Post on 27-Jun-2020
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PERFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. NAME OF THE CANDIDATE
AND ADDRESS
MRS. MARY MADONA LAWRENCE
GOUTHAM COLLEGE OF NURSING
MANJUNATHNAGAR,
WEST OF CHORD ROAD,
RAJAJINAGAR,
BANGALORE.-560010.
2. NAME OF THE
INSTITUTION
GOUTHAM COLLEGE OF NURSING
MANJUNATHNAGAR,
WEST OF CHORD ROAD,
RAJAJINAGAR,
BANGALORE.-560010.
3. COURSE OF STUDY AND
SUBJECT
1 YEAR M.Sc. NURSING.
CHILD HEALTH NURSING.
4. DATE OF ADMISSION TO
COURSE.
16-06-2010
5. TITLE OF THE TOPIC “A STUDY TO ASSESS THE
EFFECTIVENESS OF PLANNED
TEACHING PROGRAMME
REGARDING KNOWLEDGE ON
PEDIATRIC CARDIO PULMONARY
RESUSCITATION (CPR) AMONG
STAFF NURSES IN SELECTED
HOSPITALS, AT BANGALORE. “
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6. BRIEF RESUME OF THE INTENDED WORK.
6.1. NEED FOR THE STUDY
Pediatrics is the branch of medicine that deals with the medical care of
Infants, children and adolescents. The age limit of such patients ranges from
birth to 18 years. Pediatric Nursing is an area of nursing and medical practice
with a focus on providing holistic care to infants, children and adolescents.
There are different places Pediatric Nurses can work like pediatric ward,
NICU’s, PICU’s etc where the nurse support the patient and the family by
providing comprehensive care which the family cannot perform.1
Basic life support in a level of medical care which is used for patients
with life threatening illness or injury until the patient can be given full
medical care. In pediatric setup there are many pediatric emergencies like
accidents, injuries, respiratory failure, sudden cardiac arrest and shock where
the emergency professional health care team members performs a number of
life saving techniques focused on the emergency care. Among which the
Pediatric Cardio Pulmonary Resuscitation stands first and foremost in
‘ABC’of hospital emergency care1.
Cardio Pulmonary Resuscitation in children has been used in hospitals
for approximately 40 years where the staff nurses are generally the first
responders to cardiac arrest and initiate basic life support while waiting for
the advanced cardiac life support team to arrive. Speed and competence of the
first responder are factors contributing to the initial survival of a person
following a cardiac arrest. The knowledge and attitude of the staff nurse may
influence the speed and level of involvement in the emergency situation. So
this paper uses the theories of recent action and planned behaviours and
awareness of the members involved in pediatric CPR 2.
Incidence rate of cardiac arrest in the world, In- hospital cardiac arrests
of children admitted to pediatric intensive care unit occur at a rate of 0.94
cardiac arrests per 100 admissions. Pediatric patients suffering an in-hospital
cardiac arrest differ from the out-of-hospital cardiac arrest subpopulation due
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to a chronic pre-existing condition being present twice as often and a cardiac
etiology more likely as the cause of the arrest. Extra Corporeal Membrane
Oxygenation (ECMO) initiated within 24 hrs after cardiac arrest is associated
with a decrease in hospital mortality. There is a lower incidence of mortality
and greater likelihood of good neurologic outcome with an in-hospital cardiac
arrest than out-of-hospital cardiac arrest. Survival also depends on other
factors such as actual duration of CPR, quality of CPR administered and the
extent of necessary pharmacologic intervention needed during CPR.3
Incidence rate of cardiac arrest in India are due to various reasons.
