PROFOMA FOR REGISTRATION OF SUBJECTS FOR
DISERTATION
SUBMITTED BY:
Mr. BAIJU. A.K
FIRST YEAR M.SC NURSING
MEDICAL SURGICAL NURSING
YEAR 2012
NAVODAYAINSTITUTE OF NURSING
MANDYA
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS
FOR
DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / BAIJU. A.K#290/290, CHENNAPPANNA DODDI CROSS, MALAVALLI MAIN ROAD, GUTHAL HAMLET, MANDYA-571401
2 / NAME OF THE INSTITUTE / NAVODAYA INSTITUTE OF NURSING
3 / COURSE OF THE SYUDY AND SUBJECT / M.Sc NURSING
MEDICAL SURGICAL NURSING
4 / DATE OF ADMISSION / 15-06-2012
5 / TITLE OF THE STUDY / “A study to assess the effectiveness of structured teaching programme on cardio-pulmonary resuscitation among the IV year B.Sc Nursing students of a selected college in Mandya”.
6.BRIEF RESUME OF THE INTENDED WORK
6.1. INTRODUCTION:
“Life you save may be your loved once” Learn CPR for a loved one.
Once life begins instincts begin to work and also to preserve it. For life by itself strives to live and not to die, and that is the normal natural process called life. Meanwhile there are many challenges too. But instincts again seek and find ways and means of preserving that precious little life.1
In a normal and healthy individual life processes can be achieved by the physiological and physical processes on their own. But there are certain movements like accident which needs on the spot attention or at least the quickest possible attention to pull the victim out of the trauma or crisis, so as in the case of patients who has myocardial infraction. The occurrence of such an emergency is obviously unpredictable. Most of the times the emergencies would be airway obstruction hypoventilation, apnea, blood loss, cardiac arrest resulting from accident, heart attack, or other medical causes. The leading cause of preventable sudden death before old age are ventricular fibrillation from asymptomatic ischemic heart disease, non traumatic accidents like drowning, and poisoning and trauma caused by violence of man or accidents.2
A natural disaster hits, the power goes off and the lights go out. It's a common scene that plays out during hurricane and tornado seasons, and it's very similar in trying to explain sudden cardiac arrest. The heart sustains an insult, the electricity is short circuited, the heart can't pump, and the body dies.3
Irreversible brain damage may occur while cessation of circulation lasts longer than few minutes. Hence to save the precious life measures are to be taken immediately at the shortest time elapsed possible, However the immediate application of resuscitation is often capable of preventing biological death, Hence CPR is the most appropriate life saving emergency technique known so far, to reverse the cardio-pulmonary arrest which is practiced throughout the world to meet the Oxygen and blood demand of the cells of the brain.4
CPR involves physical interventions to create artificial circulation through rhythmic pressing on the patient's chest to manually pump blood through the heart, called chest compressions, and usually also involves the rescuer exhaling into the patient (or using a device to simulate this) to inflate the lungs and pass oxygen in to the blood, called artificial respiration. CPR is unlikely to restart the heart; its main purpose is to maintain a flow of oxygenated blood to the brain and the heart, thereby delaying tissue death and extending the brief window of opportunity for a successful resuscitation without permanent brain damage.5
Teaching is an essential part of education its special function is to impart knowledge, develops understanding and skills. It generally includes inculcation of values like truth, teaching technology involves the mechanism of an instructional process in a classroom situation with a level of teaching theories. There are principal teaching operations and establishment of a relation between theories and teaching operations.6
Studies has shown inadequate knowledge of nurses and nursing staffs regarding cardio-pulmonary resuscitation,that indicates a need for further training and re-training at least every two years especially for nursing in the critical care unit. “A survey on cardio-pulmonary resuscitation knowledge of the nursing staff in the Asahikawa Medical College Hospital. This shows that the CPR knowledge of both the nursing staffs and the student nurses was not sufficient, indicating the necessity of CPR education for both nursing staffs and student nurses”.7
Various teaching and reinforcement programmes have been very successful in teaching skills and knowledge required by a rescuer in a resuscitation attempt the rescuer should acquire expanded coverage of humanistic aspects of resuscitation8.
