PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
DISSERTATION PROPOSAL
“A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ONADVANCED CARDIAC LIFE SUPPORT AMONG NURSES IN SELECTED HOSPITALS, BANGALORE”.
SUBMITTED BY
PRAVEEN KUMAR.M
M.Sc NURSING 1ST YEAR
MEDICAL SURGICAL NURSING
BANGALORE CITY COLLEGE OF
NURSING, BANGALORE.
RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FORDISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / PRAVEEN KUMAR.MM.SC. NURSING 1ST YEAR
: BANGALORE CITY COLLEGE OF NURSING
BANGALORE
2 / NAME OF THE INSTITUTION / BANGALORE CITY COLLEGE OF NURSING
JOSCO BANGALORE
3 / COURSE OF THE STUDY AND SUBJECT / M.SC NURSING 1st YEAR
MEDICAL SURGICAL NURSING
4 / DATE OF ADMISSION / 16/08/2011
5 / TITLE OF THE TOPIC / “A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON ADVANCED CARDIAC LIFE SUPPORT AMONG NURSES IN SELECTED HOSPITALS, BANGALORE.”
6. BRIEF RESUME OF THE INTENDED WORK
6.1 NEED FOR STUDY
Heart is the hollow muscular vital organ located behind the sternum and between the lungs; its rhythmic contractions move the blood through the body and nourish it. Any variation in the heart will affect the precious life of human. So saving the heart is very essential part of the life.
Heart Disease Statistics describes the status areevery 34 seconds a person in the United States dies from heart disease, more than 2,500 Americans die from heart disease each day, Every 20 seconds, a person in the United States has a heart attack and at least 250,000 people die of heart attacks each year before they reach a hospital and studies show that under-educated people are more likely to suffer heart attacks1.
Cardiovascular disease is the world's leading killer, accounting for 16.7 million or 29.2 per cent of total global deaths in 2003The World Health Organization (who) estimates that 60 per cent of the world's cardiac patients will be Indian by 2010. In India in the past five decades, rates of coronary disease among urban populations have risen from 4 per cent to 11 per cent. Nearly 50 per cent of CVD-related deaths in India occur below the age of 70, compared with just 22 per cent in the West. This trend is particularly alarming because of its potential impact on one of Asia's fastest-growing economies. In 2000, for example, India lost more than five times as many years of economically productive life to cardiovascular disease than did the U.S., where most of those killed by heart disease are above retirement age2
To discuss the latest developments in the field of cardiac care, the seventh three-day conference of the Asian Society of Cardiothoracic Anaesthesia is being held at India Habitat Centre here.
Talking about the scenario of cardiac problems in India and the factors that have contributed to increasing the cardiac problems, Dr. Mehta added: “The prevalence rate of coronary heart disease in the urban population is more than three times than in the rural population. The incidence rate of stroke is 200 per 100,000 people. Every year approximately 25,000 coronary bypass operations and 12,000 angioplasties are carried out. In the past five decades, the rate of coronary disease prevalence among the urban population has risen from 4 per cent to 11 per cent. About 12.5 per cent of adult urban males suffer from coronary artery disease. Each year between 48,000 and 1,28,000 children are born with congenital heart diseases3.”
Estimates for the year 2006 are that 80,000,000people in the United Stateshave one or more forms of cardiovascular disease (CVD) in which high blood pressurewas73,600,000,Coronary heart diseasewas 16,800,000, Strokewas 6,500,000 and Heart Failure was 5,700,0004
The American Heart Association developed basic and advanced cardiac life support (ACLS) courses that expose participants to realistic learning situations to increase cardiopulmonary arrest survival. This experimental study compared results of two ACLS classes on measures of knowledge (content exam) and resuscitation skills (performance exam). Both the control and experimental groups consisted of physicians, nurses, emergency medical technicians, respiratory therapists, and advanced health care providers. The control group used low-fidelity simulation (LFS); the experimental group was exposed to enhanced realism via high-fidelity simulation (HFS). The findings showed a positive correlation between enhanced practice and learning but no significant correlation between posttest and skills test scores for the LFS and HFS groups. The HFS group did score higher on both cognitive and behavioral tests, but the difference was not statistically significant. Participants from both groups indicated satisfaction with their forms of simulation experience and course design. The largest difference noted was in verbal responses to course satisfaction. The experimental group stated that learning using HFS was enjoyable and adamantly recommended that ACLS should only be taught using HFS. Further study is required to assess if practicing beyond the course enhances short- and long-term retention of ACLS techniques5.
This study was conducted in Medical City Teaching Hospital in Baghdad during the period during which we started our own program of cardiac and trauma life support. 92 doctors who attended this program up until the end of the study were involved in the assessment.. A questionnaire and three part questions were given to them, the questionnaire assessed knowledge about important emergency procedures, while the first, second and third part questions assessed knowledge about Advanced cardiac life support, Basics life support and ATLS respectively. The same questions were given before giving the lectures and repeated afterwards. The results were evaluated by computer and the chi-squared test was applied. This low percentage of correct answers indicates more education and training are an urgent and important need in our country6.