Main causes like, 56% due to respiratory problem, 33% due to cardio vascular
disorders.4
In a population aged at least 12 years incidence of out of hospital
cardiac arrest is 36/1,00,000 – 81/1,00,000.5
The average proportion of cases out of hospital cardiac arrest that
receive bystander CPR is 27.4%.6
The rate of survival to discharge after in-hospital cardiac arrest 27%
among children. Incidence rate of cardiac arrest due to anaesthesia is 27 /
12,158.7
A study conducted quality of cardio pulmonary Resuscitation training
programme in order to determine whether it was sufficiently addressed by the
trainee team leaders during training. CRP quality of 20 consecutive
resuscitation scenario training person was audited prospectively using pre-
designed performa. A consultant intensive and a senior nurse who were also
Advanced Pediatric Life Support (APLS) instructors assessed the CPR quality
Which included Ventilation frequency, chest compression, rate of depth and
any unnecessary interruption in chest compressions. The results showed that
50% of training session did not have any change with the person in the team.
So the quality of little awareness of this inadequacy. 8
3
A retrospective study done at a children’s hospital following
resuscitation for out of hospital cardio pulmonary arrest to determine the
outcome and cause for children resuscitated following out of hospital cardio
pulmonary arrest in an organization pre hospital emergency medical system
with in Birmingham, Ala, with 150493 children under the age 15 years.
Standard resuscitative techniques were performed for all patients. Of 63
children with out of hospital cardio pulmonary arrest 60 were pulseless and
apneic on arrival 18 were successively resuscitated and admitted to intensive
care unit and 6 were discharged from the hospital. 5 of the survivors had
severe neurological deficits and 1 appeared normal. On follow up 2 patient
had died 3 were in vegetative state and 1 was normal. Resuscitation efforts in
the emergency department are commonly successful but lead to death or
severe neurological sequelae at discharge with extremely high cost of care. 9
A study was conducted on epidemiologic review and assessment of
current knowledge in out of hospital pediatric cardiac arrest in outcome of
children younger than 18 years with an out of hospital cardiac arrest, with
5.363 patients results showed that 12.1% survived to hospital discharge and
4% survived neurologically intact. Trauma patients had greater survival
submersion injury associated arrest had greater survival (22.7%, 6% intact).
Bystander cardio pulmonary resuscitation showed increased survival (relative
risks 1.99, 95% confidence interval 1.54 to 2.57). 10
Since the investigator itself is in the field of profession and has
personal experience working in the clinical side has witnessed some of the
pediatric cardiac arrest aged less than 18 years. During that time the difficulty
and lack of proficiency which is addressed by the staff nurse provoked an idea
to do the study on assessing the knowledge regarding pediatric CPR and help
them with a feeding process to improve their knowledge so that they can deal
in such situations in a competent way. So it is needed for the staff nurses to
know the recent advances in the pediatric cardiopulmonary resuscitation.
6.2 REVIEW OF LITERATURE:
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6.2.1
Review of literature is the key step in the research process, the typical
process of analysing a research existing literature is to generate a research
question to identify what is known and what is unknown about the topic. The
major goal of review of literature is to develop a strong knowledge base to
carry out research and non-research scholarly activity.
Review of literature for the present study done on following aspect:
6.2.1 Studies Related to Cardiac Arrest and Pediatric CPR.
6.2.2 Studies Related to Knowledge on Pediatric CPR.
6.2.3 Studies Related to Planned Teaching Programme.
Studies Related to Cardiac Arrest and Pediatric CPR.
