RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE.
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / MR. SOMASHEKARAYYA KALMATH.K.L.E.S’ INSTITUTE OF NURSING SCIENCES BELGAUM-590010 KARNATAKA
2 / NAME OF THE INSTITUTE / K.L.E.S’ INSTITUTE OF NURSING SCIENCES BELGAUM-590010 KARNATAKA
3 / COURSE OF THE STUDY AND SUBJECT / M.Sc. (NURSING) 1st YEAR
PEADIATRIC NURSING
4 / DATE OF ADMISSION TO THE COURSE / 15th MAY 2007
5 /
TITLE OF THE TOPIC
/ “EFFECTIVENESS OF SELF INSTRUCTION MODULE (SIM) REGARDING KNOWLEDGE AND PRACTICES OF CHEST PHYSIOTHERAPY ON CHILDREN SUFFERING WITH RESPIRATORY CONDITIONS AMONG STAFF NURSES”.6 / BRIEF RESUME OF THE INTENDED WORK.
6.1 NEED FOR THE STUDY
Young children fall an easy prey to infectious diseases. The leading childhood diseases are diarrhea, respiratory diseases, measles, pertusis, polio, T.B, and diphtheria etc. The statistics show that respiratory diseases in infants and children is a major problem that accounts for a large share of childhood mortality and morbidity.1
Infections of the respiratory tract are perhaps the most common ailment in children. Every year acute respiratory tract infections (ARI) are responsible for an estimated 4.1 million deaths worldwide. It is estimated that Bangladesh, India, Indonesia, and Nepal together account for 40% of the global ARI mortality. About 90% of the ARI are due to pneumonia. On an average, children below 5 years of age suffer about 5 episodes of ARI are responsible for about 30%to 50% of visits to health facilities and for about 20-40% of admissions to hospitals. 2
In India, in the states and districts with high infant and child mortality rates, ARI is one of the major causes of death. Hospital records from states with high infant mortality rates show that up to 13% of in patient death in pediatric wards are due to ARI. 2
The appropriate treatment of respiratory diseases in time generally showed good prognosis along with pharmacological therapy and non – pharmacological interventions like Chest Physical Therapy and Oxygenation improve airway clearance there by improving ventilation and breathing in respiratory conditions.
Chest physiotherapy (CPT) is an airway clearance technique that combines manual percussion of the chest wall by the care- giver, strategic positioning of the patient for mucus drainage with cough and breathing techniques. (Balchandran A, et al 2005). 3
Chest physical therapy (CPT) is the term for a group of treatments designed to improve respiratory efficiency, promote expansion of the lungs, strengthen respiratory muscles, and eliminate secretions from the respiratory system. (Tish Davidson, A.M. 2002). 4
The central function of chest physiotherapy in pediatric respiratory disease is to assist in the removal of tracheobronchial secretions. The intention is to remove airway obstruction, reduce airway resistance, enhance gas exchange, and improves the breathing. In the acute situation, recovery should be hastened and in the child with a chronic respiratory disorder, the progression of the lung disease should be hopefully delayed. Chest physiotherapy can improve a patient’s respiratory status and expedite recovery.5
The literature highlights the enormous benefits of chest physiotherapy in patient care and that it is an integral aspect of the nursing care of those suffering with respiratory conditions and risk for developing respiratory complications. A vast range of techniques now exist which are regarded under the heading of chest physiotherapy. The techniques include clapping or cupping (cupped hand percussion), positioning, shaking and vibrations, cough and breathing techniques and suctioning. 6
It is reported that intensive spirometry and deep breathing exercise are more effective at reducing pulmonary complications.7Another study recently reported that chest physiotherapy including positioning, chest wall regulation and suctioning; reduced the incidence of ventilator associated pneumonia in more sick infants.8
Finer and associates reported that, a significant decrease in the incidence of post extubation atelectasis in infants who were treated with bronchial drainage, vibration and oral suctioning when compared with the similar control group.1
Another study concluded that chest physical therapy appears to be beneficial for patients who were acutely and chronically ill and have large volumes of pulmonary secretions.
Usually children with respiratory conditions face many complications unless the chest physiotherapy performed effectively. chest physiotherapy reduces associated complications and enhances quality care of children with respiratory conditions. Having many benefits attached to chest physiotherapy in children with respiratory conditions and to prevent associated complications, the investigator observed that there is necessity to evaluate knowledge and practices of nurses working in pediatric units of K.L.E.S Prabhakar Kore Hospital and MRC, and district Hospital, Belgaum. The investigator also observed that a routinely though nurses perform the chest physiotherapy, but it is not showing effective results. So a SIM on chest physiotherapy will equip the nurses with necessary knowledge and skills in performing chest physiotherapy.
6.2 REVIEW OF LITERATURE
A quasi-experimental study was conducted to assess the knowledge of staff nurses and to determine the effectiveness of self instructional module in terms of gained knowledge regarding nursing management of patients having chest tube drainage at Nehru hospital, PGIMER Chandigarh. The study revealed that the post-test score increased significantly (P<0.001). 76% of subjects attained most satisfactory scores (17-25) in post test; against 6% subjects in the pre-test attained this level. The study concludes that the information given through SIM proved beneficial in improving the knowledge and skill of 100 study subjects. 9
The study was conducted to identify patterns of chest physiotherapy services in Australian Intensive Care Units (ICUs) and articulate the roles that physiotherapists and nursing staff play in the provision of chest physiotherapy. Telephone interviews with 71 clinical nurse managers and 6 physiotherapists of adult public Australian ICUs were undertaken. Findings of the study shown that almost 90% (n = 67) of ICUs had physiotherapists available during the week but over 25% (n = 22) had “on-call” service only on weekends. Less than 10% had weekday (n = 7) or weekend (n = 6) evening physiotherapy coverage. While nurses were involved in the provision of all aspects of chest physiotherapy. The study conclude that The provision of chest physiotherapy services is often shared between physiotherapists and nurses, however, the actual therapies provided appears to vary depending on the provider.10
A prospective controlled systematic allocation trial design study was conducted on whether chest physiotherapy designed to enhance sputum clearance decreases the occurrence of ventilator-associated pneumonia (VAP). Study was conducted in Tertiary teaching hospital ICU. The result shown that VAP occurred in 39% (14/36) of the control group and 8% (2/24) of the intervention group (OR=0.14, 95% CI 0.03 to 0.56, P=0.02). In this small trial, chest physiotherapy in ventilated patients was independently associated with a reduction in VAP. 11
A randomized control trial study was conducted on the effects of chest physiotherapy in patients with acute lung injury being ventilated mechanically. Patients were randomized into one of three treatment groups: Group 1 (suctioned only); Group 2 (positioned and suctioned); and Group 3 (positioned, manually hyper inflated and suctioned). Baseline and 10, 30 and 60 minutes' post-treatment data were recorded for dynamic pulmonary compliance, arterial blood gases and haemodynamic variables. Results revealed that, Eighteen patients fitted the inclusion criteria. Significant changes were observed in both PaCO2 (p = 0.026) and dynamic compliance (p = 0.019) over time for all three groups. Study concludes that, Patients with acute lung injury are notably complex to nurse and may require protracted physiotherapy intervention. 12
A study was conducted on Chest Physiotherapy in Cystic Fibrosis: Improved Tolerance With Nasal Pressure Support Ventilation. Sixteen CF patients in stable condition with a mean age of 13±4years participated in the study. For CPT, investigator used the forced expiratory technique (FET), which consisted of one or more slow active expirations starting near the total lung capacity (TLC) and ending near the residual volume. . During the study, each patient received two CPT sessions in random order on two different days, at the same time of day, with the same physiotherapist. The results shown that mean lung function parameters were comparable before the PSV and the control sessions. Baseline pulse oximetry (SpO2) was significantly correlated with the baseline vital capacity (%predicted) and forced expiratory volume in 1second (FEV1) (%predicted). PSV was associated with an increase in tidal volume (Vt) from 0.42±0.01liters to 1.0±0.02liters. Study revealed that PSV performed with a nasal mask during the CPT was associated with an improvement in respiratory muscle performance and with a reduction in oxygen desaturation. The improvement in patient comfort may help to improve compliance with CPT in CF patients. Respiratory muscles, lung function, children, cystic fibrosis, oxygenation, inspiratory assistance by positive airway pressure, mucus. 13
A study was conducted on Chest physiotherapy in the form of airway clearance techniques and exercise has played an important role in the treatment of cystic fibrosis. The primary airway clearance technique used was postural drainage combined with percussion and vibration (PD&P). These techniques include the Active cycle of breathing technique, formally called the Forced expiration technique and Autogenic drainage. Both these breathing techniques aim at using expiratory airflow to mobilize secretions up the airways and incorporate breathing strategies to assist in the homogeneity of ventilation.Results of the study suggested that exercise used in addition to an airway clearance technique there is enhanced secretion removal and an overall benefit to the patient.14
6.3 STATEMENT OF THE PROBLEM
“A study to evaluate the effectiveness of self instructional module (SIM) regarding knowledge and practices of chest physiotherapy on children suffering with respiratory conditions among nurses working in pediatric wards of selected hospitals of Belgaum city, Karnataka.”
