RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / Mr. JAIS THOMASI st YEAR M.Sc. NURSING
NISARGA COLLEGE OF NURSING,
NO.18, KIADB, B. KATIHALLY, INDUSTRIAL AREA,HASSAN, KARNATAKA
2 / NAME OF THE INSTITUTION / NISARAGA COLLEGE OF NURSING
HASSAN
3 / COURSE OF THE STUDY
AND SUBJECT / MASTER OF SCIENCE IN NURSING
CHILD HEALTH NURSING
4 / DATE OF ADMISSION TO COURSE / 01/07/ 2011
5 / TITLE OF THE STUDY / "ASSESS THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON KNOWLEDGE REGARDING NEONATAL INTRAVENOUS (IV) FLUID INFUSION AMONG 3RD YEAR DIPLOMA NURSING STUDENTS IN SELECTED NURSING SCHOOLS AT HASSAN ”
5.1 / STATEMENT OF THE PROBLEM / “A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON KNOWLEDGE REGARDING NEONATAL INTRAVENOUS (IV) FLUID INFUSION AMONG 3RD YEAR DIPLOMA NURSING STUDENTS IN SELECTED NURSING SCHOOLS AT HASSAN ”.
6. BRIEF RESUME OF THE INTENDENT WORK
6.1 INTRODUCTION
A new baby is like the beginning of all things-wonder, hope, a dream of possibilities. (Eda J. Le Shan)
A therapeutic modality in the care of neonate, whereby medication and fluid are administered via intravenous route for the purposes of replacing fluids and electrolytes and administering medication.1
Venous cannulation has been in regular use in neonates since the 1940s. This was at first through the umbilical vein, but the frequency of complications lead to other central and peripheral routes being used for infusion of fluid, nutrients and drugs.
Umbilical vein may be used if no other veins are accessible. Other common vain that can be used are frontal superficial temporal, posterior auricular, cephalic vein, basilica vein, Dorsal venous network with tributaries, median cubital vein, basilica vein, cephalic vein median vein ,great saphenous vein, dorsal venous arch.2
Today, peripheral venous access is preferred except for high volume fluid resuscitation, reliable infusion of irritant drugs and long-term parenteral nutrition. Intraosseous infusion provides a reliable alternative to peripheral veins for rapid infusion of fluid. Long, thin silastic catheters can be inserted through peripheral venous cannulae for parenteral nutrition or other central venous infusions as an alternative to direct central venous cannulation using the seldinger or other techniques. Broviac or Hickman catheters, inserted through a subcutaneous tunnel are only considered when central venous cannulation is likely to be needed for more than six weeks. The most common serious complication of vascular access is infection. Infection associated with central venous catheters is reduced by prophylactic vancomycin or teicoplanin. Other complications of central venous infusion are associated with cannulae mal positioning, bleeding and thrombosis. Distal hypoperfusion may follow arterial cannulation.3
The majority of babies receiving care on the Neonatal Intensive Care Unit (NICU) require continuous intravenous fluids as they are unable to tolerate enteral feeds. Three way taps are not used in the administration set up. Fluids given by syringe pumps are drawn up into the appropriate size syringe and connected to the main IV access or to secondary IV access as indicated by the nature of the fluid/drug to be infused.4
Disorders of fluid and electrolyte are common in neonates and a proper understanding of the physiological changes in body water and solute after birth is essential to ensure a smooth transition from the aquatic in-utero environment. The newborn kidney has a limited capacity to excrete excess water and sodium and overload of fluid or sodium in the first week may result in conditions like necrotizing enterocolitis and patent ductus arteriosus. Simple measures like use of transparent plastic barriers, caps and socks are effective in reducing insensible water loss.5
6.2 NEED FOR THE STUDY
The requirements for fluids and electrolytes of the newborn are unique. At birth, there is an excess of extra-cellular water (ECW), and this decreases. over the first few days after birth Furthermore, ECW at birth and insensible water loss decrease as birth weight and gestational age increase. Several days after birth, fluid and electrolyte requirements increase as the infant starts to grow. Therefore, appropriate management of fluids and electrolytes in preterm infants must take into consideration the birth weight, gestational age and age after birth. Fluid and electrolyte requirements are also influenced by a variety of medical conditions that affect preterm infants (e.g., patent ductus arteriosus, necrotizing enterocolitis).6
Fluid therapy may be required in a wide verity of clinical situation to correct fluid and electrolyte imbalances, administer medications, administration blood products and nutrients.7
Clinical conditions requiring fluid therapy includes continuous gastro intestinal fluid losses in vomiting, diarrhea, nastrogasrtic tube aspiration, colostomy, burn injury, diabetic keto acidosis, pyloric stenosis and salicylate intocation.7
