Post on 25-Apr-2020
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE
ANNEXURE – IIPROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1. Name of the candidate and address (in block letters)
SHAMNA MAJEED ABDUL MAJEED I YEAR M. Sc. NURSING LAXMI MEMORIAL COLLEGE OF NURSINGBALMATTAMANGALORE
2. Name of the Institution LAXMI MEMORIAL COLLEGE OF NURSINGBALMATTAMANGALORE
3. Course of Study and Subject M. Sc. NURSINGMEDICAL SURGICAL NURSING
4. Date of Admission to the course 06.06.2011
5. Title of the Topic
EFFECTIVENESS OF PLANNED TEACHING PROGRAMME
ON KNOWLEDGE AND PRACTICE OF ENDOTRACHEAL
SUCTIONING AMONG STAFF NURSES IN SELECTED
HOSPITALS OF MANGALORE.
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6. Brief resume of the intended work
6.1 Need for the study
Critical care is a term used to describe the care of hospital patients who are
extremely ill and whose clinical condition is unstable or potentially unstable.”1
Critical care units or intensive care units were designed to meet the special needs of
acutely ill patients and the critical care nurse is responsible for assessing the life
threatening conditions and instituting an appropriate treatment. Today the
technology and equipment available in intensive care units are extensive and
continually evolving. Patients may be receiving continual support from ventilator,
cardiac assisting device or dialysis machine. These invasive devices carry a risk for
infection, particularly in a patient with a compromised immunologic status, sepsis
and multiple organ dysfunctions may follow.2 Because of airway devices,
medications or physical pathology, many critically ill clients cannot communicate
their needs well, making their situation even more stressful.1
The patients in the intensive care units often require mechanical assistance
to maintain airway patency. Artificial airways are usually required for persons with
mechanical ventilation. The presence of endotracheal tube, however, presents a
threat to the integrity and normal functioning of the respiratory system. The tube
bypasses the body’s normal protective function of warming and filtering the air,
which may result in dried and tenacious secretions. In critically ill patients, the
action of ciliated cells in the respiratory tract and cough reflex in removing
secretions may also be compromised.4 Because of this, secretions tend to pool and
obstruct the airways, and aspiration is a potential hazard for the patient with an
endotracheal tube. So the mouth should be suctioned thoroughly and endotracheal
tube only when needed to prevent hypoxia and to prevent injury to bronchial and
lung tissues. Endotracheal suctioning is therefore important in order to reduce the
risk of consolidation and atlectasis that may lead to inadequate ventilation.3
Tracheal suctioning, which is an essential aspect of airway management has
been identified as a potential dangerous procedure which can lead to several
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complications and risks like hypoxemia, cardiac dysrhythmias, trauma, and
atlectasis and in extreme cases death. Other risk and complications include
infection, bleeding, pain and endotracheal tube becoming blocked or displaced,
hemodynamic instability related to hypoxia and vagal stimulation. Undesirable
fluctuation in intracranial pressure may also occur as result of reduction in cerebral
venous return. It is therefore imperative that professionals are aware of these risks
and are able to practice according to current best evidence.4
As demand of intensive care beds increase more nurse in acute and high
dependency ward areas are expected to provide safe care of patient with
endotracheal tube. The Audit commission (1999) suggested that general wards
nurses should be able to care for patients with endotracheal tube as long as they
have no other respiratory problems. However there is evidence that the practioners
are not adequately educated or experienced to care for patients with endotracheal
tube in general ward. These findings not only have serious legal implication but
they hamper the intent of comprehensive critical care, which aims to prevent the
readmission to intensive care units, facilitate discharge and share critical care skills.5
A descriptive study was conducted in UK to explore the knowledge and
competence of nurses in performing tracheal suctioning. Twenty eight nurses where
observed using nonparticipant observation and structured observation schedule. The
study demonstrated that the majority of the subjects (n=14) failed to perform the
suctioning as accurately as they had reported. The mean score for knowledge was
11.1 and 10.3 for practice (maximum score 20). Knowledge and practice were
compared using spearman’s correlation coefficient (r=0.338) and found that was not
statistically significant (p>0.05). The study concluded that a poor level of
knowledge for many subjects this was reflected in practice. This study suggested
that nurse require support, education, and training relating to tracheal suctioning.5
Many researchers have identified that nurses are unaware of the current
suctioning recommendations and practice is often based on ritual and tradition as
opposed to empirical evidence. In a study by Day (2002) in UK, many nurses have
failed to demonstrate an acceptable level of competence and some of the
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practices observed were potentially unsafe.6 All nurses who perform suction must
have received approved training and demonstrated competence under supervision.
