RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA.
ANNEXURE-II
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION.
1 / NAME OF THE CANDIDATE AND ADDRESS / Mr. MAHESH. M. REBINALIst YEAR M.Sc. NURSING STUDENT,
N.D.R.K. COLLEGE OF NURSING
B.M. ROAD HASSAN.
2 / NAME OF THE INSTITUTION / N.D.R.K. COLLEGE OF NURSING,
B.M. ROAD HASSAN.
3 / COURSE OF STUDY AND SUBJECT / MASTER OF SCIENCE IN NURSING
(CHILD HEALTH NURSING)
4 / DATE OF ADMISSION TO THE COURSE / 14th MAY 2007.
5 / TITLE OF THE TOPIC / “EFFECTIVENESS OF INFORMATION BOOKLET ON KNOWLEDGE AND SKILL OF 3rd YEAR B Sc NURSING STUDENTS REGARDING RESTRAINTS AND ITS USE FOR CHILDREN ADMITTED IN PEDIATRIC UNIT AT S. C. HOSPITAL, HASSAN, KARNATAKA.”
5.1 / STATEMENT OF THE PROBLEM / “A STUDY TO ASSESS THE EFFECTIVENESS OF INFORMATION BOOKLET ON KNOWLEDGE AND SKILL OF 3rd YEAR B Sc NURSING STUDENTS REGARDING RESTRAINTS AND ITS USE FOR CHILDREN ADMITTED IN PEDIATRIC UNIT AT S. C. HOSPITAL, HASSAN, KARNATAKA.”
6. 1 INTRODUCTION
The Nature has desired the provision that infants be fed upon their mother’s milk. They find their food and mother, at the same time. It is complete nourishment for them, both for their body and soul…….
RABINDRANATH TAGORE.
All infants and children have physiologic and psycho logic needs, children needs to be mobile. Just as in the adult, prolonged immobility of children may result in physiologic loss of muscular strength and flexibility. It may also affect the physiologic functioning of the body in other ways, such as influencing respiratory volume and peripheral circulation, psychologically; long period of restraint may result in the child’s inability to develop motor and psychosocial skills owing to a lack of motor sensory contacts with the surrounding environment. 1
Children use movement to express themselves to test reality, to master their own bodies, and to seek pleasure experiences by themselves or with others. When children are able to move, they are able to some degree to protect themselves from harm. When their arms are restrained, infants and young children cannot even suck their thumb as a means of comfort during period of frustration.1
Restraints are devices used for partially or completely immobilizing infants for various medical and nursing procedures. The common type of restraints includes Jacket restraint, Mummy restraint, Extremity restraint, Abdominal restraint, elbow restraint and Crib with Dome. The main purpose of restraints includes to immobilize the infant, to quieten the child, to examine the specific body parts and to perform medical and nursing procedures.2
A simple pediatric restraint for restraining movement makes procedure with pediatric patient much easier. The method uses a standard readily available bed sheet, which is easy to learn, can be modified for use on various body areas, and makes short procedures possible with minimal nursing assistance. Procedures are made more safe by keeping children still without sedatives. Because wrapping in a bed sheet is less threatening to a young child than a standard Velcro restraint system, the entire procedure proceeds more smoothly than with commercially available restraints.3
6.2 NEED FOR THE STUDY
The use of restraints is common and this use may be hazardous, it is important that the education of health-care providers includes acquiring knowledge, skills, and attitudes related to restraint use. Teaching method includes lectures, demonstrations, case study, simulation, interactive videos, films, discussion, debate, clinical assignment and examination.4
To meet the need for nursing education related to the current use of restraints, model education programs need to be developed, implemented, and evaluated .The health care financing administration defines physical restraints as “any manual method or physical or mechanical device, material or equipment attached or adjacent to the patient that the individual cannot remove easily which restricts freedom of movement or normal access to one’s body”. Restraints have the potential to produce serious outcomes, including physical or psychological harm, loss of dignity, violation of patient’s rights and possibility death. Health care providers need to identify opportunities to decrease the risks associated with the use of restraints through preventive strategies, innovative alternatives, and process improvements to help focus on the pediatric patients overall well-being, health, and safety.5
Crisis situation of the youth in the treatment setting may require restraints. Restraints should only be used in situations where there is imminent danger to the child and when there is a no alternative. Restraints are meant to maintain child’s safety, but there is risk for respiratory compromise. The nursing care of children in restraints must include respiratory assessment and when indicated immediate intervention to prevent disastrous outcomes. The clinical assessment and awareness of risks in physical restraints is essential for the safety and well-being of the child.6
Some method of physical restraint is a common nursing intervention in the care of children. It may be used to ensure the child’s safety, facilitate therapeutic or diagnostic procedures, decrease the possibility of disrupting therapy, restrict movement or immobilize body part.7
Nurses need to assess whether or not restraints are needed. The nurses needs to take into account the child’s development, mental status , potential threat to others or self and safety .In some health care institutions the decision to apply a restraint is a nursing decision , whereas in others a physician’s order is required before or within 1 to 2 hours of application . Parental consent may be required for reasons other than procedures.7
Nurses play an important role in the practice of using physical restraints in children. Until more research is available, nurses need to carefully assess the children in their care and apply the nursing process in the use of restraints.7
When the investigator was posted in the clinical area, he had communication with the 3rd year B Sc nursing students, while providing care for children. During that communication the investigator understood that, the 3rd year B Sc nursing students had a lack of awareness regarding restraints and its use for children. Hence this information made the investigator to select this study to be conducted among the 3rd year B Sc nursing students, with the help of health education in the form of information booklet.
