RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE , KARNATAKA
ANNEXURE – I I
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1 / Name of candidate and Address( In block letters ) / MR.RALDIN GEORGE
I YEAR MSc. NURSING
SHREE DEVI COLLEGE OF NURSING
MAINA TOWER , BALLALBAGH
MANGALORE - 575003
2 / Name of the Institution / SHREE DEVI COLLEGE OF NURSING
MAINA TOWER , BALLALBAGH
MANGALORE - 575003
3 / Course of Study and Subject / MSc NURSING,
(MEDICAL SURGICAL NURSING )
CARDIO THORACIC NURSING
4 / Date of Admission to the Course / 11.12.2009
5 / Title of the Topic
“A STUDY TO ASSESS THE EFFECTIVENESS OF SELF INSTRUCTION MODULE ON CARDIAC CATHETERIZATION AMONG STAFF NURSES AT A SELECTED HOSPITAL, MANGALORE.”
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8 / BRIEF RESUME OF THE INTENDED WORK
6.1 INTRODUCTION
BACKGROUND OF THE STUDY
Cardiac catheterization is an invasive diagnostic procedure used widely in the field of heart medicine in which radio-opaque arterial and venous catheters are introduced into selected blood vessels of the right and left sides of the heart. Most commonly, the catheters are inserted percutaneously through the blood vessels, or via a cutdown procedure. Pressures and oxygen saturations in the four heart chambers are measured. Cardiac catheterization is used to diagnose CAD, assess coronary artery patency, and determine the extent of atherosclerosis based on the percentage of coronary artery obstruction. It is currently one of the most accurate tests in the diagnosis of coronary artery disease, offering speedy non-invasive diagnosis and rapid results without the need for a hospital stay1.
Cardiac catheterization can accomplish two main purposes based on which the classification being made. The prime one is diagnostic cardiac catheterization which includes coronary angiography, cardiac biopsy, right heart catheterization, ventriculography and intracoronary ultrasound. The latter is the interventional cardiac catheterization which includes angioplasty, cardiac stenting, mitral valvuloplasty, patent foramen ovale repair or atrioseptal defect repair .Very often the two goals are accomplished at the same time. As the cardiologists all over the world are engaged in discovering new diagnostic and therapeutic methods for cardiovascular diseases, the cardiac catheterization positions as the key procedure with diagnostic as well as therapeutic properties3.
6.2 NEED FOR THE STUDY
Cardiac catheterization has been and currently remains the gold standard for the diagnosis of coronary artery disease4. It may also reveal the presence of other conditions, including enlargement of the left ventricle; ventricular aneurysms (abnormal dilation of a blood vessel); narrowing of the aortic valve; insufficiency of the aortic or mitral valve; and septal defects that allow an abnormal flow of blood from one side of the heart to the other. The procedure shows the overall shape of the heart, the four heart chambers, and accessory structures inside it which will help to plan for treatment5.
Cardiac catheterization is performed by insertion of a radio-opaque catheter into the right or left side of the heart. For the right side of the heart, a catheter is inserted through an arm vein or a leg vein. The catheter is advanced into the venacava, the right atrium, and the right ventricle. The catheter is further inserted into the pulmonary artery and pressures are recorded. The catheter is then advanced until it is wedged or lodged in a position. This wedge pressure is used to determine the function of the left side of the heart. The left heart catheterization is performed by insertion of a catheter into a femoral or brachial artery. The catheter is passed in a retrograde manner up the aorta, across the aortic valve, and into the left ventricle. Coronary angiography can be done with a left heart catheterization2.
Cardiac catheterization is a common outpatient procedure nowadays2. According to American Heart Association Statistics 2004, every year over 50,00,000 cardiac catheterizations were performed in the United States to diagnose and treat heart disease. By 2008, this has increased to more than 1.5 million which are done primarily to diagnose or monitor heart disease. The most common site for access to the coronary circulation is the femoral artery6. In Britain, 2658 cardiac cathterizations per million populations are performing every year7.
The incidence and prevalence of coronary artery disease (CAD) has increased tremendously in India too during the last two decades. There has also been a rapid progress in the treatment of CAD with proliferation of specialized cardiac care units, intensive care units, cardiac catheterization laboratories and facilities for bypass surgery. It is estimated that there are over 400 catheterization laboratories currently in India and nearly half of them are located in six major cities8.
