RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / Name of the candidate and address(in block letters) / MRS. SEETHA
I YEAR M. Sc. NURSING
LAXMI MEMORIAL COLLEGE OF NURSING
BALMATTA
MANGALORE
2. / Name of the Institution / LAXMI MEMORIAL COLLEGE OF NURSING
BALMATTA
MANGALORE
3. / Course of Study and Subject / M. Sc. NURSING
MEDICAL SURGICAL NURSING
4. / Date of Admission to the course / 01.06.2011
5. / Title of the Topic
EFFECTIVENESS OF SKILL TRAINING PROGRAMME [STP] ON CARDIOPULMONARY RESUSCITATION [CPR] ON KNOWLEDGE AND SKILL AMONG STUDENTS OF SELECTED COLLEGES IN MANGALORE
6. / Brief resume of the intended work
6.1 Need for the study
Cardiopulmonary resuscitation is a procedure to support and maintain breathing and circulation for a person who has stopped breathing [respiratory arrest] and or whose heart has stopped. CPR is performed to restore and maintain breathing and circulation and to provide oxygen and blood flow to the heart, brain, and other vital organs. CPR can be performed by trained bystanders or healthcare professionals on infants, children, and adults. It should always be performed by the person on the scene who is most experienced in CPR.1
When a person develops cardiac arrest, the heart stops beating, and the person becomes unresponsive and stops breathing normally. Sudden cardiac deaths account for more than 40-45% of cardio vascular deaths in India, 75% of the people who die of sudden cardiac arrest shows signs of a coronary artery disease. In India the annual incidence of sudden cardiac death account for 0.55 per 1000 population. In India, in the year 2009 6,16,067 people died of heart disease. The earlier you give CPR to person in cardio pulmonary arrest [no breathing, no heart beat], the greater the chance of a successful resuscitation. Because up to 80% of all cardiac arrests occur in the home.2
CPR may be necessary during many different emergences. Approximately 1,00,000 people die annually as a result of accidents such as drowning, suffocation, electrocution, drug overdose, automobile accidents, fires, and poisoning. Medical research and practical experience confirms that a significant number of these fatalities estimated at approximately 20% could have been prevented if prompt and proper cardiopulmonary resuscitation has been applied on the scene. India has the highest number of road accidents in the world. According to National Crime Records Bureau [NCRB, 2006figures] Tamil Nadu [14% of all accidents] and Maharashtra [12.4%] have the maximum accidents in the country. Majority of the deaths due to accidents occurs during the transportation of the victim to hospital. Many deaths can be averted and disability can be limited by providing CPR education services before taking the victim to hospital.3
Cardiopulmonary resuscitation is the first assistance given to the collapsed person and is aimed at the prevention of further harm. The correct CPR measures can reduce suffering, be instrumental in speeding up subsequent recovery, prevent permanent disability and even save life. First few minutes following injury is called the golden time. Many complications and events that occur during this period, can convert a simple injury to death if unattended. It is important to act and react during the golden time to reduce mortality and morbidity.4
The American heart association released its 2010 CPR guidelines followed for lay persons. And the focus for CPR is on good quality chest compressions. Now it’s C-A-B; the chest compression come first, only then do focus on airway and breathing. No looking, listening, and feeling but is an action, no assessment .push at least 2 inches deep on the chest. At the rate, 30 compressions should take 18 seconds.5
A cross sectional study was conducted to awareness about BLS [CPR] among medical students in Dow international medical college, Karachi. Using questionnaire regarding BLS by 61 students. Out of 61 students 14.7% had taken a BLS course, 85.3% students had not attended any course. The result showed that significantly more number of students had the theoretical knowledge about BLS 76.07% vs 49.18%, p<0.00. Of all the students, 57.3% had no knowledge, among 34% had heard BLS somewhere, 22, 9% had some knowledge, 50% heard about it. Significantly less number of students had complete knowledge about BLS 4% P<0.05. Among the students who had taken the course, 22% had complete knowledge p<0.05. Significantly less number of students knew about the skills for BLS 21% p<0.05.6
A nation’s hope rests on its youth. For their hopes to become reality, the younger generation needs to grow into healthy behaviour and acquire health related knowledge. According to WHO are the individuals in the age group of 16-24 years and there are 198 million young people in India [WHO, 2000]. World Health organization [WHO] Technical Report Series [1999] showed that colleges have the potential to provide an excellent base for large scale programming and there is need
