Literature Related to Knowledge of Staff Nurses on Pulmonary Artery Pressure Monitoring

Literature Related to Knowledge of Staff Nurses on Pulmonary Artery Pressure Monitoring

6 BRIEF RESUME OF INTENDED WORK
INTRODUCTION
“Knowledge is the wing whereby we fly to heaven”.
-William Shakespeare
Health is a condition or quality of human organism, expressing the optimal functioning of the organism in a given conditions like genetic or environmental aspects. It is the functional human right and a worldwide social goal, which is essential for the satisfaction of basic human needs. Any deviation from health can lead to illness or disease. The illness can be a dysfunction of physiological or psychosocial aspects. The control of illness or disease includes early detection and treatment. Earlier the disease is diagnosed better is the prognosis and prevention of long term disabilities.1
Among all prevalent diseases in today’s world cardiovascular diseases are very high in incidence with a mortality and morbidity rate of more than one million cases each year which adds up to 42% of all death. Early medical detection and treatment is the only way to reduce the incidence of cardiovascular diseases. Numerous diagnostic procedures add to the information regarding the functioning of cardiovascular system. One among these procedures which is performed in critically ill patient is hemodynamic monitoring. It helps to assess cardiovascular status, monitor patients’ response to interventions and measures the pressure of cardiovascular system.2
Parameters of hemodynamic monitoring include, arterial blood pressure monitoring, central venous pressure monitoring, cardiac output/index, oxygen saturation of arterial blood, pulmonary capillary wedge pressure monitoring, and pulmonary artery pressure monitoring. One of the important parameter among hemodynamic monitoring is pulmonary artery pressure monitoring. It is used to guide acute phase management of patient with complicated cardiovascular disorders.3
6.1 NEED FOR STUDY
Pulmonary arterial pressure is generated by the ejection of blood from right ventricle into the pulmonary circulation, which acts as a resistance to the output from the right ventricle. Normally, mean pulmonary artery pressure is about 15 mmHg, and the pulmonary artery systolic and diastolic pressure is about 25 and 10 mmHg, respectively.4 The pressure in the left ventricle at the end of diastole approximates the diastolic pressure in the pulmonary arteries and pulmonary capillaries. The measurement of pulmonary artery pressure helps to detect the changes that can occur in the left side of the heart which are not reflected on the right side of the heart.5
In the majority of critically ill patients pulmonary artery pressure is useful adjunct in the assessment of intravascular volume and hemodynamic alterations. So measurement of pulmonary artery pressures should be routinely included in the sequential hemodynamic evaluation of seriously ill patients who are hospitalized in an intensive care unit.6
In the present day nursing there is a wide variation in the quality of assessment, monitoring, and documentation of pulmonary artery pressure, due to intra and inter observer reliability, equipment’s malfunction and patient preparation. Education of nurses and other health workers in the physiological and technical rationale under pinning the collection of vital signs data, and the significance of alteration in findings remains an important challenge.7
An article suggests that numerous research-based guidelines for pulmonary artery pressure monitoring are available. Despite the availability of this large body of literature related to pulmonary artery pressure monitoring, critical care nurses continue to demonstrate insufficient knowledge and ability to apply information related to the collection and interpretation of data obtained with a pulmonary catheter catheter. This article focuses on these problematic areas, and reinforces the need to continue to include the basic principles of pulmonary artery pressure monitoring in education and training programs for nurses.8
The nurse is often placed in a vulnerable position to keep with the high technology and modernization of sophisticated equipment. In the hospital, additional specialized qualification in critical care nursing is not emphasized. This widens the gap between what they have learned and what they are expected to do in critical care nursing. Therefore it’s a felt need to assess the adequacy of the existing knowledge in monitoring pulmonary artery pressure of staff nurses.
6.2 REVIEW OF LITERATURE
Review of literature for the present study is explained under the following headings,
  1. Literature related to knowledge of staff nurses on pulmonary artery pressure monitoring.
  2. Literature related to self instructional module.
  3. Literature related to general information regarding hemodynamic monitoring.
  1. Literature related to knowledge of staff nurses on pulmonary artery pressure monitoring.

A study was conducted on intensive care unit nurses knowledge of the pulmonary artery catheter. The investigator administered 31 multiple choices question to 168 intensive care unit nurses from 15 institutions. The mean score was 57% correct. Although 90%of intensive care unit nurses correctly identify end expiration as the point at which pulmonary artery occlusion pressure should be measured, only 61% were able to measure it correctly, and answer to this practical question varied by 10 mm of hg. The results of the study indicated that formal training, frequency and exposure to the catheter and professional certification in critical care correlated with better score on the questionnaire. Additional research is needed on a larger scale to validate these findings and determine if critical care nurses' knowledge of pulmonary artery catheters is sufficient to maintain quality standards of safety and optimal patient care.9

An article was published on assessment of critical care nurses' knowledge of the pulmonary artery catheter. A 37-question multiple choice examination that tested knowledge regarding the use of the pulmonary artery catheter was administered to a group of nurses, attending a national conference (New Orleans, LA), who preregistered for a hemodynamic workshop. Two-hundred sixteen nurses completed the questionnaire. The mean test score was 16.5 +/- 5.7 (48.5%). The study concluded that a wide variation in the understanding of the use of the pulmonary artery catheter exists among nurses using this device in the care of seriously ill patients. The results indicate that current teaching practices regarding the pulmonary artery catheter need to be re-evaluated and specific credentialing policies need to be considered.10
An article was published on monitoring to ensure reliability of hemodynamic pressure readings. Work is currently being done to make sure that other factors affecting reliable and valid pulmonary artery readings do not exist. Nurses have a tremendous responsibility to their patients who have pulmonary artery catheters. They must not only be knowledgeable but also must have good surveillance skills. Because there is such a discrepancy between the amount of knowledge deemed necessary in the literature and that which is actually demanded in practice, this study should be expanded and replicated. Intensive care nurses must do all they can to maintain a critically ill patient's health, and one way in which to attempt this is through adequate knowledge and treatment using pulmonary artery catheters.11
An article was published on expert critical care nurses' use of pulmonary artery pressure monitoring. This paper reports one component of a study which used a concept attainment framework to determine what data were used by 8 expert critical care nurses in relation to hemodynamic monitoring. In addition, participants used few clinical assessment attributes, but collected a large number of attributes which they arranged around three to five central concepts and took a broad view of hemodynamic assessment. One participant did not display many of the decision-making features normally associated with an expert practitioner. In conclusion, expert critical care nurses process an immense amount of data in a short space of time. Evidence suggests not all nurses who practice in the field for a lengthy period reach the level of an expert.12
  1. Literature related to the effectiveness of self instructional module.
A study was conducted to determine the effectiveness of self instructional module for nurses on administration of selected emergency drugs to critically ill patients. Findings of the study revealed that the mean pre-test knowledge scores of nurses on administration of emergency drugs were 22.47, which was found to be inadequate. There was an increase in the post test knowledge after the administration of self instructional module.13
An evaluative study was conducted on the effectiveness of self instructional module on selected drugs used in critical care units. The pre-test mean percentage knowledge of nurses was found to be less than 50%(49.92%).Findings of the study indicated that nurses were not adequately equipped with the knowledge on selected drugs. An increased knowledge score has obtained after the administration of self instructional module.14
  1. Literature related to general information regarding hemodynamic monitoring.
A study was conducted on arterial blood pressure (ABP) is a basic hemodynamic index often utilized to guide therapeutic interventions, especially in critically ill patients. A total of 391 critical care nurses practicing in various critical care specialties were invited to participate in the study. The response rate was 17.4% (n = 68). The participants were asked to complete an 18-item and total scores ranged from 11.1% to 61.1%. Literature on nurses’ knowledge of hemodynamic monitoring is limited, but several studies, published and unpublished, indicate a general knowledge deficit in pulmonary artery pressure monitoring. Because of these research findings, in this article, we focus on areas of particular knowledge deficit related to essential principles of hemodynamic monitoring and ABP monitoring.15
PROBLEM STATEMENT
“A study to evaluate the effectiveness of self instructional module on knowledge among staff nurses regarding pulmonary artery pressure monitoring in selected hospitals, Bengaluru.”
6.3 OBJECTIVES
1) To assess the existing knowledge among staff nurses regarding pulmonary
artery
pressure monitoring by pre-test knowledge scores.
2) To administer self instructional module regarding pulmonary artery pressure
monitoring among staff nurses.
3) To evaluate the effectiveness of self instructional module regarding pulmonary
artery pressure monitoring by comparing pre and post-test knowledge scores.
4) To find out association between pre-test knowledge score with the selected
demographic variable.
6.6.3.1 HYPOTHESIS
H1: There will be a significant difference between the pre and post test knowledge
Scores.
H2: There will be a significant association between the pre test knowledge
scores and selected demographic variables among staff nurses.
6.3.2 VARIABLES
  1. Independent variable: Self instructional module on pulmonary artery pressure monitoring.
  2. Dependent variable: Post-test knowledge of staff nurses regarding pulmonary
artery pressure monitoring.
  1. Demographic variable: Age, educational background, and working experience.

6.4 OPERATIONAL DEFINITIONS
a) Evaluate: It refers to staff nurses response to self instructional module and then
comparing the response to objective.
b) Effectiveness: It refers to gain in knowledge as determined by significant
difference in pre-test and post-test knowledge scores.
c) Knowledge: It refers to the depth of information regarding pulmonary artery
pressure monitoring among staff nurses.
d) Staff nurses: Are the trained registered nurses who are working after the completion of general nursing and midwifery course, bachelors’ degree or post graduation course in nursing in selected hospitals at Bangalore.
e) Self instructional module: It is a set of carefully prepared informative booklet,
which includes pulmonary artery pressure monitoring and its nursing management.
f) Pulmonary artery pressure monitoring: It is one among the parameters of
hemodynamic monitoring which monitors the pressure in pulmonary artery.
.
6.5 ASSUMPTION
  1. Staff nurses may have some knowledge regarding pulmonary artery pressure monitoring.
  2. Self instructional module may improve the knowledge of staff nurses regarding pulmonary artery pressure monitoring.

6.6 LIMITATIONS
Study is limited to staff nurses working in selected hospitals, Bengaluru.
7 MATERIALS AND METHODS
7.1 Sources Of Data : Staff nurses working in selected hospitals, Bengaluru.
7.1.1 Research Approach : Evaluative approach.
7.1.2 Research design : Quasi experimental one group pre-test and post-
test design.
7.1.3 Setting : Selected hospitals in Bengaluru.
7.1.4 Sample size : 50 staff nurses of selected hospitals.
7.1.5 Inclusion Criteria
  1. Staff nurses who are willing to participate in the study.
  2. Staff nurses who are present at the time of data collection.

7.1.6 Exclusion criteria
  1. Staff nurses who are sick at the time of data collection.

7.2 Method of collection of data
7.2.1 Sampling technique: Non probability purposive sampling technique.
7.2.2 Tool of research: Structured questionnaire
Structured questionnaire will be constructed in two parts
Part I - Demographic data
Part II-Knowledge based questionnaire regarding pulmonary artery
pressure monitoring.
7.2.3 Collection of data
The investigator collects data from staff nurses of selected hospitals.
• Investigator herself collects the data from staff nurses through structured
questionnaire method.
• Administer self instructional module (SIM) on monitoring of pulmonary artery
pressure.
• Assess the gain in knowledge of staff nurses regarding pulmonary artery
pressure monitoring using same structured questionnaire.
7.2.4 Method of data analysis and presentation
• The investigator uses descriptive & inferential statistical techniques for data
analysis.
• The analyzed data will be presented in the form of tables, diagrams, and graphs
based on finding
7.3 Does the study require any investigation to be conducted on patients or
other human or animals? If so please describe briefly?
Yes, I am conducting the study on staff nurses with the help of self
instructional module.
7.4 Has ethical clearance has been obtained from your institution?
  • Yes, Consent will be obtained from concerned subjects and authority of
institution.
  • Privacy, confidentiality and anonymity will be guarded.
  • Scientific objectivity of the study will be maintained with honesty and impartiality.

8 Lists of Reference
  1. Park K. Park’s text book of Preventive and social medicine. 18th ed. Jabalpur: M/s
Banarasidas Bhanot publishers; 2005. p.12,13,29.
  1. Cardiovasculardisorders.[internet][Cited2010sept]Available from