6.2 NEED FOR THE STUDY:
There are no reliable national statistics on cardiopulmonary resuscitation because no single agency collects information about: How many people get cardiopulmonary resuscitation? How many people don’t get it? Who needs it? How many people are trained etc…Many studies have examined Cardiopulmonary resuscitation in specific communities while they show varying rates of success. All are consistent in showing benefits from early cardiopulmonary resuscitation9.
According to the World Health Organization [W.H.O] Cardio vascular disease such as heart disease and stroke are the leading causes of death globally killing more than 17 million in 2005. Each year 3.8 million men and 3.4 million women worldwide die from coronary heart disease. Since 1990 more people have died from coronary heart disease than from any other causes.10
6.3 STATEMENT OF THE PROBLEM:
“A study to assess the effectiveness of structured teaching programme on cardio-pulmonary resuscitation among the IV B.Sc(N) students of a selected college in Mandya”.
6.4 OBJECTIVES OF THE STUDY:
1.To assess the pre-test knowledge of the subjects regarding cardiopulmonary resuscitationamong the IV year B.Sc Nursing students.
2.To administer Structured Teaching programme for the subjects on cardiopulmonary resuscitationamong the IV year B.Sc Nursing students.
3.To evaluate the post-test knowledge of the subject on cardiopulmonary resuscitationamong the IV year B.Sc Nursing students.
4.To assess the effectiveness of Structured Teaching programme on cardiopulmonary resuscitationamong the IV year B.Sc Nursing students.
5.To find out the association between pre-test and post-test knowledge scores with the selected demographical variables of the subject among the IV year B.Sc Nursing students.
6.5 OPERATIONAL DEFINITION:
EVALUATION:-
It refers to the assessment of pre test and post-test knowledge score of the subject.
EFFECTIVENESS
It refers to the extent to which the planned teaching program enhances the knowledge & skill of the students in cardiopulmonary resuscitation.
KNOWLEDGE
It refers to the awareness or information gained both knowledge and skill about cardiopulmonary resuscitation.
CARDIOPULMONARY RESUSCITATION
Cardio pulmonary resuscitation is a technique of basic life support for the purpose of oxygenating the brain and heart until appropriate definitive medical treatment (Advanced cardiac life support) can restore the normal heart and ventilator action.
STRUCTURED TEACHING PROGRAMME
It refers to organized Structured Teaching programme design to provide information regarding cardiopulmonary resuscitation.
6.6 ASSUMPTIONS:
1.Nursing students possess inadequate knowledge regarding proper administration of cardiopulmonary resuscitation
2.Student’s knowledge is influenced by various factors such as age sex education etc.
3.The Structured Teaching programme will enhance the knowledge of the subject regarding cardiopulmonary resuscitation.
6.7 HYPOTHESIS:
H1:- There is no significant difference in the level of knowledge of the subjects on cardiopulmonary resuscitation before and after administration of Structured Teaching programme
H2:- There is no significant association between the pre test and post-test knowledge of the subjects on cardiopulmonary resuscitation with the selected demographic variables.
6.8 REVIEW OF LITERATURE:
The literature review involves the systemic identification; location scrutinizing and summary of written materials that contains information on the research problem. The investigator followed these steps in review of related research and non-research literature to broaden the understandings and to gain a better insight into the selected problem and the study.
Review of literature is an essential step in the development of research project. The purpose of review of literature is summarization of new substantive or theoretical ideas, formation of testing of theory organization of knowledge from different fields and integration of knowledge into a new whole. The review of literature further helps to refine certain parts of the study specifically the problem statement, conceptual framework, design and data analysis process. It also provides the data for comparison and justifies the need for replication.11
Review of literature is a critical summary of research on a topic of interest generally prepared to put a research problem in context or to identify gaps and weakness in prior studies so as to justify a new investigation.12
Related literature both research and non-research was explored to broaden the understanding and gain an insight into the selected problem under study. The review of literature for the present study has been done from published articles textbook reports, medline search on CPR techiniques. The present study is aimed at evaluating the effectiveness of Structured Teaching programme on CPR.among degree students in a selected college Mandya.
The review of literature is organized under the following sub headings:
- Nurses knowledge competency and attitude regarding CPR
- Factors affecting the training /learning of CPR.
- Training programme on CPR.
- Acquisition and retention of knowledge and skills post CPR training.
- Effectiveness of STP.
NURSES KNOWLEDGE, COMPETENCY AND ATTITUDE REGARDING CARDIO-PULMONARY RESUSCITATION.
Department of Anaesthesia and Intensive Care Medicine, Helsinki University conducted a study to assess the Medical and nursing students' attitudes toward cardiopulmonary resuscitation and current practice guidelines. The purpose of this cohort study was to examine medical and nursing student's beliefs and attitudes toward CPR-D and current practice guidelines. ,a modified questionnaire concerning beliefs and attitudes toward CPR-D was distributed via e-mail to 100 final sixth year medical students and to 120 final fourth year nursing students. The students had 2 weeks to answer the questionnaire the study showed that Medical students' attitudes mature as hoped for, but the nursing students need encouragement. More information is needed to diminish anxiety concerning defibrillation. Negative beliefs and attitudes toward defibrillation.13
A study to investigate RN-BSN students' clinical nursing competency in order to establish baseline data for developing nursing competency based clinical education for RN-BSN students was conducted by the Department of Nursing, Catholic University of Daegu.A survey of 1,453 RN-BSN student from 21 nursing schools was conducted using a self administered questionnaire. The mean score of the clinical nursing competency was 2.93. The items perceived as insufficient competency were physical examination and observation & monitoring in data collection, cardiopulmonary resuscitation, psycho-social care, etc. This study will contribute to developing a nursing competency based on clinical education for RN-BSN students who have various education needs and clinical backgrounds.14
FACTORS AFFECTING THE TRAINING/ LEARNING OF CPR
A study to determine if the different academic degrees or years of working experience in the emergency room (ER) modify the ability to learn the Basic Cardiopulmonary Resuscitation Guide of the American Heart Association. Over a period of 3 years, 68 health care professionals participated. Participant's data were grouped by their education level as well as their experience in ER. The course included one reading assignment before class, lecture sessions, practice sessions, and problem solving sessions of hypothetical clinic cases. The students were evaluated before and after the course with various tests. The result of the study showed that the students with more experience working in ER obtained the best grades (p < 0.001). In addition, those with higher academic degrees attained high grades (p < 0.01). The cumulative effect of experience and education also influenced the students' performance (p <0.001). Thus we can conclude that the study found that experience has the highest weight in determining learning performance. The combination of both experience and educational attainment have a synergic effect in mastering the competencies.15
A study conducted to determine the number of CPR trained adults in Sweden, and the willingness of the non-trained population to attend a CPR course. An additional purpose was to investigate differences related to sex, age, residential area, socio-economic classification and country of origin. Five thousand adults in Sweden were surveyed, which yielded 3167 valid responses, The sample was selected at random and stratified to correlate to the geographic distribution of the population. 50% of the respondents expressed a willingness to attend a course. Somewhere between 30 and 45% of the adult population of Sweden had participated in CPR training. Half of the non-trained population was willing to learn CPR but frequently did not know that such courses existed or where they were held. Elderly people, people of foreign origin, or those not included in the workforce were less likely to have participated in CPR training.16
TRAINING PROGRAMMES ON CARDIOPULMONARY RESUSCITATION
