RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DESSERTATION
1 / NAME OF THECANDIDATE AND
ADDRESS / Mr. BASIL KURIAKOSE,
1ST YEAR MSc NURSING,
WOCKHARDT INSTITUTE OF NURSING,
20/5, YELACHENAHALLIVILLAGE,
KANAKAPURA ROAD,
BANGALORE-560078.
2. / NAME OF THE INSTITUTION / WOCKHARDT INSTITUTE OF NURSING
3. / COURSE OF STUDY& SUBJECT / 1ST YEAR M. Sc. NURSING,
MEDICAL SURGICAL NURSING.
4. / DATE OF ADMISSION / 31-10-2009
5. / TITLE OF THE TOPIC / A STUDY ON ASSESSING THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON PROGRESSIVE IMPROVEMENT IN KNOWLEDGE AND SKILL OF ADMINISTERING BASIC LIFE SUPPORT AMONG STUDENT NURSES IN A SELECTED COLLEGE OF NURSING, BANGLORE.
INTRODUCTION
“To think too long about doing a thing often becomes its undoing.”
(Eva Young)
Heart disease is the world’s largest killer, claiming 17.5 million lives every year. About every 29 seconds, an Indian dies of heart problem. As many as 20,000 new heart patients develop every day. In India 9 core Indian suffer from heart disease and 30% more are at high risk1. Sudden cardiac arrest is a major public health problem. Basic Life Support (BLS) is the provision of treatment designed to maintain adequate circulation and ventilation to the patient in cardiac arrest, without the use of drugs or specialist equipment. Basic Life Support (BLS) includes recognition of signs of suddencardiac arrest (SCA), heart attack, stroke, and foreign-bodyairway obstruction (FBAO); and cardiopulmonary resuscitation (CPR) 2.
The most important aspects in Basic Life Support are ABC, is nothing but the airway, breathing and circulation. Failure of the circulation for three to four minutes will lead to irreversible cerebral damage3. For every minute that passes after a patient goes into cardiac arrest their chance of survival decreases by seven to 10 per cent until a defibrillator arrives (Metcalfe-Smith, 2003). A patient who has suffered sudden cardiac arrest must receive effective treatment rapidly. When delivered promptly, resuscitation can save the lives of many patients in cardiac arrest4. Basic Life Support acts to slow down the deterioration of the brain and heart until defibrillation and/or advance life support can be provided (Ruck and Erc-2000). Prompt recognition of cardiopulmonary arrest and prompt instigation of Basic Life Support can double the patient’s chance of survival (Bltf-2001)5.
Basic Life Support training is gaining more importance in nursing education. Being trained to perform Basic Life Support can make the difference between life and death for a victim. The Basic Life Support is an essential skill taught to the nursing students. Nurses require skills of assessment for cardiac arrest and need to initiateBasic Life Support, involving maintaining respiration and circulation for the casualty until emergency services, or advanced life support services, arrive. All nurses with a responsibility for patients must be offered regular training and updates in resuscitation. As registered nurses, we all have a responsibility to ensure we remain competent to perform resuscitation6.
Educational change is necessary to meet the demands of the current healthcare environment. Learning objectives should focus on the best practice outcomes and should emphasize what the healthcare provider is expected to do after the educational activity is over. Regulating agencies and consumers hold healthcare personal accountable for providing high quality, safe patient care. Educational activities should provide the skills and knowledge that enable nurses to meet this goal. The new nursing generation need to grow in proper and timely provision of essential care to their patients. For that, they need necessary knowledge and skill by repeated training and practice7.
6.0 A BRIEF RESUME OF THE INTENDED WORK
6.1 NEED FOR THE STUDY
“Continuous effort, not strength or intelligence is the key to unlocking our potential.” (Linaecardes)
Cardiovascular disease is the world’s leading killer. According to world Health Organization (WHO) estimates, 16.7 million people around the globe, die of cardiovascular disease each year. This is over 29 percent of all deaths globally. Cardiovascular diseases now more prevalent in India and China than all economically developing countries in the world combined. Cardiovascular disease in India quadrupled in the last 40 years. WHO estimates that by 2020 close to 60% of cardiac patients worldwide will be Indian1.
Basic Life Support competency is considered a fundamental skill for health care workers. In the wider community, it is an expectation that knowledge and competence in Basic Life Support is at a high standard in nursing education8. Participation in both successful and unsuccessful cardiopulmonary resuscitation and Basic Life Support is one of the most stressful situations that the nursing students have to deal with after their registration. A thorough knowledge and competency (skill) help them to perform Basic Life Support to the patient’s when ever is needed9.