to strengthen the college as a setting for health intervention. Colleges can provide many services to young people in addition to formal education, such as health education, skill development in the areas such as life saving skills. A college is an appropriate setting for the introduction of teaching and training of students on life saving CPR skill as it offers access to young adults on a large scale. It is economically efficient and there are possibilities for short term and long term evaluation.4
Health Teaching is an integral part of nursing and it emphasis a scientific attitude towards health which is very important to modern healthy living. Planned health teaching of the masses is one of the most effective means of health promotion. Patients suffering from cardiac diseases, shock, trauma and other such critical conditions could collapse anywhere and effective life saving measures commenced promptly by any lay person could help revive the patient. College students better listen to the teachings and could follow demonstrations. Hence the researcher felt that the need to conduct a planned teaching programme and demonstration regarding CPR and to evaluate the effectiveness of planned and skill training.7
6.2 Review of Literature
A descriptive study was conducted to assess on knowledge and skill of CPR technique among the nursing students at K.G college of nursing, Coimbatore. Using stratified random sampling techniques 50 samples were selected from 150 populations of 3rd yr and 4th yr basic nursing students. Knowledge was assessed by MCQ [40 items] and skill was assessed by observing CPR performance on resusci– Anne- skill- manikin by using checklist. The result showed that knowledge [21.64], and skill [13.58] showed the negative correlation [r-0.31].8
A pre-experimental research design was conducted to effectiveness of a planned teaching module on knowledge and practice of pulmonary resuscitation among staff nurses in Punjab. Purposive convenient sample consisted of 40 subjects, were in the age of 24-26 years and 55% had professional experience more than 12
months; 40% were working in emergency ward and 82.5% were never exposed to in service education program on CPR. The results showed that the mean post-test knowledge score [40.68] was found to be significantly higher than the mean pre-test score [29.53] similarly the mean post-test score [26.75] was found to be significantly higher than the mean pre-test practice score [18.53].the co-efficient of correlation between the pre-test knowledge and practice score was found to be 0.11 at 0.05 level indicating low positive correlation between the knowledge and practice. But a high positive correlation [r=0.59] was found between post-test knowledge and practice of nurses regarding CPR.9
A quasi experimental study was conducted to evaluate the effectiveness of STP on CPR technique among staff nurses in selected hospital in Bangalore city. The sample size was sixty staff nurses. The result showed that total mean percentage of post- test knowledge score was 97.10% with enhancement of 46.9% [SD=3.7] which shows gain in knowledge after implementation of STP and ‘t’ value was 29.06 at p<0.01 level. The mean post test skill score was 95.18% with enhancement of 44.20% and ‘t’ value was 6.46 at p<0.01 level. From the analysis of data it is found that the structured teaching programme on CPR has enhanced the knowledge of staff nurses regarding CPR.10
Prospective randomized interventional study was conducted. Among a sample 80 nurse randomized to two groups; each group underwent three trails of stimulated cardiac arrest. The feedback group received real-time audio visual feed back during the second and third trails, whereas the debriefing- only group performed cardio pulmonary resuscitation without feedback. Both groups received short individual debriefings after the second trial. The results showed that in the debriefing only group, the percentage of participants providing compression of adequate depth increased but from 38% to 68% [p=0.015]. In the feedback group, depth compliance improved from 19%to 58% [p=0.002] compression rate did not improve significantly with either intervention alone. The combination of feedback and debriefing improved compression rate compliance from 45% to 84% [p=0.001] and resulted in a doubling of participants providing compressions of both adequate rate and depth, 29%VS.64% [P=0.005].11
A study was conducted among 371 patients at least 60 years of age on the influence of the probability of survival on patient’s preferences regarding cardiopulmonary resuscitation in Denver. The result showed that 287 completed the interview [mean age, 77 years; range 60 to 99]. Forty-one percent patients opted for CPR before learning the probability of survival to discharge, when they were asked if they had cardiac arrest during an acute illness. After learning the probability of survival [10 to 17%], 22% opted for CPR under these conditions. When asked about a chronic illness in which the life expectancy was less than one year, 11% of the 287 patients opted for CPR before learning the probability of survival to discharge. After learning the probability of survival [0 to 5%], 5% said they would want CPR.12
6.3 Statement of the problem
Effectiveness of skill training programme [STP] on Cardiopulmonary Resuscitation [CPR] on knowledge and skill among students of selected college in Mangalore.
6.4 Objectives of the study
1. To determine the existing level of knowledge and skill of college students regarding CPR.
2. To determine the effectiveness of skill training programme [STP] of CPR of college students regarding CPR.
3. To find out the relationship between post test knowledge level and post test skill regarding CPR among college students
4. To find out the association of post test knowledge level of college students with demographic variables
5. To find out the association of post test skill of college students with demographic variables.
6.5 Operational definitions
1. Effectiveness: It refers to producing an intended result.
In this study effectiveness refers to the extent to which training programme helps to improve the knowledge and skill on CPR among college students.
2. Skill training programme of CPR: Skill training programme refers to the teaching of specific verbal and non verbal behaviours and practicing of these behaviours by the patient.
In this study skill training programme refers to systematically organised teaching strategy of 20 minute duration of CPR, its steps techniques and sequence with demonstration and return demonstration with the aid of an economy adult sani manikins.
3. Cardio pulmonary resuscitation: CPR combines compression of chest with rescue breathing to keep blood flowing through the body and brain while delivering oxygen to the bloodstream.
In this study the American Heart Association released its 2010 guidelines for lay persons is followed. It is C-A-B: the chest compression come first, only then do focus on airway and breathing. No looking, listening, and feeling but is an action, no assessment. Push at least 2 inches deep on the chest and at the rate, 30 compressions should take 18 seconds.
4. Knowledge: knowledge is the theoretical or practical understanding of a subject.13
In this study knowledge is defined as awareness of the college students regarding the CPR as measured by structured knowledge questionnaire on CPR.
5. Skill: The abilityto do something well, usually as a result of experience and training.13
In this study the skill refers to the ability of the college students to perform CPR by following correct techniques as measured by the CPR observation check list.
6. Student: In these study students refers to studying individuals in colleges of Mangalore.
6.6 Assumptions
The study assumes that:
1. Basic cardiac life support measures helps to save lives of people in emergency situation.
2. Demonstrations are done to provide an opportunity to learn new exploration and visual learning tasks from a different perspective.
6.7 Delimitations
The study is delimited to:
· The study delimited to college students with in the age group 18-20 years in selected colleges of Mangalore
· The college students who are studying in selected colleges of Mangalore.
6.8 Hypotheses
All hypotheses will be tested at 0.05 level of significance.
H1: There is significant difference between mean pre-test and mean post test knowledge scores of CPR.
H2: There is significant difference between mean pre test and mean post test skill scores of CPR.
H3: There is significant relationship between mean post test knowledge and mean post test skill scores regarding CPR among the college students.
H4: There is significant association of the mean post test knowledge scores of students regarding CPR with selected demographic variables.
H5: There is significant association of the mean post test skill of college students with demographic variables.
7. / Material and methods
7.1 Source of data
Selected college students in Mangalore
7.1.2 Research design
One group pre-test post-test design is selected for the study.
E = O1 X O2
E = Experimental group
O1 = Pre-test of skill and knowledge of CPR
X = skill training programme of CPR
O2 = Post-test of skill and knowledge of CPR
7.1.3 Setting
The study will be conducted in selected colleges in Mangalore.
7.1.4 Population
In this study population consist of college students of Mangalore.
7.2 Method of data collection
7.2.1 Sampling procedure
Simple random technique with lottery method without replacement.
7.2.2 Sample size
A sample of 30 students will be selected. Simple random technique with lottery method without replacement will be used to select the sample.