This study examines Need for advanced cardiac life-support training in rural, community hospitals in southern Wisconsin. The objective of the study is to define the relative needs of the staffs of rural, community hospitals for training in advanced cardiac life support (ACLS), identify weaknesses, and modify a standard ACLS course to meet these needs: A well-validated, multiple-option, precourse test for life-support knowledge and clinical judgment was administered to the staff nurses, respiratory therapists, and practicing physicians of 12 rural, community hospitals in southern Wisconsin before their participation in a modified, extended, ACLS course, using the pre-1992 American Heart Association standards and guidelines. This study concluded that there is a need for ACLS training in community hospitals. Educational programs for physicians and staffs should be designed to meet that need7.
Patients with heart failure are prone to a variety of arrhythmias, symptomatic and asymptomatic;those are prognostically significant and have an important bearing on the management of these patients. However there are some inherent problems in assessing the frequency of these arrhythmias within a large patient population, due to a lack of uniformity in defining heart failure and the transient nature of these rhythms. Patients with heart failure commonly die suddenly. The causes of these deaths are difficult to ascertain accurately and are often presumed arrhythmic. With the advent of effective interventions to prevent sudden death, accurately defining the causal relationship between the arrhythmias and sudden death has assumed great importance to appropriately target therapy. Several attempts have been made to predict such deaths on the basis of non-invasive and invasive diagnostic investigations with variable success.
All the study show that advanced cardiac support is essential in emergency care. And nurses have inadequate knowledge in cardiac life support8
Dearth of study in India regarding nurses knowledge on advanced cardiac support and lack of knowledge among nurses motivated the researcher to do this study. And it is anticipated that the study will help the nurses to acquire knowledge regarding advanced cardiac support.
6.2 REVIEW OF LITERATURE
Review of literature provides basis for future investigations, 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.
- Studies related to importance of education regarding cardiac life support
- Studies related to importance of advancedcardiac life support
- Studies related to importance of education regarding cardiac life support
This study conducted on knowledge level of residents in a turkish university hospital on advanced cardiac life support. The aim of the study was to determine the advanced cardiac life support (ACLS) knowledge level of residents and related factors in the departments of Anesthesiology, Emergency Medicine, Internal Medicine, and Cardiology in a university hospital. For this cross-sectional study, a total of 20 multiple-choice questions were prepared concerning several different topics, including: fatal dysrhythmias, oxygenation, ventilation and airway control, asystole, and pulseless electrical activity. Questions were given to residents before their periodic training meetings and collected in 30 min. The present study emphasizes the necessity for a standardized systematic postgraduate ACLS training program for the residents of related medical disciplines. Further studies with larger groups are needed to investigate theoretical knowledge, resuscitation skill competency, and related factors9.
This is a Case-Control Study Based Education Improves Quality of Care during Cardiac Arrest among team Responses at an Academic Teaching Hospital. Simulation technology is widely used in medical education. Linking educational outcomes achieved in a controlled environment to patient care improvement is a constant challenge. During the study period, both simulator-trained and traditionally trained residents responded to ACLS events. We evaluated the effects of simulation training on the quality of the ACLS care provided. This study highlight that simulation-based educational program significantly improved the quality of care provided by residents during actual ACLS events. There is a growing body of evidence indicating that simulation can be a useful adjunct to traditional methods of procedural training10
This study conducted on teaching advanced cardiac support on stroke .the objective of the study is to determine whether a case-based educational module would increase pre hospital care providers' short-term and long-term knowledge about stroke and to compare the educational impact when the module was moderated by a physician versus an advanced cardiac life support. Identical 25-question tests (based on 1997 ACLS prehospital stroke objectives) were administered before and after the module. . This case-based approach to emergency medical services S stroke education is effective and can achieve equal benefit when administered by a physician or an ACLS instructor11.
A study conducted on Assessment of the general knowledge of emergency physicians from hospitals of the city of Salvador (Brazil) on the care of cardiac arrest patients. The objective of the study was to identify the proportion of emergency physicians certified in immersion courses of Advanced Cardiac Life Support (ACLS), professional profile, participation or not in ACLS, FCCS and ATLS immersion courses, and cognitive assessment with 22 objective questions on cardiopulmonary resuscitation In the sample studied, theoretical knowledge of CPR was higher among physicians who had attended the ACLS course, as opposed to those who had attended the ATLS course. Cardiologists who had attended the ACLS demonstrated a higher theoretical knowledge of the care of CA patients when compared with physicians from other specialties taken as whole – internal medicine, surgery, and orthopedics. Physicians who had attended the ACLS and FCCS courses demonstrated a higher theoretical knowledge of the care of CA patients when compared with physicians who had attended only one of those courses; continued education is therefore essential12.