A study conducted on recent advances in pediatric cardio pulmonary
arrest and resuscitation. The data in the 21st century indicate that more than
25% of children treated for in hospital cardiac arrest survive to hospital
discharge and more than 10% of children older than 1 year treated for out of
hospital cardiac arrest. Before arrest, exciting new studies demonstrate that the
implementation of in-hospital pediatric medical emergency teams in
associated with significant decreases in cardiac arrest incidence and overall
pediatric hospital mortality. During arrest, 25% of in hospital pediatric cardiac
arrest are due to ventricular fibrillation &ventricular tachycardia; further extra
corporeal membrane oxygenation cardio pulmonary resuscitation appears
promising in improving the outcome from highly selected in hospital pediatric
cardiac arrest victims. 11
A prospective study conducted on the investigation of the
epidemiology of in-hospital pediatric CPR, where 129 in hospital CPR, during
12 months at a 122 bed university children’s hospital in Sao Paulo, Brazil
were described and evaluated which include standardized descriptions of
hospital variables, patient variables, arrest / event variables and outcome
variables of the 6024 children admitted to the hospital, 176 (3%)had an
episode that met the criteria for provision of CPR and 129 (2%)received CPR,
86 for clinical cardiac arrest and 43 for bradycardia with poor perfusion 61%
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6.2.2
with respiratory failure and 29% with shock Out of this 64% of children
attained sustained return of spontaneous circulation with less than 20 minutes
and 33% were alive at 24 hours after CPR. So it concluded that pediatric CPR
was effective with nearly 2/3 of the children were initially successfully
resuscitated. 12
A study on outcome and factors associated with survival in children
treated with extra corporeal CPR during cardio pulmonary arrest from the
American Heart Association National Registry of CPR, Pediatric patients <18
years of age received CPR in hospital for cardiac arrest out of 6288 events
reported, 199 (3.2%) index extra corporeal CPR resuscitation events were
identified, 56 (94.9%) had favourable outcome after CPR which was
associated with an increased survival to hospital discharge. 13
Studies Related to Knowledge on Pediatric CPR.
A study conducted an examining the knowledge of staff nurses and
factors that enhance the skills during and after CPR training, in order to find
out the educational strategies that will optimize survival for victims of cardio
pulmonary arrest. 105 first grade nurses and 157 end grade nurses were
identified who met the criteria for the final training programme on CPR at
Narham University hospital Nits trust at UK. Out of which 40% of them found
to have lack of competence and awareness on CPR guide lines which
concludes that training and video self instruction has been recommended to
improve the level of knowledge and competence in resuscitation. 14
A study among hospital personnel’s and their self report on pediatric
CPR use, training and their knowledge and self confidence in skills, a cross
sectional study was performed at three Norwegian hospitals and ESI hospital
personnel data on CPR training and CPR use were collected by self reports.
The results showed that total 89% reported to the training in CPR, but only
11% had tried to update their knowledge and skills in accordance with the
time interval recommended by National guidelines Real resuscitation
experience was imported by one third of the respondents. Both training
intervals and use of skills in resuscitation situations differed among the
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6.2.3
professions. So it concluded there is a gap between the recommendations and
reality in CPR training among the hospital personnel. 15
A cross sectioned mail survey carried out in hospital resuscitation
management and training with questionnaire outline on the present status level
of the nurse and the physicians in the university hospitals of Finland. Out of
most hospitals 72% reported having a nurse and physician is mandatory
among them 80% were nurses and 53% were physicians, surprisingly, a
majority of respondents 70% reported that they felt the knowledge and the
training in pediatric CPR was insufficient and out of that only 16% to 31% of
cases performed by the nurse compared with physician at 91%. The duty
concludes that more attention needs to be paid on the awareness of CPR
management in Finish Hospitals. 16
Studies Related to Planned Teaching Programme.
Nurses self-performing and teaching others breast self-examination (BSE):
Implications for advanced practice nurses were conducted in Panama City.
The purpose of this study was to explore the personal behaviours and
professional practices of nurses in the use of BSE and to discuss implications
for the Advance Practice Nurse (APN) . The sample consisted of staff nurses
and senior nurses. While almost all nurses had performed BSE atleast once
fewer than half did this monthly. The majority believed it was the nurses role
to teach BSE, but almost three fourths of the sample taught it only
occasionally or rarely. Not thinking of it and not knowing when or how to
teach were reasons identified for not teaching. The roles of the APN as an
educator, leader, consultant, direct care provider, and researcher are examined
in light of these findings to promote nurses performing and teaching BSE. 17
A study was conducted to evaluate nurses’ knowledge about pressure
ulcer prevention, wound assessment and staging. 141 Baccalaureate Nurses
(BSN) employed by the hospital were samples at the time of the study using a
Portuguese Version of Pieper’s Pressure Ulcer Knowledge Test (PUKT)
participants were asked to indicate whether 33 statements about pressure ulcer
assessment and staging were true or false. Nurses working on inpatient
7
clinical nursing units had significantly better scores. The study concluded that
the nurses had an overall understanding of pressure ulcer prevention and
assessment principles but important knowledge deficits exit. Focused
continuing education effects are needed to facilitate the implementation of
evidence based care. 18
6.3. STATEMENT OF THE PROBLEM:
A study to assess the effectiveness of planned teaching programme
regarding knowledge on pediatric Cardio Pulmonary Resuscitation (CPR)
among staff nurses working in selected hospitals, at Bangalore.
