RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE-560041
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS(in block letters) / Mr. ATAULLA KHAN
VIVEKANANDA COLLEGE OF NURSING, CHITRADURGA-577501
KARNATAKA-INDIA
2. / NAME OF THE INSTITUTION / Vivekananda College of Nursing
Chitradurga-577501
3. / COURSE OF STUDY AND SUBJECT / 1st Year M.Sc Nursing,
Medical Surgical Nursing
4. / DATE OF ADMISSION TO THE COURSE / 11/07/2008
5. / TITLE OF THE STUDY / Assessment of the impact of the structured teaching programme on knowledge of selected cardiac arrhythmias among staff nurses working in selected hospitals at Chitradurga, Karnataka.
6. INTRODUCTION
The heart, muscular pump of circulatory system, engineered and powered by and electrical impulse that Singles the heart’s four chambers to contract, each at the proper time. The heath works in and endless contract-relax/contract relax cycle. And average heart beats 100,000 times a day, pumping some 2000 gallons of blood through its chambers and then back to the heart. Over a seventy years of life span, that adds up to more than2.5 billion heart beats.
But many forms of heart disease can interrupt the normal contract – relax cycle and cause abnormally fast or usually slow heart beats, called cardiac dysrhythmias.
These conditions make the heart pump less effectively. So that no enough blood reached the brain and other vital organs. When the body’s blood flow is in inadequate, the can faint or suffer chest pain, even sudden death can occure.
According to Nancy, when the rate, rhythm or contour of any of the individual wave of Electro Cardiogram (ECG) is abnormal, the disorder is called arrhythmias. development of arrhythmias is one of the most common complications in patients with acute myocardial infarction (Nancy).
Arrhythmias can lead to dramatic changes in circulatory dynamics such as hypotension, myocardial injury, heart failure and shock even lead to death (Black).
According to American Heart Association, the most life threatening result of cardiac arrhythmias is sudden cardiac death. Assessment and prompt adequate nursing care at early stage can prevent complications even death. The nurses working in ICCU and selected wards should be familiar with identification of such arrhythmias instant recognition of all general types including lethal arrhythmias and immediate resuscitation saves the lives of the patients.
According to Capucci. A and Ascheiri.D, recovery from non traumatic cardiac arrest depend on the presence of all the elements chain of survival.
The cardiac arrhythmias are associated with numbers of cardio rhythmic disturbances due to formation or conduction defect of the heart. The cardiac patient’s alleviating anxiety and fear, as the degree of problems raised. Patients need some one competent person for help. Staff nurses are immediate closer to patients who can play an important role to decrease fear and anxiety. By a sympathetic stress response which decreases the work load of heart and relieve pain, anxiety and further complications.
6.1 NEED FOR THE STUDY
Out of global total 52 millions deaths, 15.3 millions were due to circulatory disease, most death from circulatory disease where due to coronary heart diseases (7.2 millions). About 330 to 350 global deaths per year are due to the cardiac arrhythmias with the weighted average of 3158.1 death prevalence of arrhythmias is 53/1000. In developing countries like India non communicable diseases are becoming are more prevalent. This is the mainly due to adoption western life style and their accompanying risk factors smocking, high fat diet, obesity and lack of knowledge(WHO report 1998). In India coronary heart diseases appear a decade earlier compared with the age incidence in developed countries death from heart disease would double in India by 2015, as their growing incidence among the youth and woman according to world health organization.
India is a ageing as indicated by increase in elderly population singh and et al conducted a descriptive study over a fifty a sympathetic elderly age (65 or more) subjects having normal cardio vascular examination and absence of cardiac diseases in the part of drug history. They were subjected to 24hour holter monitoring for evaluation of arrhythmias and silent ischemia. In this study the rhythms of the elderly persons should evidence ectopic activity and occasional spells of silent myocardial ischemia.
Arrhythmias is a most prevalent life threatening alarming signal for the cardiac patients. The staff nurse requires sufficient knowledge to handle such a patient efficiently. The staff nurses have basic knowledge about cardiac emergency but she needs sufficient high level of knowledge to assess cardiac arrhythmic abnormalities, complications effectively. Hence, there is a essential needs for the staff nurses to conduct a study, to assess the impact teaching programme to update the knowledge of the nurses on cardiac arrhythmia in ICCU and selected hospitals of Chitradurga which will help for the betterment of sufferers.
The investigator felt that there is a need to study to assess the impact of structured teaching programme on knowledge of cardiac arrhythmias among the staff nurses working ICCU and selected hospitals at Chitradurga, Karnataka.
6.2 REVIEW OF LITERATURE
The purpose of review of related literature was to gain and insight into various aspects of problems under study such design method, instruments, measures and techniques of data collection that may prove useful in the proposed project.
The literature review for this study was done in the following areas:-
(1) Etiology and factors influencing of cardiac arrhythmias.
(2) Effective and significant of cardiac arrhythmias
(3) Diagnosis of cardiac arrhythmias
(4) Importance of Treatment of cardiac arrhythmias
(5) Nurses role in the management of cardiac arrhythmias
(6) Study findings related to cardiac arrhythmias and patient knowledge
(7) Knowledge of nurses related to cardiac arrhythmias and effectiveness of teaching programme.
1. Etiology and factors influencing of cardiac arrhythmias
According to Kleinman, C.S., and Nehgme, R.A,. (2004) State that fetal cardiac arrhythmias have been recognized, with increasing frequency during the past several years. The most common important fetal arrhythmias are Supra ventricular tachycardia and severe brady arrhythmias associated with complete heart block.
Symptomatic fetal tachycardia are usually supra ventricular in origin and may be associated with development of hydrops foetalis.
2. Effective and significant of cardiac arrhythmias
According To O. Neill, J.O., and et al,(2004) conducted to study to determine the prognostic importance of frequent ventricular ectopy in recovery after exercise among patient with systolic heart failure.
Systematic electrographic data during, exercise, and recovery were gathered in 2123 consecutive patients with left ventricular systolic ejection infarction <35% who were referred for symptom limited metabolic treadmill exercise testing. Of 2123 patients 140 (7%) had severe ventricular ectopy during recovery. Severe ventricular ectopy during recovery was associated with an increased risk of death (three years death rates 37%, VS 22% after adjustment for ventricular ectopy at rest and during exercise peek oxygen uptake, and other potential confounder’s severe ventricular ectopy during recovery remained predictive of death.
3. Diagnosis of cardiac arrhythmias
According to Billingnurst. F,. and et al.,(2003) conducted a study to determine the frequency of rhythm disturbance evert among the patient on remote cardiac telemetry and identify how many of these event were detected by the telemetry nurses and to explore the impact of managing telemetry on nurses workload. This prospective observational study took place in a nine bed coronary respiratory care unit (CRCU) in a tertiary Canada University hospital no lethal arrhythmias were detected during 420 hours. There was a high number of remote telemetry warning along, the vast majority of which were artifacts. A warning alarm accrued every 2.1 to 6.2 minutes. Nurses detected between 60 to 100% of valid warning alarms study showed that remote cardiac telemetry without a dedicated monitor watcher places unnecessary demand on CRCU nurses time because the vast majority of arrhythmias alarms are inconsequential. The addition of monitoring remote telemetry the CRCU nurses worked has the potential to negatively influence the care of provided to CRCU patients.
4. Importance of Treatment of cardiac arrhythmias
According to wyaman, M.G, and et al.(2002) primary ventricular fibrillation (PVF) during and acute myocardial infarction (AMI) occurs with high incidence and morality rate with or without thrombosis. The incidence where is from 2% to 19%. The conducted on observational study of 4,254 patients with, which reports the incidence and mortality rates of PVF or 32 years. The incidence of PVF was 0.5% among the 4150, who received prophylactic lidocain and 10% among the 104 who did not P<0.0001 mortality rates were 10.5% in patients without PVF and 25% in patients with VF (P<0.0001). Thus it was conducted that prophylactic lidicain markedly decreased the incidence of PVF in 4150 patients with AM 1 to 0.5% compared with trails before and after throbolysis 2% to 19% and with the 104 patients in this study who did not receive prophylactic lidocian 10%.30.
5. Nurses role in the management in cardiac arrhythmias
According to Dougnetry, C.M.(2002) and et al conducted a study of two group randamanaised clinical trail design was used with majors at base line, one month, and three months after ICD therapy primary outcomes included physical functioning, psychological adjustment, knowledge and health care use. The intervention group, as compared to the control group, had significantly reduced mean patients concerned assessment (PCA) asymptoms at one month(P<0.02) and reduced anxiety (P<0.08) and enhanced knowledge (P<0.02) at three months. It was concluded that the structured telephone intervention delivered during the first week after ICD therapy by expert cardio vascular nurses decreased ICD related physical asymptoms and anxiety and increased sudden cardiac arrest knowledge over 3 months.