This study investigates the Mastery learning of advanced cardiac life support skills by internal medicine residents using simulation technology and deliberate practice. The aim of the study was to use a medical simulator to assess postgraduate year 2 residents’ baseline proficiency in ACLS scenarios and evaluate the impact of an educational intervention grounded in deliberate practice on skill development to mastery standards. After baseline evaluation, residents received 4, 2-hour ACLS education sessions using a medical simulator. Residents were then retested. Performance improved significantly after simulator training. All residents met or exceeded the mastery competency standard13.
A study conducted on Knowledge and skill after brief ACLS training. An objective was to determine the knowledge level and skill base in nurse anesthetists before and after brief ACLS training, and again three months later. Thirty nurse anesthetists were tested for knowledge and skill before ACLS training comprising 1-hr lecture and handout, and 1-hr simulation training. Skill practice comprised airway management, chest compression and practice with equipment. After the training, the nurse anesthetists were immediately tested and again three months later. Conclusion of the study was after the brief ACLS training knowledge and skills were significantly improved, but knowledge was not retained at the post-training test levels until the 3-month check, albeit skills had persisted. More frequent ACLS education is necessary14
A study conducted on the retention of advanced cardiac life support knowledge among registered nurses.In an investigation into the retention of advanced cardiac life support (ACLS) knowledge over time, the authors found that ACLS scores significantly decreased for a subgroup of a sample of 40 RNs employed in critical care areas in the first year after certification. Several variables that influenced scores were identified. Recommendations for inservice educators include reconstructing the ways in which ACLS courses are taught, conducting mock mega code scenarios every 6 months, constructing mega code scenarios that reflect the reality of practice, and routinely conducting refresher courses based on problems identified in a particular group15
- Studies related to importance of advanced cardiac life support
This study examines advanced cardiac life support in out-of-hospital cardiac arrest in 17 cities before and after advanced-life-support programs were instituted and enrolled 5638 patients who had had cardiac arrest outside the hospital. The addition of advanced-life-support interventions did not improve the rate of survival after out-of-hospital cardiac arrest in a previously optimized emergency-medical-services system of rapid defibrillation. In order to save lives, health care planners should make cardiopulmonary resuscitation by citizens and rapid-defibrillation responses a priority for the resources of emergency-medical-services systems16
A prospective study on Withholding advanced cardiac life support in out-of-hospital cardiac arrest among One hundred and fourteen patients. This was a descriptive study, in a physician-staffed emergency medical service during a 12 month period. All patients presenting with a cardiac arrest were included. Patients were allocated to two groups: immediate decision to give CPR (R group) or withholding CPR (NR group). Characteristics of patients including previous health status, time intervals, therapies and outcomes, were collected. This study concluded that decision criteria leading to refrain from starting CPR in the prehospital setting are age, previous health status and initial BLS17
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This study was examining treatment of prolonged ventricular fibrillation. The purpose of this study was to compare cardiac resuscitation outcome between immediate counter shock of prolonged ventricular fibrillation with high-dose epinephrine therapy and conventional CPR before counter shock of prolonged ventricular fibrillation in a canine model. Early counter shock of ventricular fibrillation has been shown to improve immediate and long-term outcome of cardiac arrest. The findings of this study suggest that a brief period of myocardial perfusion before countershock improves cardiac resuscitation outcome from prolonged ventricular fibrillation18
STATEMENT OF THE PROBLEM
“A Study To Evaluate The Effectiveness Of Structured Teaching Programme On advanced cardiac life support among nurses in selected hospitals, Bangalore.”
6.3 OBJECTIVES OF THE STUDY
- Assessingthe knowledge regarding advanced cardiac life supportamongnurses in the terms of pretest
- Evaluate the effectiveness of structured teaching programme regarding advanced cardiac life support by comparing pretest score on post test knowledge score
- Find out the association between knowledge score on post test knowledge score and selected demographic variables..
6.4 OPERATIONAL DEFINITIONS
1) Effectiveness: Refers to the extent to which the structured teaching programmes on advanced cardiac life support has achieved the desired effect in improving the knowledge of nurses as assessed by structured questionnaire
2) Structured Teaching Programme: Refers to systematically planned group instructions by lecture cum discussion method designed to provide information regarding advanced cardiac life support such as meaning, indications, uses, equipments setting, clinical interventions and management.
3) Advanced cardiac life support refers toa set of clinical interventions for the treatment of cardiac arrest and other life threatening medical emergencies,and also refers to the knowledge and skills necessary to deploy those interventions.
6.5 HYPOTHESIS
H1 : There is a significant deference in the knowledge score on advanced cardiac life supportin the post test knowledge score than the pretest knowledge score among nurses
H2 : There is a significant association between knowledge score and demographic variable
6.6 ASSUMPTION
The nurses will have inadequate knowledge regarding advanced cardiac life support
The planned teaching programme improves the knowledge of nurses regardingadvanced cardiac life support
6.7 PROJECTED OUTCOME
The structured teaching programme will enhance nurse’s knowledge regarding advanced cardiac life support
6.8DELIMITATION
The data collection period is limited to 6 weeks
Assessment of knowledge is measured by one observation only
Teaching strategy is delimited to lecture method only