A descriptive study was conducted in New Delhi among inpatients and outpatients of the cardiac unit to find out the cardiovascular disease trends. The results revealed that only 117 cardiac catheterizations were done in 1988 where as in 2005, this rate has increased to a peak level of 10,011. This significant increase in the number of cardiac catheterization suggests its wide acceptance as a therapeutic as well as diagnostic procedure in India9.
Cardiac catheterization is usually performed in a specially designed cardiac catheterization suite in a hospital. A cardiac catheterization team consists of a physician (e.g., interventional cardiologist), a nurse, a circulating nurse, and a radiologic technologist5. Nurses’ role in cardiac catheterization includes preparation of patients, assisting in the procedure, removing femoral sheaths after the procedure, achieving hemostasis, assessing for potential complications, maintaining bedrest, immobilizing the patient's affected limb, providing emotional support, educating patients, and promoting patient comfort. The nurses must have an advanced knowledge and understanding of cardiac catheterization so that any procedural complications may be handled rapidly and effectively10.
A survey was conducted in Australia and New Zealand among 148 cardiovascular nurses to determine the practice standards and priorities of nursing care following a cardiac catheterization. The study identified diversity of practice patterns and a range of educational needs regarding cardiac catheterization among nurses11.
Another study was conducted among 12 staff nurses and 105 post-femoral artery cardiac catheterization patients to compare the outcomes of post-cardiac catheterization patients assessed for readiness for ambulation by trained nurses with those undergone traditional physician assessment. The nurses received a competency-based educational program and the post intervention study results showed that the knowledge and skill of staff nurses has increased significantly10.
Many of the studies and researcher’s own experience reveal an inadequate knowledge among the staff nurses. Hence the researcher wants to improve the knowledge of staff nurses regarding cardiac catheterization by using a Self Instruction Module.
6.3 REVIEW OF LITERATURE
The literature review will be presented under the following headings
· Incidence and prevalence of cardiac catheterization.
· Pre and post procedural nursing care of patients undergoing cardiac catheterization.
· Knowledge of staff nurses regarding care of patients undergoing cardiac catheterization.
· SIM as an effective teaching strategy.
Literature related to incidence and prevalence of cardiac catheterization.
A survey was conducted in Spain by Spanish society of cardiology to assess the scope of cardiac catheterization and interventional cardiology. The data was collected from 131 hospitals. The results of the study revealed that there is an increase in the number of cardiac catheterization procedures significantly every year. Researcher concludes that as the scope of cardiac catheterization is increasing, the health care providers should have adequate knowledge regarding cardiac catheterization. 12
A survey was conducted in nonfederal hospitals of United States to determine whether the rates of cardiac procedures increased after 1997. The study results revealed that rates of cardiac catheterization increased after 1997, peak between 2006 and 2007 and an apparent increase is seen among black than white. Researcher concludes that the significant increase in the rate of cardiac catheterization might be because of its increased acceptance as a diagnostic as well as therapeutic procedure among cardiologists.13
Literature related to pre and post procedural nursing care of patients undergoing cardiac catheterization
A randomised controlled trial was conducted in UK among 355 patients to compare a nurse practitioner(NP) to junior medical staff(JNS) in the preparation of patients for diagnostic cardiac catheterisation. Results revealed that major adverse clinical events occurred in 0/175 (0%) patients in the NP group and 2/161 (1.2%) patients in the JMS group and patient satisfaction was greater in the NP group (P=0.04). The researchers’ conclusion was that the preparation of patients for diagnostic cardiac catheterization can be safely performed by an appropriately trained nurse practitioner. This approach may be associated with improved patient satisfaction and reduced clinic duration times. 14
An experimental study was conducted in USA among 86 patients after diagnostic cardiac catheterization to determine a significant difference in the incidence of bleeding from femoral artery insertion sites between cardiac catheterization patients who remained in bed for 4 hours and those who remained in bed for 6 hours after sheath removal. Both groups had pressure dressings and sandbags in place over the insertion site during time in bed. The results showed that there was no significant difference in the incidence of bleeding related to out-of-bed activity between the groups. The conclusion of the study was that requisite time in bed after cardiac catheterization can be safely decreased from 6 to 4 hours. This change has implications for enhancing patient comfort and decreasing both length of hospital stay and healthcare costs. 15
Literature related to knowledge of staff nurse
A descriptive study was conducted in US among critical care nurses to assess the knowledge and understanding of nursing personnel regarding cardiac catheterization. The mean knowledge score was 48.5% for nurses who had years of experience in critical care settings. The study concludes that a wide variation in the understanding of the use of the cardiac catheterization exists among nurses. The result indicates that current teaching practices regarding the cardiac catheter need to be re-evaluated and specific credentialing policies need to be considered. 16
Literature related to effectiveness of SIM
An evaluative study was conducted in Chennai, with 30 subjects selected through non-probability sampling techniques to find the effectiveness of information booklet provided to care givers of patients undergoing haemodialysis on the knowledge of home care management. The major findings showed the overall improvement in the mean score (35-89)with the ‘ t’ value 13.4 which was highly significant at 0.001 level which showed a significant improvement in care givers after understanding the information given in the booklet. 17
6.4 STATEMENT OF PROBLEM
“A study to assess the effectiveness of self instruction module on cardiac catheterization among staff nurses at a selected hospital, Mangalore.”