6.3 STATEMENT OF THE PROBLEM:
“A study to assess the effectiveness of information booklet on knowledge and skill of the 3rd year B Sc nursing students regarding restraints and its use for children admitted in pediatric unit at S .C. Hospital, Hassan, Karnataka.”
6.4. OBJECTIVES:
The objectives of the study is to:-
1) Identify the knowledge of the 3rd year B. Sc nursing students regarding restraints and its use for children during the pre-test.
2) Assess the knowledge and skill of 3rd year B. Sc nursing students regarding restraints and its use for children after the administration of information booklet and demonstration.
3) Determine the knowledge and skill of 3rd year B. Sc nursing students regarding restraints and its use for children after the post-test.
4) Compare the knowledge score and skill score of 3rd year B. Sc nursing students regarding restraints and its use for children.
5) Associate the knowledge gain and skill of 3rd year B. Sc nursing students regarding restraints and its use for children with selected socio- demographic data.
6.5 RESEARCH HYPOTHESIS
There will be significant difference in the knowledge and skill of 3rd year B Sc nursing students who have received the information booklet and attended the demonstration on restraints and its use for children.
6.6. ASSUMPTION:
This study will:-
1. Increase the knowledge and skill of 3rd year B Sc nursing students regarding restraints and its use for children.
2. Enable the 3rd year B Sc nursing students to grow in knowledge and skill regarding restraints and its use for children.
3. Improve the knowledge and skill of 3rd year B Sc nursing students regarding restraints and its use for children, thus promoting quality pediatric care related to preventive pediatrics.
6.7. OPERATIONAL DEFINITIONS:-
1. Assess: -An activity to estimate the outcome of the knowledge and skill related to the information booklet and demonstration of restraints and its use for the children.
2. Effectiveness: - It is a process which produces an intended result on knowledge and skills among 3rd year B Sc nursing students regarding restraints and its use for children.
3. Information booklet: - It is a pre-planned explanatory document which helps in the learning process for 3rd year B Sc nursing students about restraints and its use for children.
4. Restraint: - A device which limits or prevents freedom of movement.
5. Children: - A young human being below the age of full physical development, (0 to 18 years,)
6. Knowledge: - Refers to the understanding and awareness regarding restraints and its use.
7. 3rd year B Sc nursing students:- The students of N.D.R.K College of nursing , Hassan those who have completed 2nd year B Sc nursing and are presently studying in the 3rd year B Sc nursing and are posted in the pediatric unit for clinical experience.
8. Skill: refers to respondent’s physical ability to do the procedure regarding restraints and its use for children among 3rd year B Sc nursing students.
9. Pediatric unit:-It is a unit, where the children are get admitted
10. S.C. hospital Hassan: It is a government district 1000 bedded multi – Specialty Hospital which is located at the heart of the Hassan city, attached with a Medical College and a Nursing College.
6.8 CRITERIA FOR SAMPLE SELECTION
Inclusion criteria
1. Male and Female students studying in the 3rd year B Sc nursing at N.D.R.K College of nursing , Hassan, Karnataka.
2. 3rd year B Sc nursing students who know to speak, read and write in Kannada and English
3. 3rd year B Sc nursing students who are willing to participate in the study.
