RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCE KARNATAKA BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. / Name of the candidate and address (in block letters) / AMJITH KARUNAKARAN
CITY COLLEGE OF NURSING
SHAKTHINAGAR
MANGALORE-575016
2. / Name of the Institution / CITY COLLEGE OF NURSING
SHAKTHINAGAR
MANGALORE-575016
3. / Course of Study and Subject / M. Sc. NURSING
MEDICAL SURGICAL NURSING
4. / Date of Admission to the Course / 30.5.2008
5. / Title of the study
EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON CEREBRAL CARDIOPULMONARY RESUSCITATION (CCPR) AMONG IV YEAR B. Sc. NURSING STUDENTS OF SELECTED COLLEGES AT MANGALORE.
6. / Brief resume of the intended work
6.1Introduction
Coronary heart disease is the leading cause of death in most developing countries with over half of this due to sudden cardiac arrest. It is widely acknowledged that unless effective CCPR is initiated death is evitable. Furthermore, it has recently been reported that the speed and competence of the first responder are important factors that contribute to the initial survival of a person following a cardiac arrest1.
Sudden Cardiac Death (SCD) often occurs in active, outwardly healthy people with no known heart disease or other health problems. But the truth is that sudden cardiac death is not a random event. Most victims do have heart diseases or other health problems, although they may not know it. There are numerous contributors to cardiac arrest, but two of the most important ones are a previous heart attack (75% of the people who die of SCD show signs of a previous heart attack), and coronary artery disease: (80% of SCD’s victims have signs of coronary artery disease)2.
CCPR is a part of the emergency cardiac care system designed to save lives. Many deaths can be prevented by prompt recognition of the problem and notification of the emergency medical system, followed by early CCPR and advanced cardiac life support measures. Early CCPR and defibrillation combined with early advanced emergency care can increase survival rate for people with ventricular fibrillation by as much as 40%3.
Cerebral Cardiopulmonary Resuscitation (CCPR) 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 (cardiac arrest)3. CCPR is synonymously termed as Cardiopulmonary Cerebral Resuscitation (CPCR). The ABCs of CCPR are to establish an Airway, initiate Breathing, and maintain Circulation4. A new protocol emphasising immediate continuous chest compressions appears to improve survival rates in people who suffer out-of-hospital cardiac arrest5.
6.2The need for the study
In India, 70% of the patients that are in medical emergencies like cardiac and brain emergencies die only because of lack of basic life support in the first hour of emergency6. One in 6 men and one in 8 women over the age of 45 have had a heart attack or stroke according to the American Heart Association. Approximately 45% of all heart attacks occur in people under the age of 65 years.2
CCPR is most successful when administered as quickly as possible, but you must first determine if it’s necessary. It should only be performed when a person isn’t breathing or circulating blood adequately. The American Heart Association estimates that 1,00,000 to 2,00,000 lives of adults and children could be saved each year if CCPR was performed early enough7.
CCPR is likely to be effective if commenced within 6 minutes after the blood flow stops, because permanent brain cell damage occurs when fresh blood infuses the cells after that time, since the cells of the brain become dormant in as little as 4-6 minutes in an oxygen-deprived environment and the cells are unable to survive the reintroduction of oxygen in traditional resuscitation3. Many statistics show that the earlier the CCPR is initiated, the greater the chance of survival. The new guidelines of CCPR published by European Resuscitation Council ratio of 30 compressions to two breaths should replace the current recommendation of 15:2. So all nurses and other healthcare staff will now have to be retrained in line with the new advice.8
Nurses are the first at the scene of cardiac arrest in hospital setting, their demanding role expects of them to be well-trained, competent and confident in order to overcome such emergencies. Knowledge about CCPR and skill in its performance are necessary to enhance the role of survival in cardiac arrest patients. A structured education programme on CCPR provides student nurses with knowledge needed to be competent enough to handle an emergency situation.1
A survey conducted in AshikawaMedicalCollegeHospital regarding Cerebral Cardiopulmonary Resuscitation on knowledge of the 66 nursing staffs and compared the results with that of 53 student nurses. The average scores of the test among the nursing staff’s and the student nurses were 61 points and 54 points respectively. The ‘ability’ defined as an indicator of capability of practicing CCPR of the nursing staffs was 17% and that of the student nurses was 0%. This result show that CCPR knowledge of both the nursing staffs and the student nurses was not sufficient, indicating the necessity of CCPR education for both nursing staffs and student nurses9.
The knowledge and skills surrounding the practice of CCPR have become essential to intensive care nurses and to nurses in general. A quasi experimental study conducted to find out the retention of basic cardiopulmonary resuscitation skills and knowledge among 19 registered nurses in England. The tool used was a 8-point skills testing observation tool and a 26-point knowledge testing questionnaire. While a 3-hour update in CCPR skills revealed an initial improvement, the decrease in retention of skills 10 weeks later was significant (P<0.000). The update in CCPR knowledge also revealed an initial improvement but the decrease in retention of knowledge 10 weeks later was significant (P<0.000). The finding of this study suggests that retention of skills and knowledge quickly deteriorates if not used or updated regularly. Therefore this study supports the importance of CPR refresher courses on a regular basis.9
Students are really unlicensed assistive personnel with some additional education and background. Their view of patient care is still pure. Students freely admit (and assume you know) that they do not know everything. For example, they
freely admit they will be afraid of defibrillating a patient in ventricular fibrillation because “they might do it wrong.” They need confidence to do what nurses must do. But nurses are reluctant to admit they do not know everything because they do not want to look stupid. There have been questionable scenarios for which they wonder if there should have been a different course of action10.
From the above studies and literature the investigator was motivated to conduct this study because the guidelines of CPR has been revised in order to increase the survival rate after the sudden cardiac arrest by adding a new protocol emphasising immediate continuous chest compression, that is, cerebral cardio pulmonary resuscitation and various studies showed that the knowledge and skill of staff nurses and students deteriorated quickly. Keeping this in mind the investigator was instigated to provide a planned teaching programme on CCPR and the skills to perform it.Moreover VI year B. Sc.nursing students are the immediate future staff nurses or the teachers or the clinical instructors who assume these jobs soon after graduation. Therefore a planned teaching programme for them would be essential to keep them informed and retained the new guidelines of CCPR and its skills.
6.2Review of literature
A pre-experimental research was conducted by using purposive convenience sampling to find out the effectiveness of planned teaching module on knowledge and practice of CCPR among staff nurses working in a hospital at Punjab. The sample consisted of 40 subjects. The tools used were knowledge questionnaire and observational checklist. The study revealed that the mean post-test knowledge score (40.68) was significantly higher than the mean pre-test knowledge score (29.53). Similarly the mean post-test score (26.75) was significantly higher than the mean pre-test practice score (18.5) when analysed by paired t-test. So it can be concluded that planned teaching module is highly effective tool to enhance the knowledge and practice of subject on CCPR1.
A study was conduct on 70 nursing students of Y Nursing College at Korea to evaluate the effectiveness and competence level of trainees of CCPR training targeted for nursing students. The tool used was knowledge questionnaire. The study revealed that the post-test knowledge level of trainees increased compared to the pre-test (t=15.075, p<0.000), competence level also increased (t=14.86, p<0.00). The study concluded that effective teaching programme will improve the knowledge of nursing students on CCPR11.
A study was conducted to describe the basic cardiac life support skills of nurses and nursing students in Southern Finland and Hungary and to assess the influence of resuscitation teaching and other group characteristics on performance. The study group consisted of 75 nurses from Helsinki University Central Hospital Medical Outcome Unit and 188 final term students from a Hungarian Institute of Nursing. The tool used was structured knowledge questionnaire and skill meter. The statistical differences were calculated using the chi-square test. The results showed that 53% of the participants had studied resuscitation during the last 6 months, but
7% had never participated in resuscitation teaching. Before testing 55% of participants estimated that their resuscitation skills were good. The results showed that 36% first assessed the patient’s response, 67% opened the airway, but only 3% determined pulselessness before starting to resuscitate, 21% of the participants compressed correctly for at least half of the test, and 33% ventilated correctly for at least half of the time. Logic regression showed that the best predictors join good response assessment skills event to those who were nursing students who had studied resuscitation skills some time during the previous 6 months. This study revealed that teaching on CCPR was effective among nursing students.12
6.3Statement of the problem
Effectiveness of planned teaching programme on cerebral cardio pulmonary resuscitation (CCPR) among IV year B.Sc. nursing students of selected colleges at Mangalore.
6.4Objectives of the study
  1. To determine the level of knowledge of IV year B. Sc. (N) students regarding CCPR before administering planned teaching programme by using knowledge questionnaire.
  2. To determine the skill of IV year B. Sc. Nursing students regarding CCPR before administering planned teaching programme by using observation checklist.
  3. To find out the effectiveness of planned teaching programme on CCPR in terms of gain in knowledge scores and skill scores.
  4. To find out the association with the pre-test knowledge scores and selected demographic variables.
  5. To find out the association with the pre-test skill scores and selected demographic variables.

6.5Operational definitions
  1. Knowledge: In this study knowledge refers to the scores obtained by the students by giving correct responses to structured knowledge questionnaire.
  2. Effectiveness: In this study, effectiveness refers to determining the extent to which the planned teaching programme has achieved the desired effect as expressed by gain in post-test knowledge scores.
  3. Planned teaching programme: It refers to systematically developed instructional teaching aids and demonstration of CCPR for IV year B. Sc. nursing students in order to provide accurate information and skill.

  1. Cerebral cardio pulmonary resuscitation (CCPR): It 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 (cardiac arrest). It is a combination of basic and advance cardiac life support.
  2. Skill:In this study it means the capability to accomplish steps of CCPR with proper technique.

6.6Assumptions
The study assumes that:
  1. Planned teaching programme will be one of the effective methods to improve the knowledge and skill of nursing students.
  2. IV year B.Sc. Nursing students have some knowledge and skills on CCPR.

6.7Delimitations
The study is delimited to IV year nursing students:
  • Studying in the selected colleges of nursing.
  • Who are presently studying in the colleges at the time of data collection.

6.8Hypotheses
All hypotheses will be tested at 0.05 level of significance.
H1:The post-test knowledge scores of planned teaching programme will be significantly higher than pre-test knowledge scores.
H2:There will be a significant association with the knowledge scores and the selected demographic variables.
H3:There will be a significant association with the skill scores and the selected demographic variables.
7. / Material and methods
7.1Source of data
In this study the data will be collected from IV years B. Sc. nursing students who are studying in selected colleges at Mangalore.
7.1.1Research design
Pre-experimental one-group pre-test post-test design.
7.1.2Setting
The study will be conducted in the selected nursing colleges at Mangalore.
7.1.3Population
Population includes IV year B. Sc. nursing students of the selected nursing colleges at Mangalore.
7.2Method of data collection
7.2.1Sampling procedure
Stratified random sampling.
7.2.2Sample size
The sample for the study would comprise of 50 IV year B. Sc. nursing students from selected colleges at Mangalore.
7.2.3Inclusion criteria for sampling
  • Students studying in the IV year of B. Sc. nursing and age group between 20-30 years.
  • Students who are willing to participate in the study.

7.2.4Exclusion criteria for sampling
  • Students who have not cleared the IV year B. Sc. nursing subjects.

7.2.5Instruments intended to be used
  • Structured knowledge questionnaire and observation checklist.

7.2.6Data collection method
Permission will be obtained from the selected nursing colleges at Mangalore.
By using stratified random sampling, selecting 50 IV year B. Sc. Nursing students
Purpose of the study will be explained and consent will be taken from the subjects.
Participants’ pre-test knowledge will be assessed by using a structured knowledge questionnaire and skill will be assessed by administering an observation checklist. A planned teaching programme will be given to them on the same day.
The post-test will be conducted using the same knowledge questionnaire and skills by using the same observation checklist on the seventh day.
7.2.7Data analysis plan
The data will be analysed using both descriptive (mean, median, SD) and inferential statistics (chi-square test and t-test) and the data will be presented in the form of tables, graphs and diagrams.
7.3Does the study require any investigations or interventions to be conducted on patients, or other animals? If so please describe briefly.
Yes, the investigator needs to evaluate the effectiveness of PTP on CCPR among IV year B. Sc. nursing students.
7.4Has ethical clearance been obtained from your institution in case of 7.3?
Yes, ethical clearance has been obtained from the institution.
8. / References
  1. Kaur N. CPR. Nurses of India 2006 Feb;4-6.
  2. planet.com/nr//index
  3. PotterPE, Perry G. Fundamentals of nursing. 6th ed. Philadelphia: Elsevier.
  4. Zimmermann PG. Minimally interrupted cardiac resuscitation. AJN 2008 Oct;108(10):73.
  5. Hande V. What to do in an emergency. Herald of Health 2007 May.
  6. Scott H. Clinical guidance on CPR overhauled. NT6 2005 Dec;101(49):6.
  7. Burg S. Effectiveness of CPR refresher courses. Herald of Health 2006 Jun;25.
  8. Zimmerman PG. The difference between teaching nursing student and registered nurse. Journal of Emergency Nursing 2002 Dec;28(6):574.
  9. Nyman J. Resuscitation 2000;47:179-84.

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