6.4. OBJECTIVES OF THE STUDY:
i) To assess the existing knowledge on pediatric CPR among staff nurses.
ii) To evaluate the effectiveness of planned teaching programme regarding
pediatric CPR.
iii) To find out the association between the level of knowledge and selected
demographic variables.
6.5. OPERATIONAL DEFINITIONS:
Assess: Knowledge of staff nurses regarding pediatric CPR by using
structured questionnaire.
Effectiveness: It refers to the significant increase in knowledge scores among
staff nurses after administration of structured teaching programme as
determined by difference in pre test and post test score.
Planned teaching Programme: It refers to the contents of pediatric CPR
which is systematically prepared & organized and teaching will be given to
the staff nurses.
Knowledge: It refers to the responses / awareness of the staff nurses on
pediatric CPR which is measured by using a structured knowledge
questionnaire.
Pediatric Cardio Pulmonary Resuscitation (CPR) : It refers to an
emergency procedure which is attempted to the children less than 18 years of
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age in an effort to return the life of the person with cardiac arrest in order to
restore the blood flow (circulation) and breathing which refers to a
combination of chest compression and rescue breathing.
Staff nurses: It refers to the nurses who are registered with GNM/B.Sc
(N)/Pc.B.Sc (N) and working in the clinical setup / hospital.
6.6. HYPOTHESIS
H1. There will be a significant difference between pre and post test
knowledge scores on pediatric cardio pulmonary resuscitation after the
planned teaching programme at 0.05 level -
H2. There will be a significant association between the pre test and post test
knowledge score of staff nurses on pediatric CPR with selected demographic
variables at 0.05 level
6.7. ASSUMPTIONS
The staff nurses may have some basic knowledge regarding pediatric
cardio pulmonary resuscitation.
Planned teaching programme may improve the knowledge of staff
nurses on pediatric CPR.
6.8. DELIMITATIONS:
The study is delimited to:
- Collect the data from registered staff nurses working in a selected hospital.
- Knowledge aspects only.
7. MATERIALS AND METHODS
7.1. SOURCE OF DATA Staff nurses working in a selected
hospitals at Bangalore.
7.2. SAMPLING CRITERIA:
INCLUSION CRITERIA The staff nurses
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- Who have qualified & registered
and working in the hospital.
- Who are able to read and
understand in English or Kannada
- Who give consent for the study.
EXCLUSION CRITERIA - Staff nurses who are not available
at the time of study.
- Staff nurses those who have
attended any educational
programme about the same topic
earlier.
7.2.5 SAMPLING TECHNIQUE Non-probability purposive sampling
technique.
7.2.6 SAMPLE SIZE 40 Staff nurses who fulfil the inclusion
criteria.
7.2.7 TOOL FOR RESEARCH Section A:
Socio demographic questionnaire
Prepared by the investigator (Age, sex,
educational status, work experience etc.,)
Section B:
Structured self administered
questionnaire will be developed by the
researcher to assess knowledge regarding
pediatric CPR among staff nurses.
7.2.8 COLLECTION OF DATA 1. A prior formal permission will be
obtained from their higher
authority of selected hospitals,
Bangalore.
2. The purpose of the study will be
explained to the staff nurses.
3. Consent of all the participants will
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be obtained prior to the study.