Exclusion criteria
1. 3rd B Sc nursing students who are not willing to participate.
6.9 DELIMITATIONS:
This study is limited to:-
2. The children admitted in the pediatric unit at S.C. Hospital, Hassan, Karnataka.
3. A Period of 4 – 6 weeks
4. A sample size of 80 3rd year B Sc nursing students.
6.10 PROJECTED OUTCOME (SIGNIFICANCE OF THE STUDY)
This study will;-
1. Promote the knowledge and skill of 3rd year B Sc nursing students regarding restraints and its use for children of the future.
6.11 CONCEPTUAL FRAME WORK
Based on Lydia Halls Core, Care and Cure Theory
6.12 REVIEW OF LITERATURE
Review of literature is a key step in the research process. It refers to an extensive, exhaustive and systematic examination of publications relevant to the research. A literature review helps to lay the foundation for a study and can also inspire new research ideas. It can help with orientation to what is known and not known about an area of inquiry, to ascertain what research can best make a contribution to the existing base of evidence.8
A study was conducted at Ankara University Cebeci School of Health Turkey, to determine pediatric nurses' ideas and attitudes towards physical restraint in Turkey, by using descriptive, analytical and cross-sectional methods with 121 pediatric nurses working in four hospitals. The questionnaire consisted of open-ended questions and was applied via face-to-face interviews. The results revealed that, 66.9% of the nurses reported that nurse shortages were the main reason for increased physical restraint applications, 58.7% tried alternative methods, and 71.1% indicated no need of written orders for physical restraint use. Physical restraint decreased while the mother accompanied her child and increased while inexperienced clinical nurses were in charge. Wrist, ankle, and whole body restraints were used. The researcher concluded the study that, Physical restraint could be reduced by a wiser combination of education and expert consultation in the pediatric unit.9
A study was conducted in Turkey, to determine the frequency and types of physical restraints used by nurses in intensive care units, emergency departments, and neurosurgery wards; The study had used a descriptive, cross-sectional study was carried out on 254 nurses working in intensive care units, emergency departments, and neurosurgery wards in four Turkish hospitals where physical restraints were used for children. The findings revealed that, nurses used wrist, ankle, or whole body restraints at various levels. Those nurses who worked in surgical intensive care units and emergency departments had in-service training and used more physical restraint than the others. The conclusion of the study includes actions to reduce use of and prevent the complications of physical restraints and emphasis must be stressed on the nurse staffing and they need to be educated and its use.10
A study was conducted in Italy, to fill the knowledge gap on the extension and quality of physical restraints in acute care hospitals a survey aiming at evaluating knowledge, opinions and behaviors of nurses in this area of care was performed. A questionnaire has administered to the nurses of a large Italian hospital obtained a response rate of 66.2% (227 nurses) and the situation of 77 patients (15.8% of admitted patients) hospitalized and constrained in the target wards was reported. Fifty-two per cent of nurses felt uneasy in constraining patients because of the relational implications with relatives. The study had concluded that, different forms of constriction and on alternative strategies warrant an educational intervention to control and improve the implementation of physical measures of containment.11
A study was conducted at Division of Emergency Medicine, Children's Mercy Hospital, Kansas City, USA, to measure the knowledge, opinions and behaviors of Emergency Medical Services (EMS) personnel regarding child and provider restraint use in ambulances, by using survey method. The results revealed that a total of 95% report wearing seatbelts in the front seat of the ambulance. The majority (91%) reported some training in child-restraint use in ambulances, and half reported that they know a lot or very much about securing a critically ill child for transport. The researcher concluded the study that improved equipment and education may help to alleviate this risk and allow providers to take care of patients safely.12
A study was conducted at University College Dublin, Dublin, Ireland; the aim of the study are to present a review of available literature with the purpose of stimulating discussion on the topic of this extraordinarily stressful event in the lives of hospitalized children and their parents. Studies for this literature review was identified by using library catalogues and computerized searches of the Cumulative Index of Nursing and Allied Health Literature (CINAHL). The majority of the articles reviewed were secondary sources that advocated awareness and encouraged the use of restraint alternatives when managing the care of a child during a procedure. The results revealed that review accentuates the dearth of research in relation to the use of restraints in pediatric nursing, and highlights the need for pediatric nurses and allied health-care professionals to explore this sensitive topic.13