Basic Life Support is the fundamental technique for the emergency treatment of cardiac arrest. The standardised training of cardio pulmonary resuscitation has been emphasised more than ever. Common people in developed countries have received popular education of cardiopulmonary resuscitation programme of Basic Life Support training10. Cardio pulmonary resuscitation and Basic Life Support training is mandatory for nurses and is important as nurses often first discover the victims of cardiac arrest in-hospital. Available literature suggests a need for both initial cardiopulmonaryresuscitation training and refresher courses. In this context, the training of nursing students to improve the knowledge and competency in Basic Life Support is having atmost significance. It is because in future they are the one who is assessing and providing the needed care for the patient at the earlier stage11.
In a study conducted to assess the knowledge and skill regarding Basic Life Support among nurses and nursing students in Finland, results showed that the best predictors for good response assessment and resuscitation skills went to those who were nursing students who had studied Basic Life Support sometime during the previous 6 months6. In a survey conducted in HainanProvince, regarding the knowledge of Basic Life Support and cardio pulmonary resuscitation was found that the knowledge level was very low among nurses10.
Poor knowledge and skill retention following cardio pulmonary resuscitation and Basic Life Support training has been documented over the past 20 years. In order to enhance the retention of knowledge and skill repeated training is needed. However, some students have difficulties in developing competence in cardiopulmonary resuscitation and evidence suggests that resuscitation skill may only be retained for several months. So further training is necessary for developing and retaining the skills11.
In a study conducted among nurses, regarding skill and knowledge of Basic Life Support shows that retention of skill and knowledge quickly deteriorates if not used or updated regularly12. In another study, the student performing Basic Life Support for the second time achieved better results than those undertaking practice and testing for the first time. These data and studies figure out the need of repeated teaching and assessment to ensure adequate knowledge and skill gained among the students6. The repeated training programme provides students with sound basic knowledge and adequate practical skills in first aid and Basic Life Support that adequacy of time and physical and human resources are important prerequisites to facilitate practice and enhance confidence in skills11.
Hence, the investigator felt the need and desire to carry out a study on assessing the effectiveness of structured teaching programme on progressive improvement in knowledge and skill of administering Basic Life Support among student nurses in a selected college of nursing, Bangalore.
6.2 REVIEW OF LITERATURE
A study was conducted regarding the effectiveness of planned teaching programme (PTP) on knowledge and practice of Basic Life Support among high school students in Bangalore. The research design used for the study was quasi-experimental design. The sample consisted of 40 rural high school students. The study was conducted in rural high school of Mangalore and the subjects were selected through simple random sampling technique. The study showed that majority (87.5%) of the students had inadequate knowledge and (100%) had poor practice. The planned teaching programme facilitated them to update their knowledge and practice related to Basic Life Support. Hence, the planned teaching programme is an effective teaching strategy to improve knowledge and practice of sample on BLS13.
A study was conducted on assessment of cardiopulmonary resuscitation and defibrillation (CPR-D) skills of nursing students in two institutions. The purpose of this study was to use Objective Structured Clinical Examination (OSCE) test in assessing guideline based CPR-D skills of newly qualified nurses. The CPR-D skills of newly qualified registered nurses studying in Halmstad University (n = 30) Sweden, and Helsinki Metropolia University of Applied Sciences (n = 30) Finland, were assessed using an Objective Structured Clinical Examination (OSCE) which was built up with a case of cardiac arrest with ventricular fibrillation as the initial rhythm. Forty-seven percent of the students in the Swedish group (mean score 32.47/49, range 26-39, SD 3.76) and 13% of the students in the Finnish group (mean score 23.80/49, range 13-35, SD 4.32) passed the OSCE (P<0.0001), the cut-off point being 32.47. Performance grade for the Swedish group was 2.9/5.0 and for the Finnish group 2.1/5.0 (P<0.0001). Good nontechnical skills correlated with high grading of the clinical skills. The results shows, CPR-D skills of the newly qualified nurses in both the institutes were clearly under par and were not adequate according to the resuscitation guidelines14.
A study was conducted on Training nurses for cardiopulmonary resuscitation (CPR) by using the problem-based approach, To assess whether problem-based learning (PBL) is more effective over conventional teaching methods by comparing final resuscitation exam results of nursing students who received cardiopulmonary resuscitation (CPR) training either by traditional or by problem-based learning (PBL) approach. A retrospective and comparative research design was implemented. Data on final CPR exam grades, collected both from PBL and traditionally trained students, were obtained for a total of 1775 students between 2000 and 2007 in three major schools of health sciences in Hungary. Comparison between PBL and traditional teaching methods as well as across schools was made. t-tests on means yielded significant differences (t=3.569; p<0.001) between PBL and conventional training favouring PBL instructed students. Students who received PBL training had better final cardiopulmonary resuscitation exam grades than traditionally trained peers. Students who attended PBL classes achieved greater theoretical knowledge and demonstrated better resuscitation skills when tested15.