Insertion of peripheral venous catheters in premature and term newborns is a common practice in neonatology units and neonatal intensive care units. Nurses are responsible for the insertion and maintenance of peripheral venous catheters and for the prevention of complications. Although this technique is routine, a series of recommendations, supported by evidence-based practice, should be keep in mind when inserting these catheters. The following steps should be carried out: preparing the material, selecting the vein, selecting the catheter, cleaning and disinfecting the area, inserting the catheter, fixing the catheter, and restoring intravenous therapy. In addition, attention must be paid to potential risks in order to resolve them as quickly as possible, thereby avoiding complications.8
Fluid, electrolyte, and nutrition management is important because most infants in a neonatal intensive care unit require intravenous fluids (IVFs) and have shifts of fluids between intracellular, extracellular, and vascular compartments. Therefore, careful attention to fluid and electrolyte balance is essential. If inappropriate fluids are administered, serious morbidity may result from fluid and electrolyte imbalances. Inadequate attention to nutrition in the neonatal period leads to growth failure, osteopenia of prematurity and other complications.9
A study was conducted in USA, to describe the effect of nurse experience and competence on the length of time and the number of attempts to establish a successful IV placement in the hospitalized child. Data from a convenience sample of 592 evaluable patients and 1135 venipunctures showed that successful IV placements required an average of 2 venipunctures over 28 minutes. Although nurse experience and self-rated competence were correlated with attaining a successful IV placement, time of day, predicted difficulty of the venipuncture, and cooperativeness of the child appeared to be better predictors of success.10
A survey was performed in England on the survival of 446 peripheral intravenous infusion sites in 82 babies in a neonatal intensive care unit. Median survival was 31 hours. Factors identified by multivariate survival analysis as significantly decreasing site survival were faster infusion rates, total parenteral nutrition rather than dextrose, decreased gestational age, and co-infusion of phosphate, ceftazidime and metronidazole. Pancuronium, aminophylline and, possibly, saline and ampicillin increased survival. These data indicate that, while neonatal infusions fail more rapidly than infusions in adults, there appear to be relatively few factors that have marked effects of the rate of failure.11
Placement of peripheral pediatric intravenous (IV) catheters in infants and children is difficult, even in skilled hands.10
The researcher felt the need of education regarding neonatal intravenous fluid infusion is necessary for the diploma nursing students. As diploma nursing students will be the future nursing staff, the knowledge to do the neonatal intravenous fluid infusion will enable them to provide better care for sick child. Very rare studies were conducted on education about neonatal intravenous fluid infusion. So the researcher felt that the planned teaching programme on neonatal intravenous fluid infusion will help the diploma nursing students to gain knowledge regarding neonatal intravenous infusion.
6.3 STATEMENT OF THE PROBLEM
"A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME (PTP) ON KNOWLEDGE REGARDING NEONATAL INTRAVENOUS (IV) FLUID INFUSION AMONG 3RD YEAR DIPLOMA NURSING STUDENTS IN SELECTED NURSING SCHOOLS AT HASSAN"
6.4 OBJECTIVES OF THE STUDY
1. To assess the knowledge of the 3rd year diploma nursing students regarding neonatal Intravenous fluid infusion.
2. To develop and administer planed teaching programme regarding neonatal intravenous fluid infusion.
3. To assess the effectiveness of planned teaching programme regarding neonatal intravenous (IV) fluid infusion among 3rd year diploma nursing students through post test.
4. To compare pretest and post test knowledge on neonatal intravenous fluid infusion among 3rdyear diploma nursing students.
5. To find out the association between the knowledge on neonatal intravenous (IV) fluid infusion among 3rd year diploma nursing students with their selected demographic variables.
6.5 HYPOTHESIS
H1:- There will be significant difference between pre-test and post-test knowledge scores on neonatal intravenous (IV) fluid infusion among diploma nursing students.
H2:- There will be significant association between the post test knowledge scores regarding neonatal intravenous (IV) fluid infusion and selected demographic variables.
6.6 ASSUMPTION
1. The diploma nursing students are having basic knowledge regarding neonatal intravenous infusion.
2. The planned teaching programme improves the knowledge of diploma nursing students regarding neonatal intravenous fluid infusion.
6.7 OPERATIONAL DEFINITION
1. Assess: It refers to the process of critical analysis and valuation or judgment of the status or quality of particular condition or situation.
2. Effectiveness: It reflects to the extent to which the planned teaching programmes will improve the knowledge regarding neonatal intravenous fluid infusion among 3rd year diploma nursing students.
