6.
7. / Brief Resume of the intended work
6.1 Need for the study
Cardio Pulmonary resuscitation is an emergency procedure in which the heart and lungs are made to work by manually compressing the chest overlying the heart and forcing air into the lungs. Cardio pulmonary resuscitation is used to maintain circulation when the heart stops pumping, usually because of disease, drugs, or trauma9.
The airway of a child easily obstructed by aspiration of small objects such as removable parts of toys, hard candies, popcorn, peanuts, mucus, blood. If the obstruction is complete and the airway cannot be cleared the child will lose consciousness1.
Each year in the United States >150,000 emergencies threaten lives of children, approximately 10,000 of these children die (of the total of ≈ 55,000 annual pediatric deaths over all), and at least 90,000 survive with the permanent disability. These emergencies may need immediate treatment in various settings like home, community, and hospital2.
The world health organization (WHO) has released statistics on the global burden of injury it showed that drowning is the fifth leading cause of death world wide among females aged 5 to 14 years. Any drowning victim who was submerged for more than one minute was cyanotic required pulmonary resuscitation3.
Brain Nolan, vice chair person of emergency care association, said: “It was important for staff nurses to have on going training in new techniques. Resuscitations, as with any skill, have to be practiced to maintain competency4.
It is important to begin Cardio Pulmonary Resuscitation soon as possible due to cessation of breathing and later the brain damage. It is important to prevent brain damage and the steps of CPR should be initiated right away10.
A study shows most hospital (72%) reported having a physician or a nurse incharge of resuscitation management and training. Training in advanced life support was more common among nurses (80%) than among physician (53%) surprisingly, a majority of respondents (75%) reported that they felt training in cardiopulmonary resuscitation was insufficient 5.
Nurses caring for children in an acute care setting may be faced with a pediatric emergency. Being prepared is essential. This article describes the development of a program that gives nurses the opportunity to transfer their knowledge and skill into practice. Nurses who participate in this program report feeling more confident to provide life saving measures11.
The investigator during the clinical posting identified many infants and children admitted in pediatric critical care units, with critical illness. The interaction with staff nurses has observed most of the staff nurses revealed of knowledge regarding cardiopulmonary resuscitation. The very few literature were found on CPR research and especially on staff nurses knowledge regarding the same. As it is the most important task of staff nurses, this motivated the investigator thought of conducting a study to determine the knowledge & promote health education regarding cardiopulmonary resuscitation to staff nurses.
6.2 Review of Literature:
The related review literature was received from journals, books, websites and periodicals.
A retrospective review study on 32 patients ranging in age from 1 day to 21 years (Median, 1 month) in a total of 38 episodes of cardio pulmonary arrest showed a remarkable significant recovery among 38 episodes of CPR, 24 episodes (63%) were successful, with 20 episodes resulting in return of spontaneous circulation and 4 patients being, successfully placed on mechanical cardio pulmonary support. Among them 14 children including 4 patients rescued with mechanical cardiopulmonary support were survived to discharge. This literature stresses the need of CPR in life saving8.
A retrospective study in children’s hospital among 6024 children highlighted the causes for CPR as chronic diseases. 71% respiratory failure (61%) among them 64% of the children attained sustained return of spontaneous circulation (> 20 minutes), 33% were alive at 24 hours, 19% were alive upto 30 days, and 15% until the age of one year12.
Asahikawa medical college survey in nurses showed an interest among 80% to receive an education and training on CPR as students or after graduation. The results of this survey demonstrated the need to provide more education on CPR to nursing staff6.
A study on resuscitation skills and the self-assessment of CPR methods of hospital staff were investigated. CPR refresher course was offered to 53 nursing staff members. The individual skills and competence in CPR procedures of 425 nurses
were examined according to the standards and guidelines of the German medical association. The least (16.2%) of the participants felt sufficiently trained to perform CPR independently and 77.2% did not. CPR skills were sufficient or good in 36% only 4% of the participants were able to perform all standard CPR procedures as recommended by the guidelines However 71.8% failed to perform effective CPR manoeuvres. This study recommends the need for the present research7.
6.3 Objectives
  1. Assessment of the knowledge of staff nurses on cardio pulmonary resuscitation through a self prepared structured questionnaire.
  2. Evaluation of the effectiveness of planned intervention program on cardiopulmonary resuscitation to staff nurses.
  3. Finding an association between the pretest level of knowledge on staff nurses with selected variables.
6.4 Statement of the problem
“EFFECTIVENESS OF A PLANNED INTERVENTION PROGRAMME ON PEDIATRIC CARDIO PULMONARY RESUSCITATION (CPR) TO THE STAFF NURSES OF A SELECTED HOSPITAL AT MANGALORE”.
6.5 Assumption:
  1. Staff nurses will have some basic knowledge regarding cardio pulmonary resuscitation.
  2. Planned intervention programme is an acceptable teaching strategy.
3. Cardiopulmonary resuscitation is an emergency intervention to rescue the
lives.