They should ensure that their knowledge and skills are maintained. Nurses should
also make sure that they under take role in accordance with their original protocols
policies and guidelines.4 Hence it was felt that planned teaching programme on
endotracheal suctioning would enable the staff nurses to improve their knowledge
and skill and also practice according to current research recommendations.
6.2 Review of literature
A descriptive study was conducted in Spain among 34 nurses to assess the
performance of tracheal suctioning by direct observation and knowledge on the
procedure was assessed using a self administered questionnaire. The total mean
score obtained for practice observation grid (p) was 12.09 for a maximum score of
19, while it was 14.24 in the knowledge questionnaire. When the total scores
obtained were compared; both in practice and knowledge, with the years of
experience in intensive care units, no statistically significant difference were found.
The study concluded that the nurses have scientific knowledge of the suctioning
procedure that is better than their practice competence.7
An experimental study was conducted to evaluate the effectiveness of
individual performance feedback on knowledge and practice of tracheal suctioning.
Ninety five qualified health care professionals (nurses and physiotherapist) in two
acute care hospitals in London were randomly allocated to receive either
individualized performance feedback or no additional feedback after a standardised
lecture and practical demonstration of tracheal suctioning. Randomisation was
stratified by profession, seniority and site. Data were collected in 2005 in a clinical
setting involving patients and a simulation setting. The outcome measures were
knowledge and practice of tracheal suctioning assessed by self-completion
questionnaire and structured observation. In both settings, intervention groups
performed statistically significantly better in terms of knowledge (p=0.014) and
practice (p=0.037) at final follow up. Those who received performance feedback
had statistically significantly higher knowledge (p=0.004) and practice (p<0.01)
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scores than the control group. Retention of knowledge and tracheal suctioning
practice is improved when training is followed by a performance feedback.6
A quasi experimental study was performed to assess the impact of
instruction on the knowledge and performance of NICU nursing staff in Shiraz
University of Medical Sciences in 2006 among fifty nurses. At first, their
knowledge and performance in neonatal endotracheal tube suctioning was
investigated using test and checklist. After specifying the experimental and control
group through systematic random allocation, the suctioning instruction was done for
experimental group and infection prevention instruction was done for control group.
Two days and 2 months after instruction, nurses' knowledge and performance were
assessed again. Data analysis was done using Chi- Square; The study result showed
that means for knowledge and performance of experimental group respectively two
days and two months after instruction was 16.56 and arrived from this score to
28.48 and 27.4 and from 20.6 arrived to 39.14 and 38.34. The study concluded that
instructing the principles of endotracheal tube suctioning improves the level of
knowledge and performance in nurses.8
A quasi experimental study was conducted to evaluate the teaching
intervention to improve the practice of endotracheal suctioning in intensive care
units among nurses in London. The study was a randomised controlled, single
blinded comparison of two research based teaching programmes, with 16 intensive
care nurses, using a non participant and self report questionnaire. Initial base line
revealed a low level of knowledge for many participants, which was also reflected
in practice, as suctioning was performed against of the research recommendations.
Following teaching, significant improvements were seen in both knowledge and
practice. Four weeks later these differences were gradually sustained and provide
evidence of effectiveness of the educational intervention. The study raised concern
about all aspects of endotracheal suctioning and highlights the need for change in
nursing practice with clinical guidelines and focused based education.9
A quasi experimental study was conducted in 2002 to assess the
effectiveness of planned teaching programme on knowledge and practice of
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endotracheal suctioning among staff nurses in different ICU of St. John’s National
Academy of Health Science, Bangalore. Using purposive sampling technique data
were collected from 50 nurses using knowledge questionnaire and non-participant
observation check lists. After pre-test was over a teaching was administered. Post
test for knowledge, from 5th day after teaching and post test for practice was taken
only after 12 days of teaching. Results showed that the post test knowledge and
practice score obtained were significantly higher than the pre-test scores.10
6.3 Statement of the problem
Effectiveness of planned teaching programme on knowledge and practice of
endotracheal suctioning among staff nurses in selected hospitals of Mangalore.
6.4 Objectives of the study
1. To determine the knowledge of staff nurses regarding endotracheal
suctioning.
2. To determine the practice of staff nurses on endotracheal suctioning.
3. To evaluate the effect of planned teaching programme in terms of gain in
knowledge and practice score.
4. To find out the correlation between knowledge score and practice score on
endotracheal suctioning among staff nurses.
5. To find out the association of knowledge and practice with selected
demographic variables.
6.5 Operational definitions
1. Effectiveness: Effectiveness refers to producing intended results.11
In this study, effectiveness refers to the extent to which the planned
teaching programme can improve the knowledge and practice of
endotracheal suctioning among staff nurses.
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2. Planned teaching programme: Planned teaching programme refers to
series of studies and lectures in accordance with a plan.11
In this study, planned teaching programme refers to systematically
organised teaching strategy on endotracheal suctioning, its indications, steps
and techniques, and its complications.
3. Knowledge: It means the facts/condition of knowing something with
familiarity gained through experience or association.11
In this study, knowledge refers to awareness of nurses regarding
endotracheal suctioning as measured by structured questionnaire.
4. Practice: Practice refers to habitual or customary performance.11
In this study, practice refers to drilling or reinforcing the already
learned skills of nurses in performing the endotracheal suctioning as
measured by observation checklist.
5. Endotracheal suctioning: It is a practice performed to maintain a clear
airway and optimise respiratory function in patients with an artificial airway
such as endotracheal tube who cannot cough or void pulmonary secretions.12
6. Staff nurses: Staff nurses are those who are working in ICU of selected
hospital of Mangalore.
6.6 Assumptions
The study assumes that:
The staff nurses have inadequate knowledge and practice regarding
endotracheal suctioning.
Planned teaching programme will improve the knowledge and practice of
staff nurses.
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6.7 Delimitations
The study is delimited to:
1. The staff nurses who are working in selected hospital of Mangalore.
2. Staff nurses who are working in intensive care unit areas.
6.8 Hypotheses
All hypotheses will be tested at 0.05 level of significance.
H1: The mean post-test knowledge score will be higher than the mean pre-test
knowledge score.
H2: The mean post-test practice score will be significantly higher than the mean
pre-test practice score.
H3: There is a significant correlation between knowledge and practice.
H4: There is a significant association of knowledge and practice with
demographic variables.
7. Material and Methods
7.1 Source of data
Staff nurses working in selected hospitals of Mangalore.
7.1.1 Research design
One group pre-test post-test design is selected for the study.
E = O1 X O2
E = Experimental group
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O1 = Assessment of knowledge and practice of endotracheal suctioning
before the intervention.
X = Planned teaching programme on endotracheal suctioning.
O2 = Assessment of knowledge and practice of endotracheal suctioning
after the intervention.
7.1.2 Setting
The study will be conducted in selected hospitals in Mangalore.
7.1.3 Population
Staff nurses working in ICU of selected hospitals of Mangalore.
7.2 Method of data collection
7.2.1 Sampling procedure
Purposive sampling technique will be used to select the sample.
7.2.2 Sample size
The sample would comprise of 30 staff nurses.
7.2.3 Inclusion criteria for sampling
Staff nurse who are working in intensive care units.
7.2.4 Exclusion criteria for sampling.
1. Staff nurses who were not willing to participate in the study.
7.2.5 Instruments intended to be used
1. Demographic proforma.
2. Structured knowledge questionnaire on endotracheal suctioning.
3. Observation checklist on endotracheal suctioning.
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7.2.6 Data collection method
Prior to data collection permission will be obtained from the hospital
authority for conducting the study. Subject will be selected according to the
selection criteria. The setting will be the ICU of selected hospital.
Interventions
1. A pre-interventional knowledge of endotracheal suctioning will be assessed
by a structured questionnaire for the whole group.
2. A pre-interventional practice of endotracheal suctioning will be assessed by
using an observation checklist.
3. A detailed description on endotracheal suctioning, its indications, procedure,
and complications, will be executed to the whole group.
4. The demonstration of endotracheal suctioning, steps, and after-care will be
shown to 5 subjects at a time.
5. Subjects are allowed to perform the endotracheal suctioning on following
days.
6. The post-interventional knowledge of the whole group will be assessed
using the same structured questionnaire.
7. The post-interventional practice of each individual will be assessed by using
the same observation checklist.
7.2.7 Plan for data analysis
Analysis will be done by using the descriptive and inferential statistics.
7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly.
Yes. Endotracheal suctioning.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Yes, ethical clearance has been obtained from the concerned authority.
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8. Bibliography
1. Black JM, Hawks JH. Medical surgical nursing. 7th ed. Philadelphia:
Elsevier Publishers.
2. Lewis SM, Collier IC, Heitkemper MM. Medical surgical nursing:
assessment and management of clinical problems. 4th ed. Philadelphia:
Mosby; 1996.
3. Pederson CM, Rosendahl, Nielsen M. Endotracheal suctioning of the
adult intubated patients-what is the evidence? Intensive and Critical
Care Nursing 2009 Feb;25(1).
4. Higgins D. Tracheal suctioning. Nursing Times 2005 Feb
22;101(8):36.
5. Day T, Farrell S, Hayes S. Tracheal suctioning an exploration of
nurse’s knowledge and competence in acute and high dependency ward
area. Journal of Advanced Nursing 2002.
6. Day T, Lies N, Griffiths P. Effect of performance feedback of tracheal
suctioning knowledge & skills: randomised controlled trail. Journal of
Advanced Nursing 2009.
7. Gongalez AN, Mingo MA. Assessment of practice competence &
scientific knowledge of ICU nurses in tracheal suctioning. Enfermaria
Intensia 2009 Jul-Sep;15(3).
8. Shirazi HZ, Karger M, Edraki M. The effect of instructing the
principles of endotracheal tube suctioning on knowledge and
performance of nursing staff working in neonatal intensive care units
Shiraz university of medical science. IJME 2010;9(4):365-70.
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9. Day T, Wainwrigh SP, Wilson-Barenett J. An evaluation of teaching
intervention to improve the practice of endotracheal suctioning in
intensive care units. Journal of Clinical Nursing 2001 Sep;10(5).
10. Mathew B. Effectiveness of planned teaching programme on
knowledge and practice of endotracheal suctioning. Nurses of India
2005 Dec.
11. Illustrated Oxford Dictionary. Great Britain: Dorling Kindersley Ltd.;
2003.
12. Smeltzer SC, Bare B. Text book of medical surgical nursing. 11 th ed.
Philadelphia: Elsevier publishers.
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9. Signature of the candidate
10. Remarks of the guide
11. Name and designation of (in block letters)
11.1 Guide MRS. SHAMBAVIASSISTANT PROFESSORDEPT. OF MEDICAL SURGICAL
NURSINGLAXMI MEMORIAL COLLEGE
OF NURSINGBALMATTA, MANGALORE
11.2 Signature
11.3Co-guide (if any) DR. LARISSA MARTHA SAMSPRINCIPAL AND H.O.DDEPT. OF MEDICAL SURGICAL
NURSING.LAXMI MEMORIAL COLLEGE OF NURSING, MANGALORE
11.4Signature
12 12.1Head of the department DR. LARISSA MARTHA SAMSPRINCIPAL AND H.O.DDEPT. OF MEDICAL SURGICAL
NURSING.LAXMI MEMORIAL COLLEGE
OF NURSING, MANGALORE
12.2 Signature
13. 13.1 Remarks of the Chairman and Principal
13.2 Signature
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