6.5 OBJECTIVES
1. To assess the prior knowledge of staff nurses regarding the care of patients undergoing cardiac catheterization.
2. To develop SIM regarding the care of patients undergoing cardiac catheterization.
3. To find out the effectiveness of SIM in terms of gain in post test knowledge score.
4. To associate the pre test knowledge score with demographic variables.
6.6 OPERATIONAL DEFINITION
· Assess : According to Oxford dictionary, assess means “evaluate or estimate the nature, value or intended results”.
In the present study, assess means judging the status of pretest and post test knowledge of staff nurses on cardiac catheterization.
· Effectiveness: According to Oxford dictionary, effectiveness means “ability to produce a desired or intended result’.
In the present study, effectiveness refers to the extent to which the SIM has achieved the desired objective, that means improvement of knowledge scores among staff nurses on cardiac catheterization.
· Self Instructional Module: According to B Sankaranarayan, SIM is an organized collection of learning experiences assembled in order to achieve a specified group of related objectives.
In the present study, SIM is a learning package planned and prepared from the beginning till end on cardiac catheterization provided to staff nurses with an aim to facilitate self learning.
· Cardiac catheterization: According to Baillier’s nurses’ dictionary, cardiac catheterization is a procedure whereby a radio-opaque catheter is passed from an arm vein to the heart. Its passage through the heart can be watched on a screen. Also blood pressure readings and specimens can be taken, thus aiding diagnosis of the heart abnormalities.
In the present study, cardiac catheterization is a diagnostic as well as a therapeutic procedure that allows a comprehensive examination of the heart and surrounding blood vessels.
· Staff nurses: According to Oxford dictionary, nurse means ‘a person trained to care for the sick or infirm.
In the present study, staff nurse is a person who is having a diploma or basic degree in nursing from a recognized university or board, registered under a state nursing council and is working in selected hospital, Mangalore.
6.7 VARIABLES
· Independent Variable: SIM on cardiac catheterization
· Dependent Variable: Nurses’ knowledge on cardiac catheterization.
6.8 ASSUMPTION
The study assumes that,
· Staff nurses will have some knowledge regarding cardiac catheterization.
· Knowledge may vary from person to person
6.9 DELIMITATION
The study would be delimited to staff nurses in a selected hospital, Mangalore.
6.10 HYPOTHESES
H1: The mean post test score of the staff nurses will be significantly higher than mean pre test score .
H2: There will be significant association between pre test knowledge score of staff nurses on cardiac catheterization with demographic variables.
MATERIALS AND METHODS
7.1.1 SOURCE OF DATA
Data will be collected from staff nurses in a selected hospital, Mangalore.
7.1.2 RESEARCH DESIGN
The research design selected for this study is pre experimental one group pre and post test design.
O1 --- X --- O2 O1= Pre test knowledge of staff nurses
E = O2 - O1 X = Intervention with SIM
O2= Post test knowledge of staff nurses
E = Effectiveness of SIM
7.1.3 SETTING
The study will be conducted in a selected hospital, Mangalore.
7.1.4 POPULATION
The population for this study will be staff nurses in a selected hospital, Mangalore.
7.2 METHOD OF DATA COLLECTION
7.2.1 SAMPLING PROCEDURE
Purposive sampling technique will be adopted for this study.
7.2.2 SAMPLE SIZE
The sample size will be approximately 50 staff nurses in a selected hospital, Mangalore.
7.2.3 INCLUSION CRITERIA
Staff nurses who are
· able to speak and understand English.