6.4 OBJECTIVES OF THE STUDY
1. To assess the knowledge regarding chest physiotherapy on children suffering with respiratory conditions among nurses.
2. To assess the practices regarding chest physiotherapy on children suffering with respiratory conditions among nurses.
3. To prepare and administer self-instructional module (SIM) regarding knowledge and practices of chest physiotherapy on children suffering with respiratory conditions among nurses.
4. To evaluate the effectiveness of self-instructional module (SIM) regarding knowledge and practices of chest physiotherapy on children suffering with respiratory conditions among nurses.
5. To find out the association between the pre-test knowledge and practice scores.
6. To find out the association between the pre-test knowledge and selected demographic variables.
7. To find out the association between the pre-test practices and selected demographic variables.
6.5 OPERATIONAL DEFINITIONS
1) Effectiveness: - Refers to determine the extent to which the information in the self instructional module (SIM) has achieved the desired effect as measured by gain in knowledge scores.
2) Self instructional module: - Refers to an informational booklet prepared by the investigator and contents validated by experts regarding knowledge and practices of chest physiotherapy on children suffering with respiratory conditions.
3) Knowledge: -Refers to the appropriate response from the nurses regarding chest physiotherapy on children suffering with respiratory conditions through structured knowledge questionnaire.
4) Practice: - refers to the correct responses from the nurses regarding techniques of performing chest physiotherapy on children suffering with respiratory conditions.
5) Chest physiotherapy: - refers to an airway clearance technique that combines manual percussion of the chest wall by the care- giver, strategic positioning of the patient for mucus drainage with cough and breathing techniques.
6) Children: - Refers to the age group between the 1-12 years.
7) Respiratory conditions: - Refers to Acute Respiratory Infections like pneumonia, bronchiectasis and conditions like Atelectasis, cystic fibrosis and Asthma.
8) Nurses: - Refers to registered staff nurses with a B.Sc. Nursing or GNM qualification working in pediatric wards of selected hospitals of Belgaum city.
9) Pediatric wards: - Refers to pediatric general wards and Pediatric Intensive Care Unit.
10) Selected demographic variables: - Refers to demographic factors such as age, gender, marital status, professional qualification, total year of experience, year of experience in pediatric wards.
11) Selected hospitals: - Refers to KLES Prabhakar Kore Hospital & MRC, and District Hospital, Belgaum.
6.6 HYPOTHESIS
H1: The mean post test knowledge score of subject exposed to self instruction module (SIM) will be significantly greater than the mean pre test knowledge scores at 0.05level of significance.
H2: The mean post test practice score of subject exposed to self instruction module (SIM) will be significantly greater than the mean pre test practice scores at 0.05level of significance.
H3: There will be association between pretest knowledge and practice scores at
0.05 level of significance.
H4: There will be association between pretest knowledge scores and selected demographic variables at 0.05level of significance.
H5: There will be association between pretest practice scores and selected
demographic variables at 0.05level of significance.
6.7 ASSUMPTIONS
1. Nurses are having some knowledge regarding chest physiotherapy on children
suffering with respiratory conditions.
2. Nurses are practicing chest physiotherapy on children suffering with respiratory
conditions.
3. Self instructional module (SIM) is effective self-learning package for nurses to
update their knowledge.
4. Demographic variables of the staff nurses have influence on knowledge and
practices regarding chest physiotherapy on children suffering with respiratory conditions.
6.8 DELIMITATIONS
The study is delimited to nurses who are working in pediatric general wards and Pediatric Intensive Care Unit of KLES Prabhakar Kore Hospital & MRC, and District Hospital, Belgaum.
6.9 PROJECTED OUTCOME
The pretest findings of the study will throw a light on the knowledge regarding chest physiotherapy on children suffering with respiratory conditions, which will help to develop appropriate SIM and further which can also be used as a protocol in performing routine chest physiotherapy in wards.
7 / MATERIALS AND METHOD
7.1 SOURSES OF DATA
Primary source : - The nurses, working in KLES Prabhakar Kore Hospital &
MRC, and District Hospital, Belgaum.
Research approach : - Evaluative
Research design : - A Pre-Experimental. One group pre-test; post-test.
Research setting : - The study will be conducted at pediatric wards of KLES
Prabhakar Kore Hospital & MRC, and District Hospital,
Belgaum.
Population : - The nurses, working in pediatric general wards and Pediatric