A study was conducted by the Department of Intensive Care Medicine, Birmingham Heartlands Hospital,UK. to determine the efficacy of a peer-led tuition model for traininghealthcare students in basic life support compared to tuition delivered byclinical tutors.A Randamized controlled trial was used. 122 first-year medical,dental, nursing and physiotherapy students participated. Students were randomised to receive basic life support tuition from either second-year student instructors or from experienced clinical staff.Students' practical skills, knowledge and satisfaction were tested at the end of the course. Instructor reliability was assessed throughout the course. Students taught by their peers were significantly more likely to be successful in the end-of-course practical CPR test than those taught by clinical staff (56/57 vs 53/62). This model of peer-led undergraduate training in basic life support provides a quality of education which is at least as good as that provided by clinical staff, while offering advantages in terms of reliability. The re-deployment of clinical tutors from basic to more advanced training may allow the overall enhancement of undergraduate resuscitation and critical care training.31
A quasi-experimental design utilizing random allocation of matched subjects to one experimental and two control groups was adopted with a sample of 20 undergraduate nursing students. The subjects' CPR ability was assessed concurrently using are resuscitation manikin and an observational checklist. Subjects undertaking self-instruction produced significantly (P < 0.05) higher ability scores than those who did not participate in retraining. The time spent in self-instruction was evaluated positively by the students. Re-commendations for regular CPR updating by all clinical nurses.17
ACQUISITION AND RETENTION OF KNOWLEDGE AND SKILL POST CPR TRAINING.
A study was conducted for “Undergraduate nursing students' acquisition and retention of CPR knowledge and Skills”. And to investigate the extent to which Irish nursing students acquire and retain CPR cognitive knowledge and psychomotor skills following CPR training. A pre-test, CPR training programme, post-test, and re-test were conducted. CPR knowledge was assessed by a multiple-choice assessment and psychomotor skills were assessed by observing CPR performance on a Resusci-Anne skill-meter manikin. The findings showed an acquisition in nurses' CPR knowledge and psychomotor performance following a 4h CPR training programme. However, students' knowledge and skills were improved over their pre-training scores, which clearly indicated a positive retention in CPR cognitive knowledge and psychomotor skills. The study findings present strong evidence to support the critical role of CPR training in ensuring that nursing student’s progress to competent and confident responders in the event of a cardiac related emergency.18
In order to increase CPR training in Quebec, the Department of Surgery, McGill University, Montreal General Hospital Trauma Program, Montreal, Québec, Canada designed a pilot study to test out the efficacy of training CEGEP (junior college) students in CPR.the student were trained using four different methods of teaching CPR on students (Group A 'control', 4 h course, manikin to student ratio 1:4; Group B, 4 h course, manikin to student ratio 1:1; Group C, 2 h course, manikin to student ratio 1:1; Group D,video-assisted CPR instruction, manikin to student ratio 1:1). CPR skills were tested on a computerized manikin at the end of the initial course and again at the end of the semester in order to evaluate short and long-term retention of skills. There were no significant differences between the test groups and the control group in terms of compressions or ventilations at the beginning and end of the semester, however groups C and D performed significantly better primary surveys (Airway, Breathing, Circulation - ABC sequences) during the initial testing.19
A study to test registered nurses' abilities to retain basic or advanced life support psychomotor skills and theoretical knowledge the study results showed a decline in skills retention with nurses unable to perform ACLS and BLS skills to standard for the entire certification period. The need for more frequent refresher training is needed. No formal research at this institution indicates skill degradation adversely affected patient outcomes. Further research on ACLS and BLS course content, design, management, and execution is needed.20
A study “Confidence vs. competence: basic life support skills of health professionals”. was conducted to assess BLS confidence as assessed against competence of doctors in-training, qualified nurses and healthcare assistants (HCAs) following the development of structured resuscitation training. This study has highlighted that the introduction of a structured resuscitation training programme has resulted in a noticeable improvement in BLS skills, particularly with regard to doctors. Registered nurses have improved with regular training There remains a mismatch between confidence and competence, with only doctors demonstrating both confidence and competency and therefore changes to training programmes may be required to address this mismatch..21
7. MATERIAL AND METHODS: