RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCE,
KARNATAKA, BANGLORE – 78
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1 / NAME OF THE CANDIDATEAND ADDRESS / Mr. SHINE ABRAHAM
1ST YEAR M.Sc. NURSING
N.D.R.K COLLEGE OF NURSING,
B.M ROAD, HASSAN
KARNATAKA
2 / NAME OF THE INSTITUTION / N.D.R.K COLLEGE OF NURSING
3 / COURSE OF THE STUDY
AND SUBJECT / MASTER OF SCIENCE IN NURSING,
MEDICAL SURGICAL NURSING
4 / DATE OF ADMISSION TO
COURSE / 01 – 06 - 2009
5 / TITLE OF TOPIC / STATEMENT
OF THE PROBLEM / “A STUDY TO EVALUATE THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME (PTP)ON KNOWLEDGE REGARDING PREVENTION OF COMPLICATION OF INTRAVENOUS THERAPY (IVT) AMONGIII YEAR GNM STUDENTS OF N.D.R.K SCHOOL OF NURSING, HASSAN”
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION:
“An ounce of prevention is better than a pound cure”
Medication administration is a basic nursing function that involves skillfultechniques and consideration of patient’s development, health status and safety. The nurse needs knowledge base about drugs including drug name, preparation, classification, adverse effect and physiologic factors that affect the drug action.Among all method of drug administration, intravenous administration of fluids, drugs and nutrition is very common in hospital.1
Intravenous infusion therapy is process of introducing drugs or liquids in to the body through veins. Both central veins and peripheral veins can be used for this purpose. It delivers the drug into the blood stream in order to have immediate effect.Intravenous infusion therapy is used when a person must receive fluids, electrolytes and medication swiftly or over a long period, such as, people in a life threatening situation, people who all are enable to ingest oral fluids and who are under nil per mouth, when the body need to absorb the substance quickly, when the drugs would be destroyed or would not be absorb by gastro intestinal tract. Arm and hand veins are typically used although leg and foot veins are occasionally used.2
Medications can be administered through three methods of insertion namely a syringe and needle, a peripheral intravenous line or a central intravenous line. The central intravenous lines are larger than peripheral intravenous lines and assess the heart directly. Fluid administration via intravenous therapy, travel throughout the body more quickly than those delivered by other method. It is very common and effective and can supply nutrition to a patient who is unconscious.3
A group ofcomplications can occur after peripheral intravenous therapy and arterial vascular cannulation. The main reason for complications is inappropriate use and poor technique which is followed by health professionals. Some of the important complications are infection, phlebitis, Thrombophlebitis, infiltration, Hematoma, nerve damage, fluid overload, electrolyte imbalance, embolism and extravasations.2
Nurses play major role in the prevention of complication by minimizing the risk and through effective interventions. Some of the measures to prevent complications are securing the cannula at intravenous site, using appropriate gauge needle or cannula, use aseptic technique while doing procedure, check history for allergy, change the dressing for every 24 hrs, maintain intravenous flow rate, avoid re-inserting the needle, check intravenous site frequently for any skin changes, change solution tubings and cannula at recommended times, and so on.
6.1 NEED FOR THE STUDY
“Intellectuals solve problem geniuses prevent them”
Albert Einstein
As per an article report approximately 150 million peripheral intravenous devices are inserted annually in the United States, with a 5 % incidence rate of phlebitis. In 2002, the Center for Disease Control and Prevention recommended that peripheral intravenous sites and sets can be changed at every 96 hours yet clinical practice supported that at least 25% of peripheral intravascular devices shows no signs of phlebitis at 96 hours dwell time.3
The US Centers for Disease Control and Prevention updated their guidelines and now advise the cannula need to be replaced every 96 hours.A peripheral IV cannot be left in the vein indefinitely, because of the risk of insertion-site infection leading to phlebitis, cellulites and sepsis. This was based on studies organized to identify causes and risk factors associated with increased Methicillin-resistant Staphylococcus aurous infection in hospitals. Now include intravenous cannula, central venous cathetersare the main factors increasing the risk of spreading antibiotic resistant strain bacteria in hospitals.4
Astudy was conducted to determine the infectious complication of intravenous therapy among hospitalized patientsin USA. 300 patients were selected from two hospital-based intravenous therapy services. Diagnoses included 92 cases of osteomyelitis, 33 of pneumonia, 35 of malnutrition, 26 of chronic pain, and 114 of other diseases. Peripheral IVT was given to 97 patients. Mean age was 39.4 years (range, 0.3–98).Six bacteremias (one death) (2%, 4.6/10,000 catheter days), two subclavian thromboses, 13 catheter site infections, and one additional death occurred. PICC experience included 76 patients, mean age 46 years (range, 4–76), primarily with infections, chronic pain, or dehydration. Mean duration of therapy was 24 days (0–67) and was completed in 51 patients; others completed therapy with standard peripheral catheters a mean of 6 days later. Complications included 17 obstructions by clot, 11 cases of phlebitis, six catheter fractures, five punctures, two accidental removals, and one infiltration. Liquid silicone repaired holes; urokinase opened clots. Successful completion of therapy was more common in the second year, 88% versus 57%.5
The Infusion Nurses Society's national standards of practice require that a nurse who administers IV medication or fluid know its adverse effects and appropriate interventions to take before starting the infusion. A serious complication is the inadvertent administration of a solution or medication into the tissue surrounding the IV catheter when it is a non vesicant solution or medication, it is called infiltration; when it is a vesicant medication, it is called extravasation. Both infiltration and extravasation can have serious consequences: the patient may need surgical intervention resulting in large scars, experience limitation of function, or even require amputation. These outcomes can be prevented by using appropriate nursing interventions during IV catheter insertion and early recognition and interventionupon the first signs and symptoms of infiltration and extravasation. Nursing interventions include early recognition, prevention, and treatment including the controversial use of antidotes, and heat and cold therapy.6
A serious of complications after peripheral intravenous therapy and arterial vascular cannulation have been reported. Inappropriate use and poor technique carry risk for the patients with many complications. Some of complications are infection, phlebitis, Thrombophlebitis, infiltration, Hematoma, nerve damage, fluid overload, electrolyte imbalance, embolism and extravasation.3
The student nurses must understand the signs and symptoms of the complications of intravenous therapy along with its etiology and defining characteristics. With this information she can formulate a nursing diagnosis and responsibility carry out the nursing inventions.
The above studies shows that most of the patients experiencing complications during or after intravenous therapy. Some studies reveal that student nurses have less than adequate knowledge regarding prevention of complication. During his clinical experience observed the complications such as infection, inflammation and other complication occur due to lack of knowledge in prevention of complication of intravenous infusion therapy. Thestudent researcher felt thatthe III Year GNMnursing students need adequate information about intravenous therapy. Hence this study aims to provide necessary information to the nursing student on prevention of complication of intravenous therapy. The student researcher plan to construct planned teaching programme and test its effectiveness to achieving the desired goals of educating the III Year GNM nursing students about complications of intravenous therapy and its prevention.
6.2REVIEW OF LITERATURE
Review of literature is the selection of available documents on the topic which containinformation, ideas, data and evidence. It is an examination of the research that has beenconducted in a particular field of study.
Review of literature is divided into three parts; the literature related to,
6.2.1 Knowledge on Intravenous Therapy.
6.2.2 Knowledge on prevention of complication of Intravenous Therapy.
6.2.3 Planned teaching programme.
6.2.1Literature related to knowledge on IntravenousTherapy.
A nonequivalent experimental study was conductedto examine the impact that implementation of guidelines for the management of peripheral intravascular devices on nurses knowledge and practicein a Hong Kong tertiary care teaching hospital. The results showed that the percentage of correct answer for all questions was significantly higher at the posttest. The overall results also showed significant practice improvement in terms of the flushing agent used, documentation, and site dressing. There was also a decrease in the incidence of extravasation and phlebitis. It was concluded that evidence-based practice is important for improving patient outcome.7
A randomized, prospective, controlled study was conductedto determine whether the use of an IV therapy team decreases peripheral venous catheter-related complications in adult medical patientsin Michael Reese hospital and MedicalCenter, Chicago, USA Patients were randomized to undergo peripheral catheter insertion and/or maintenance either by the IV team or by medical house staff. The result shows that patients with catheters started by the house staff and maintained by ward nursing staff more often had signs or symptoms of inflammation (21.7%) than did patients with catheters maintained by the IV team (7.9%) (P<001). Patients monitored by the IV team had a greater mean number of catheters placed per patient than did patients monitored by house staff (2.1 and 1.6, respectively) (P<.01). Three episodes of catheter-related sepsis occurred in house staff patients and none in IV team patients (P=.004). They concluded that an IV therapy team significantly reduced both local and bacteremic complications of peripheral IVcannulations. Timely replacement of the cannulations appeared to be the most important factor in reducing the occurrence of complications.8
6.2.2 Literature related to knowledge on prevention of complication of IntravenousTherapy.
A study was conducted to evaluate the effect of an educationalintervention designed to reduce the rate of inappropriate cannulationand to improve cannulation technique inUK.The result shows thatthere was a non-significant reduction in inappropriate (no intravenousfluids or drugs given) cannulation rates in the interventionarea (1.0% to 0%) compared with the control area (2.5% to 2.6%).There was a significant (p<0.001) reduction in cannulationrates in the intervention area (9.1% to 6.5%; OR 0.7, 95% CI0.48 to 1.03) compared with an increase in the control area(13.8% to 19.1%; OR 1.47, 95% CI 1.15 to 1.90), a significantdifference (p<0.001). Paramedics in the intervention areawere significantly more likely to use correct hand-washing techniquespost-intervention (74.5% vs. 14.9%; p<0.001). They concluded thatthe educational intervention was effective in bringing aboutchanges leading to enhanced quality and safety in some aspectsof hospital cannulation.9
A study was conducted to assess the perceptions of risk factors for infusion phlebitis among Swedish nurses. A majority of the nurses believed that insertion of a peripheral venous catheter in the forearm and catheter rotation within 48 hours was protective. Surveillance of the educational level of staff, who inserts peripheral venous catheters, is an important tool for reducing the incidence of infusion phlebitis. Sometimes followed by thrombosis with a palpable cord. Host factors such as gender, age, size of cannulated vein, insertion site, and hemoglobin level have also been investigated. They also found that the day-specific risk for phlebitis doubled when the catheter was left in place for 48 hours as compared with 24 hours. After 48 hours the day-specific risk was constant, further supporting the updated CDC guidelines, It has been shown that the skills of the staff, who insert and maintain the peripheral intravenous catheters, are of importance for the incidence of phlebitis.10
6.2.3 Literature related to planned teaching programme.
A study was conducted to evaluate the effectiveness of planned teaching programme in improving the knowledge of G.N.M. students on clinical skills. A sample of 30 Second year G.N.M. students was selected by lottery system (simple random sampling technique). A structured questionnaire and observational checklist were found to be suitable for the study to assess the knowledge of a group of G.N.M. students. The findings of this study indicate that the planned teaching programme enhanced -the knowledge and developed the ability of G.N.M. students. The PTP is a suitable method of instruction for educating G.N.M. students for disseminating health information.11
A study was conducted to measure the impact of teaching program on their level of knowledge of first year medical students.All 34 newly qualified medical students in one teaching hospital were offered a six-session teaching programme in pain and symptom management. A multiple-choice questionnaire was used to assess their level of knowledge at the beginning and at the end of a 6-month period over which the teaching sessions took place. Attendance at and satisfaction with the programme were high. There was a significant improvement in the level of knowledge at the end of the programme, with the greatest improvement in those who attended most sessions. The low scores recorded for the questionnaire administered before the teaching programme suggest that there is a critical need for improved education in palliative care amongst health workers.12
STATEMENT OF THE PROBLEM:
“A study to evaluate the effectiveness of Planned Teaching Programme (PTP)on knowledge regarding prevention of complication of Intravenous Therapy(IVT) among III Year GNM students in N.D.R.K.School of Nursing,Hassan.”
6.3OBJECTIVES:
6.3.1To asses the knowledge level of III YearGNM nursing students regarding the prevention of
complicationof IVT before PTP.
6.3.2To asses the posttest knowledge scores ofIII YearGNM students regarding thepreventionof complication of IVT afterintervention to evaluate the effectiveness of PTP.
6.3.3 To determine the association between knowledge scores ofIII YearGNM students withtheir selected socio demographic variables.
HYPOTHESIS
H1 The posttest knowledge score will be significantly higher than the pretest knowledgescore after
intervention.
H2 There will be an association between knowledge scores with their selectedSocio demographic
variables.
ASSUMPTION
- TheIII YearGNM nursing studentsmay not have adequate knowledge on the prevention of
complication of IVT.
2. There will be an improvement in the knowledge level ofIII YearGNM students after thePTP.
3. Planned teaching programme is an effective method of imparting knowledge to theofIII YearGNM students.
OPERATIONAL DEFENITIONS
- Evaluate : It involves ascertain the difference between pretest and posttest scores with
appropriate statistical methods
- Effectiveness : It refers to statistical measurement of difference between pretest and
posttestknowledge scores.
3. Planned TeachingProgramme:It refers to the systematically organized instruction and
discussion which helps in the learning process for nursing students about
prevention of complication of Intravenous Therapy
- Knowledge:It is the awareness of III Year GNM students about prevention of complicationof
IVT as revealed by knowledge scores obtained from self administered questionnaire.
5. Intravenous Therapy:Intravenous infusion therapy is the administration of
liquid substances directly in to a vein.
6. III YearGNMNursingstudents:It refers to Nursing Students studying in Diploma Nursing
programme in N.D.R.K.School of nursing, Hassan.
7. MATERIALS AND METHODS
7.1.1 SOURCE OF DATA
Data will be collected from III YearGNM students inN.D.R.K.School of Nursing, Hassan.
7.2 METHODS OF COLLECTION OF DATA
7.2.1RESEARCH APPROACH:
Evaluative approach.
7.2.2 RESEARCH DESIGN:
Pre experimental studywith Single group pretest – posttest design
GROUP / PRETEST / INTERVENTION / POSTTESTSINGLE GROUP / O1 / X / O2
KEY
O1= Assessment of the pretest knowledge ofIII YearGNM students regarding prevention
of complicationof IVT.
X = PTPon prevention of complication of IVT.
O2 = Assessment of posttest knowledge ofIII YearGNM students regarding prevention
of complicationof IVT.
7.2.3 POPULATION
III YearGNM students studying inNursing Schools of Hassan. .
7.2.4SAMPLE:
III YearGNM students studying inN.D.R.K.School ofNursing who have fulfilled the inclusioncriteria.
7.2.5SAMPLE SIZE
The sample consists of 60 III YearGNM students studying in N.D.R.K.School of Nursing.
7.2.6SAMPLING TECNIQUE
Probability sampling with Simple random sampling technique will be used.
7.2.7SELECTION OF TOOL
Structured questionnaire consists of two sections.
Section A - Socio Demographic variables.
Section B - Knowledge questions on prevention of complication of IVT.
7.2.8CRITERIA FOR SELECTION
Inclusive criteria:III Year GNMstudentsof both the genders who are
- Studying in N.D.R.K.School of nursing.
- Willing to participate in study.
- Present during the period of data collection
Exclusive criteria:III Year GNMstudents of both genders who are
- On leave during data collection.
- Not willing to participate in the study.
7.2.9 Delimitation of the study: this study is delimited to,
1. 60 III YearGNM students studying inN.D.R.K.School of nursing.
2. Data will be collected in a period of 4 weeks.
7.2.10 SIGNIFICANSE OF THE STUDY
The study signifies the importance of PTP on prevention of complication of intravenous
therapy and it will enhance the knowledge of III YearGNM students.
7.2.11 CONCEPTUAL FRAMEWORK
Modified theoretical model based on Von Bertanlanffy general system model (1968)
7.2.12 SETTING OF THE STUDY
The study will be conductedinN.D.R.K.School of nursing, Hassan.
7.2.13PILOT STUDY
The pilot study is planned with 10% of the population which will beconducted in III Year GNM of N.D.R.K.School of nursing, Hassan and that will be excluded in the main study.
7.2.14 VARIABLES:
- Independent variables:PTP on prevention of complicationofIVT.
- Dependent variables:Knowledge ofIII YearGNM students regarding prevention of complicationof IVT.
- Extraneous variables:Socio demographic variables such as age, sex, religion, education status of father and mother, occupation of father and mother, income of the family per month, area of residence, previous information regarding Intravenous Therapy, mass media exposure on prevention of complication of Intravenous therapy.
7.2.15 DATA ANALYSIS METHOD
It includes descriptive and inferential statistics.
Descriptive Statistics:It includes frequency, percentage,mean and standard deviation.
Inferential Statistics: It includes Paired‘t’-test, Chi-Square test.
7.3DOES THE STUDY REQUIRE ANY INTERVENTIONS TO BE CARRIED OUT ON PATIENTS OR OTHER HUMANS?
Yes, Planned Teaching Programme is used as an intervention on III YearGNM students.
7.4HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION?