowledge scores and selected demographic variables.
6.7 ASSUMPTIONS :
1. Nurses have some knowledge regarding care of patients with PPM.
2. Use of Learning Package helps method to update the knowledge of nurses on care of patients with PPM.
6.8 DELIMITATION :
The study is delimited to registered staff nurses
a) working in KLES Prabhakar Kore Hospital and MRC, Belgaum.
6.9 PROJECTED OUTCOME :
The learning package will help the nurses to keep abreast of the latest practices in care of patients with PPM.
7. / MATERIAL AND METHOD:
7.1 SOURCES OF DATA:
Primary Source :
Nurses working in selected areas of Heart Foundation, K.L.E.S, Prabhakar Kore Hospital and MRC, Belgaum.
Secondary Source :
Review of literature collected from various journals, magazines, newspapers, books and internet.
Research Approach : Evaluative
Research Design :
One Group pretest-post test design.
Research Setting : Heart Foundation, K.L.E.S, Prabhakar Kore Hospital and MRC, Belgaum.
Population :
Nurses working in Heart Foundation, K.L.E.S, Prabhakar Kore Hospital and MRC, Belgaum.
Sample Size : 55
Inclusion Criteria:
Nurses -
a) who are working in selected areas of KLES’s Prabhakar Kore Hospital and MRC, Belgaum.
b) who are willing to participate.
Exclusion Criteria:
Nurses -
a) with managerial responsibilities
b) who are not present at the time of data collection.
7.2 METHOD OF COLLECTION OF DATA:
Sampling Technique- Purposive sampling technique
Instrument : Structured knowledge questionnaire.