4. Structured questionnaire will be
administered to assess the
demographic data and pre-test
knowledge related to Pediatric
Cardio Pulmonary Resuscitation.
5. A planned teaching programme
will be given to staff nurses on the
same regarding pediatric CPR.
6. Post test will be conducted after 7
days with same questionnaire.
7. The duration of the study is 30
days.
7.2.9 METHOD OF DATA
ANALYSIS
The investigator will analyze the data
obtained by using descriptive and
inferential statistics. The plan of data
analysis will be as follows:
1. Organizes the data in Master sheet
/ computer.
2. Frequencies and percentage of
analysis of demographic data.
3. Mean, standard deviation and
paired ‘t’ test to determine the
effectiveness of planned teaching
programme
4. Chi-square to measure the
association ( ) tests to determine
the association
7.3 DOES THE STUDY REQUIRE ANY INVESITIGATION OR
INTERVENTION ON PATIENT OR OTHER HUMAN I ANIMALS? IF
SO PLEASE DESCRIBE BRIEFLY
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Yes, Assessing the knowledge and effectiveness of planned teaching
programme among staff nurses.
7.4 HAS ETHICAL CLEARENCE BEEN OBTAINED?
Yes, ethical clearance will be obtained and confidentiality and anonymity will
be maintained.
8. LIST OF REFERENCES
1. Resuscitation council (UK) Adult basic life support 2005.
2. American Heart Association and European Resuscitation council
guidelines and COSTR documents 2005.
3. Michelle L Schlunt, Lynn Wang. Hypothermia and pediatric cardiac
arrest. Journal of emergency trauma and shock. Nov 2010. 25.(3):277-
281.
4. http://www.slideshare.net/cardiac arrest in pediatric- OR -2446611.
5. John BT, Thompson B, Dogra V. current burden of sudden cardiac
death. JAMA. 2004: 44:1268-1275.
6. Murray JA, Welles B, Lewis RJ. Public access defibrillation in out of
hospital cardiac arrest. Circulation 2004. 109:1859-1863
7. http://www.slideshare.net/cardiac arrest in pediatric- OR -2446611.
8. 7) Muhammed Arshid et al, “Quality of pediatric CPR training”,
Journal of emergency medicine. May: 2009.80 (5): 558 — 560
9. Ricardo Ronco, William King, Samuel J. Arch Pediatr Adolesc
Med.1995.149(2): 210-214.
10. Annals of Emergency Medicine 2005.46 (6) 512-522.
11. Top.jian AA, Nadkarni, Berg RA “Cardio pulmonary resuscitation in
children and its recent advance in prevention and management: Journal
of current opinion in critical care. June 2009.15 (3):203-207.
12. REIS AG Nadkarni V et al “Prospective investigation of epidemiology
in hospital pediatric CPR” Journal of advanced pediatric. Feb2002.
109 (2):200—209.
13. Raymond TT et al” Outcome among children after CPR for in hospital
pediatric cardiac arrest” Journal of emergency trauma July2010.3(3)
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243 —250
14. Hamilton R et al “Nurses knowledge following CPR training “Journal
of acta. Anaesthesiol scandal. April2002. 46 (4) 458 — 463.
15. Laila A Hopstock et al “A Self report study among hospital personnel
on pediatric CPR” Journal of trauma, resuscitation and emergency
medicine. 2008.18(3)241—246.
16. Castren M, Kurola J Rosenberg H et a! “Awareness of nurses and
physician on in hospital CPR at PICU “Journal of ACTA.
Anaesthesiol scandal. May2010.11 (3) 362—371.
17. Ludwick R and Gaczkowskit [2000]. Breast self exams by teenagers:
Cancer Nurs.Feb 1991.14(1): 35-40
18. Tania. Touto Machado Thianca, Jamara Figueiredo Rezendo, Eline
Lima Gorges B.D, Veralucia Nogueira, Maria, Helena, Larcher Paliri,
pressure ulcer knowledge among nurses in a Brazilian University
Hospital, Oct 2010.
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