3. Planned teaching programme: It refers to systematically developed instructions designed on teaching regarding the neonatal intravenous fluid infusion among 3rd year diploma nursing students.
4. Knowledge: It refers to the awareness regarding the neonatal intravenous fluid infusion among 3rd year diploma nursing students.
5. Neonate: The period from birth to 28 days of life is called neonatal period and the infant in this period is termed as neonate or new born baby
6. Intravenous (IV) fluid infusion: The infusion of fluid substance directly in to the vein.
7. 3rd year diploma in nursing students : A learners who are practice an entry-level tertiary education in nursing credential
8. Nursing school: A nursing school is a type of educational institution, or part thereof, providing education and training to become a qualified nurse.
6.8 CITERIA FOR THE SAMPLE SELECTION
1. Inclusion criteria
The study includes,
1. 3rd year diploma nursing students who are willing to participate in this study
2. 3rd year diploma nursing students who are present at the time of study.
2. Exclusion criteria
The Study excludes,
1. 3rd year diploma nursing students who are not willing to participate at the time of data collection.
2. 3rd year diploma nursing students who are absent at the time of data collection
6.9 DELIMITATION
This study is limited to:
1. 3rd year diploma nursing students in selected nursing schools at Hassan.
2. Sample size of 60.
3. A period of 4-6 weeks.
6.10 SIGNIFICANCE OF THE STUDY
1. This study signifies the importance of assessing the knowledge level of 3rd year diploma nursing students regarding intravenous fluid infusion.
2. This study enhances the knowledge of 3rd year diploma nursing students regarding intravenous fluid infusion.
6.11 CONCEPTUAL FRAME WORK
The conceptual framework adopted for the study is general system theory.
6.12 REVIEW OF LITERATURE
6.12.1 Reviews related to placement and administration of neonatal IV fluid infusion
A study was conducted in USA, Validation and refinement of the difficult intravenous access score: a clinical prediction rule for identifying children with difficult intravenous access, The difficult intravenous access (DIVA) score, a proportionally weighted four-variable (vein palpability, vein visibility, patient age, and history of prematurity) clinical rule, has been developed to predict failure of intravenous (IV) placement in children. Patients undergoing peripheral IV placement by pediatric emergency department (ED) nurses were enrolled proposed refinement predictor variables include history of newborn intensive care unit stay, operator experience characteristics and skin shade. The result revealed that Patients with a DIVA score of 4 or greater had more than 50% likelihood of failed first IV attempt, This study validated the previously derived four-variable DIVA score. The researcher concluded that a simpler three-variable rule was as predictive of failed IV placement on first attempt as the four-variable rule. Validation in nonpediatric EDs is needed to thoroughly evaluate generalizability.12
A study was conducted in Chile, Randomized controlled trial of vascular access in newborns in the neonatal intensive care unit. To compare the effectiveness of two methods of vascular access in new borns.It was randomized controlled trial in neonatal intensive care unit in Regional Hospital of Valdivia. The result revealed that there were no statistically significant differences in the length of the neonatal intensive care unit stay and in the incidence of sepsis between groups. The researcher concluded that there was a significant higher incidence of phlebitis in the peripheral intravenous catheter group.13
A study was conducted in England, percutaneous central venous catheter versus peripheral canulae for delivery of parentral nutrition in neonate to determine the effect of infusion via a percutaneous central venous catheter versus a peripheral cannula on nutrient input, growth and development, and complications including systemic infection, or extravasation injuries in newborn infants who require parenteral nutrition by the use of randomized control trial. The result revealed that the use of a percutaneous central venous catheter was associated with a decreased risk of cumulative nutritional deficit during the trial period In another trial, infants in the percutaneous central venous catheter group needed significantly fewer catheters/cannulae per infant during the trial period. The researcher concluded that no evidence was found to suggest that percutaneous central venous catheter use increased the risk of adverse events, particularly systemic infection.14
A study was conducted in New Delhi a comparative study on Limb splinting for intravenous cannulae in neonates: a randomized controlled trial, to evaluate the efficacy of peripheral intravenous (IV) cannula site joint immobilization by splint application on functional duration of peripheral IV cannula in neonates. Eligible cannulations were randomized to either "splint" or "no-splint" group. In the splint group, a cardboard splint was used to immobilise the joint at peripheral IV cannula site. No attempt was made to immobilize the limb in the no-splint group. The result was duration of cannula was lesser in the splint group compared to the no-splint group. Joint immobilization with splint at cannula site did not improve the functional duration of peripheral IV cannula.15