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

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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

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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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