  1. Lewis Sharon Mantik, Heitkemper Margaret Mclean, Dirksen Shannon Ruff,
O’Brien, Bucher. Medicalsurgical nursing: Nursing assessment and management
of clinical problem. 7th ed. Mosby Publication; 2007. p.1738,1741.
  1. Quinn T. Cardiovascular monitoring. Journal of advanced nursing. 1998; 27(3):
666.
  1. Black M Joyce and Hawks Jane Hokanson. Medical surgical nursing clinical
management for positive outcomes. 7th ed. Elsevier publications: 2005. p.1596.
  1. Critical care procedures.[internet] [cited non2010 sep] available from
www.ncbi.nim.nih.gov/pub
  1. Harvey S, Harrison D. Hemodynamic monitoring and its practice. The Medical
Journal.2007; 22: 72-77.
  1. Bridges EJ. Monitoring pulmonary artery pressures: just the facts. Crit Care Nurse.
2000 Dec; 20(6):59-78; quiz 79-80.
  1. Burns D, Burns D, Shively M. Critical care nurses' knowledge of pulmonary
artery catheters. Am J Crit Care.Palomar Medical Center, Escondido, Calif, USA.
1996 Jan; 5(1):49-54.
  1. Williams & Wilkins 1994. Assessment of critical care nurses' knowledge of the
pulmonary artery catheter. Crit Care Med 1994; 22:1674-1678.
  1. Alpen M, Robnett M, Dolter KJ. Monitoring to ensure reliability of hemodynamic
pressure readings. J Nurs Qual Assur. 1989 May; 3(3):36-44.
  1. Aitken LM. Expert critical care nurses' use of pulmonary artery pressure
monitoring.Intensive Crit Care Nurs. 2000 Aug;16(4):209 20.
  1. Balasaraswathy(1995). A study to determine the effectiveness of self instructional
module for nurses on administration of emergency drugs to critically ill patients of
selected hospitals in Mangalore. Master science in nursing, Mangalore university.
  1. Sams L. M(1997). Effectiveness of structured SIM on selected drugs used in CCU,
for the staff nurses working in these units in selected hospital of Karnataka.
Unpublished MSc thesis. Manipal academy of higher education, Deemed university.
  1. Beate H, Elizabeth J Bridges. Monitoring Intra Arterial Blood Pressure: What You
May Not Know. Crit Care Nurs. 2007; 22: 60-79.
9 / SIGNATURE OF CANDIDATE
10 / REMARKS OF THE GUIDE / THE STUDY IS FEASIBLE AND OF GENUINE INTEREST OF THE STUDENT
11 / NAME & DESIGNATION OF
11.1GUIDE / MRS. MANIMOZHI R, M.SC. (N)
PROFESSOR/HOD
DEPARTMENT OF MEDICAL AND SURGICAL NURSING
SJB COLLEGE OF NURSING ,
BANGALORE-60
11.2SIGNATURE
11.3CO-GUIDE / MRS.VIJI C,M SC (N)
LECTURER
DEPARTMENT OF MEDICAL SURGICAL NURSING
SJB COLLEGE OF NURSING,
BANGALORE-60
11.4SIGNATURE
11.5 HEAD OF THE DEPARTMENT / MRS. MANIMOZHI R, M SC. (N)
PROFESSOR/HOD
DEPARTMENT OF MEDICAL AND SURGICAL NURSING
SJB COLLEGE OF NURSING ,
BANGALORE-60
11.6SIGNATURE
12 / 12.1REMARKS OF THE PRINCIPAL
12.2 SIGNATURE

Rajiv Gandhi University of Health Sciences, Bengaluru

Karnataka

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

Ms. REMYA RAJU

Medical surgical Nursing

I Year M.Sc Nursing

Year 2010-2011

SJB COLLEGE OF NURSING

BENGALURU-560060

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BENGALURU, KARNATAKA

ANNEXURE-I

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS / Ms. REMYA RAJU
1ST YEAR M.Sc NURSING
SJB COLLEGE OF NURSING,
BENGALURU 60.
2. / NAME OF THE INSTITUTION / SJB COLLEGE OF NURSING
KENGERI, BENGALURU 60.
3 / COURSE OF STUDY AND SUBJECT / I YEAR M.Sc NURSING,
MEDICAL SURGICAL NURSING
4 / DATE OF ADMISSION TO COURSE / 03-05-2010
5 / TITLE OF THE TOPIC: / “A STUDY TO EVALUATE THE EFFECTIVENESS OF
SELF-INSTRUCTIONAL MODULE ON KNOWLEDGE AMONG STAFF NURSES REGARDING PULMONARY ARTERY PRESSURE MONITORING IN SELECTED HOSPITALS, BENGALURU”.
6 BRIEF RESUME OF INTENDED WORK
INTRODUCTION
“Knowledge is the wing whereby we fly to heaven”.
-William Shakespeare
Health is a condition or quality of human organism, expressing the optimal functioning of the organism in a given conditions like genetic or environmental aspects. It is the functional human right and a worldwide social goal, which is essential for the satisfaction of basic human needs. Any deviation from health can lead to illness or disease. The illness can be a dysfunction of physiological or psychosocial aspects. The control of illness or disease includes early detection and treatment. Earlier the disease is diagnosed better is the prognosis and prevention of long term disabilities.1
Among all prevalent diseases in today’s world cardiovascular diseases are very high in incidence with a mortality and morbidity rate of more than one million cases each year which adds up to 42% of all death. Early medical detection and treatment is the only way to reduce the incidence of cardiovascular diseases. Numerous diagnostic procedures add to the information regarding the functioning of cardiovascular system. One among these procedures which is performed in critically ill patient is hemodynamic monitoring. It helps to assess cardiovascular status, monitor patients’ response to interventions and measures the pressure of cardiovascular system.2
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