6.6 Operational Definitions:
1) Effectiveness:
Refers to the extent to which the planned intervention has achieved the desired results as expressed in terms gain in knowledge score on Pediatric CPR as measured by a structured knowledge questionnaire.
2) Knowledge:
It is the responses given by staff nurses to the questions on pediatric CPR as tested in structured questionnaire. The responses are arbitraly classified into excellent, good, average and poor knowledge based on the scores.
3) Planned CPR Program:
Refers to a systematically developed intervention programme designed for staff nurses to provide information regarding pediatric CPR through lecture, demonstration and discussion through the use of the audiovisual aids.
4) Staff Nurses:
Refers to all the graduate nurses either with completed general nursing and midwifery course or Basic B.Sc Nursing degree having minimum a year of clinical experience and working presently in FatherMullerMedicalCollegeHospital, Mangalore.
6.7 Delimitations:
  1. Study is restricted to a batch of graduate nurses who have a year of clinical experience.
  2. Study includes all the staff nurses irrespective of their experience in pediatric health units.
6.8 Hypothesis/projected outcome:
All the hypothesis will be checked at 0.05 level of significance.
H1: The mean post-test knowledge score of the staff nurses on peadiatric CPR, will be significantly higher than their mean pre-test knowledge score.
H2: There will be an association between the pretest knowledge of staff nurses with selected variables.
Materials and Methods:
7.1 Source of data
Staff nurses with one year of experience working in FatherMullerMedicalCollegeHospital at Mangalore.
7.1.1 Research Design
One group pre-test – Post-test design
7.1.2 Setting
This study will be conducted in Father Muller Medical hospital of Mangalore with bed strength 1050. It is multispeciality hospital consisting of following services, Dialysis, Burns unit, ICU, CCU, Medical Surgical, Oncology and radiotherapy. The pediatric unit consists of Neonatal ICU with 20 beds, Pediatric ICU, 13 beds
and Pediatric ward 44 beds.
7.1.3 Population:
Staff nurses working in FatherMullerMedicalCollegeHospital with a minimum of one year experience.
7.2 Methods of Data Collection:
7.2.1 Sampling Procedure:
Simple Random Sampling
7.2.2 Sampling Size:
The sample comprises of 75 staff nurses with one year of clinical experience working presently in FatherMullerMedicalCollegeHospital.
7.2.3 Inclusion Criteria for Sampling:
  1. Nurses completed Basic B.Sc. Nursing degree and General Nursing and Midwifery course.
  2. Nurses with one year of clinical experience in the hospital after their completion of course.
  3. Nurses willing to participate in the study.
7.2.4 Exclusion Criteria for sampling:
Nurses trained in special pediatric CPR course
7.2.5 Instruments Intended to be used:
Structured knowledge questionnaire to gather data before and after the teaching plan.
7.2.6 Data collection method:
Permission will be obtained from the concerned authority and in formed consent will be taken from the subjects. The knowledge on CPR prior to teaching program will be checked with structured knowledge questionnaire. The teaching will be delivered to them by the investigator. Followed by after sevendays, post test will be given with pre tested tool.
7.2.7 Data Analysis Plan:
Descriptive and inferential statistics will be used.
Section I
Demographic data will be analyzed using frequency and percentages.
Section II
Knowledge will be arbitraly categorized into following levels. Excellent, Very good, Good, average and poor.
Section III
The relationship and association will be tested by using ‘t’ test and chi-square test
7.3 Does the study receive any investigation or interventions to be conducted on patients or other human or animals? If so, please describe briefly.
Yes, Administration of knowledge questionnaire to staff nurses regarding CPR in pediatrics.
7.4 Has ethical clearance been obtained from your institution in case of 7.3
Yes, Ethical clearance has been obtained from the ethical committee of the institution.
List of references:
  1. Kliegman, Behrman, Jenson, nelson textbook of pediatrics, 18th edition, Thomas press Ltd :2007;387-98.
  2. Frank A, Oskicatherine.DA, textbook of Principles and Practice of Pediatrics, Jaypee Lippincott Company 751-3.
  3. James S, Orlowski, David S.Pediatric Critical care & New Millennium. 2001 June ; 48(3):627.
  4. Caroline W Scheme tackles asthma fears, Nursing time 2006 June; 102 (25): 26-9
  5. Skrifvars M B, Castrn K, Rosenberg. In-hospital Cardiopulmonary resuscitation. Acta Aaesthesiol Scand. 2002 APR; 46(4): 458-63
  6. Nagashima K, Takahata O, Fujimoto K. Investigation on nurses knowledge of & experience in cardiopulmonary resuscitation. Journal of advanced Nursing. 2005 Aug; 51(3); 288-97.
  7. Pediatric code readiness; practice is the key. Journal for nurses in staff development 2005 May-June ; 21(3): 126-31.
  8. Kuhnnigk H, Sefrin P, Paulus T. Skills & self-assessment in cardiopulmonary resuscitation of the hospital nursing staff. Journal of emergency medicine. 1994 Dec;1 (4); 193-8
  9. resuscitaion/health.
  10. http//peadiatics.aapaulications.org/cgi/content/abstract