6. Study related to knowledge deficit of staff nurses and effectiveness of teaching programme.
Broomfield,.R.,(2002) conducted quasi experimental study to investigate the retention of basic cardio pulmonary resuscitation, (CPR) skills and knowledge by qualified nurses following courses in a professional development the 19 nurses participated in the research were qualified staff undertaking the English national board (ENB) 923 course in professional development, which included a refresher on basic CPR skills and included some discussion regarding advance techniques.
Two research tools namely an eight point skills testing observation tool and a 26 points knowledge testing questionnaire, were designed an used while a 3 hours update in CPR skills revealed an initial improvement, the decrease retention of skills ten weeks later was significant (P<0.001) the update in CPR knowledge also revealed an initial improvement but the decreases in retention of knowledge 10 weeks was significant (P<0.001). The findings of this research of suggested that retention of the skills and knowledge quickly deteriorates if not used or updates regularly. There fore this research support the importance of CPR refresher courses on irregular basis.
7. Knowledge of nurses related to cardiac arrhythmias and effectiveness of teaching programme
The study finding focused on to extend the knowledge of nurses on cardiac arrhythmias, this knowledge will help nurses to extend appropriate nursing care or cardiac arrhythmias patients.
Hence a study to assess the impact of the structured teaching Programme on knowledge of cardiac arrhythmias among staff nurses working in ICCU, in selected hospital at Chitradurga, Karnataka.
6.3 STATEMENT OF THE PROBLEM
Assessment of the impact of the structured teaching programme on knowledge of selected cardiac arrhythmias among staff nurses working in selected hospitals at Chitradurga, Karnataka.
6.4 OBJECTIVES OF THE STUDY
- To assess the label of knowledge on management of selected cardiac arrhythmias by pre-test.
- To prepare and implement the structured teaching programme on knowledge of arrhythmias among the staff nurses.
- To determine the impact of structured teaching programme on management of selected cardiac arrhythmias by post-test.
- To analyze and interpret the study findings with different socio demographic variables.
6.5 OPERATIONAL DEFINATION
1. Impact: refers to the effectiveness of teaching programme given to staff nurse.
2. Cardiac arrhythmias: disorder of the formation or conduction or both of the electrical impulse with in the heart.
3. Nurses: Staff nurses and midwifery working in selected hospitals in Chitradurga.
4. STP: Structured Teaching Programme refers to the teaching method utilized by investigator to assess and extend the knowledge of staff nurse regarding cardiac arrhythmias.
5. Knowledge: It is the ability to response the things and self awareness about their work.
6. Selected Cardiac Arrhythmias: Refers to know specific pattern of selected cardiac abnormalities.
6.6 INCLUSION and Exclusion CRITERIA
Inclusion Criteria
Staff Nurses working in different wards in selected Hospital in Chitradurga:
· Staff Nurses.
· Age: between 30 – 55 yrs.
· Sex: Male & Female.
· Available at the time of data collection.
· Willing to participate in the study.
EXCLUSION CRITERIA
· Depend upon the solution after post test situations.
· Not available at the time of data collection.
· Not willing to participate in the study.
6.7 HYPOTHESIS
H1:
There is significant difference between level of nurse’s knowledge between scores of pre-test & post-test on knowledge of among staff nurses of selected cardiac arrhythmias.
H2:
There is a significant association between post-test level of knowledge and selected socio demographic variables among staff nurses.
6.8 Assumption -
6.9 Delimitation -
7. MATIREAL AND MATHODS
7.1 SOURCES OF THE DATA
Staff nurses working in selected hospital in Chitradurga.
7.2 Method of data collection
7.2.1 Type of Study
Pre-experimental Study.
7.2.2 Research Design
Quasi experimental without control, one group pre & post test.
7.2.3 Variables
I .V- teaching programme.
D.V-knowledge of the staff nurse.
7.2.4 SAMPLE Technique
Convenience sample technique.
7.2.5 Sample SIZE
50.
7.2.6 Followup -
7.2.7 Duration of Study
1 Months.
7.2.8 Instrument
By Questionnaire Method.
7.2.9 Data Collection Procedure
Interview Method.
7.3 Does the study any investigation or intervention to be conduct on patients or other humans or animals? If so, please describe briefly.
Yes, Intervention to be conducted on humans.
The study requires investigation to assess the knowledge of staff nurses working selected cardiac unit and general ward. To intervention to improve their knowledge regarding selected cardiac arrhythmias.