A study was conducted regarding exploration of student nurse’s thoughts and experiences of using a video recording to assess their performance of basic life-support (BLS) and cardiopulmonary resuscitation (CPR) during a mock objective structured clinical examination. An action research project was conducted with six students who were assessed by an examiner at a video-recorded mock objective structured clinical examination. Students self-assessed their skills using the video and a checklist. Semi-structured interviews were conducted to compare checklist scores, and explore students' thoughts and experiences of the objective structured clinical examination. The findings indicate that students may need to repeat this exercise by comparing their previous and current performances to develop both their self-assessment and CPR skills. All students reported the benefits of participating in this project, by discussion and identification of knowledge and skills deficits, thus emphasising the benefits of formative assessments to prepare students for summative assessments and ultimately clinical practice16.
A study was conducted on Basic Life Support knowledge of undergraduate nursing students and chiropractic students. The aim of this study was to examine retention of cardiopulmonary resuscitation and basic life-support (CPR/BLS) knowledge of third year nursing and fourth year chiropractic students following instruction and assessment of CPR/BLS skills and knowledge as part of their undergraduate degree program. Non-experimental exploratory survey to determine perceived ability and knowledge of CPR/BLS following completion of CPR/BLS instruction. The study was conducted in University Health Sciences School. Eighty-seven third year undergraduate nursing and forty-three fourth year undergraduate chiropractic students at Royal Melbourne Institute of Technology (RMIT). The level of knowledge of CPR/BLS was assessed via the number of correct responses to questions regarding CPR/BLS. A visual analogue scale was used for the students to score their self-rated perceived knowledge and skill. The majority of students (78%) felt they were well prepared to perform CPR/BLS, however there were deficiencies in both groups about knowledge of current guidelines. Chiropractic students were less likely to identify the correct compression rate compared to the nursing group (Spearman’s rho 0.669, p.001) with 95% of the chiropractic students not able to identify the correct rate. Thirty four percent of the students were unable to identify the correct ventilation compression ratio with nursing students again more likely to respond correctly (Spearman’s rho 0.508, p.001). Nursing students scored themselves highly for self rated knowledge and ability to perform CPR. Chiropractic students tended to score themselves at a lower rating in these areas than the nursing students. Although students from both disciplines had significant gaps in knowledge of CPR/BLS, nursing students outperformed chiropractic students in all aspects of CPR/BLS knowledge8.
A study was conducted on Evaluation of the Basic Life Support CD-ROM, its effectiveness as learning tool and user experiences. This study presents the evaluation of a Basic Life Support (BLS) CD-ROM, developed as part of the Interactive Teaching and Learning (INTaL) staff development project. Student nurses’ pre- and post-test percentage results were compared using the non-parametric Wilcoxon test. Competency in delivering BLS skills was measured at one of the sites. A Pearson’s co-efficient test was applied to measure any correlation between knowledge attainment and skill performance. Focus groups facilitated an exploration of the students’ experiences and feelings of using interactive multi-media technology for learning. Lecturers’ views were sought through individual interviews. Learning had occurred across all groups, though this was not uniform. There was no correlation between knowledge of BLS and skill attainment measured through expired air respiration and external chest compression scores, though those students performing BLS for the second time achieved better results than thoseundertaking practice and testing for the first time6.
6.3 STATEMENT OF THE PROBLEM
“A study on assessing the effectiveness of structured teaching programme on progressive improvement in knowledge and skill of administrating Basic Life Support among student nurses in a selected college of nursing, Bangalore.”
6.4 OBJECTIVES
1. To assess the existing knowledge of student nurses regarding Basic Life Support by administering a knowledge questionnaire.
2. To determine the skill of administering Basic Life Support among student nurses by using an observational checklist.
3. To evaluate the effectiveness of structured teaching programme as measured by increase in knowledge scores on Basic Life Support of student nurses by administering a knowledge questionnaire.
4. To evaluate the effectiveness of structured teaching programme as measured by improvement in skill of administering of Basic Life Support among student nurses by using an observational checklist.
5. To find an association between knowledge scores of student nurses on Basic Life Support with selected demographic variables.
6. To find an association between skills scores of student nurses on Basic Life Support with selected demographic variables.
6.5 OPERATIONAL DEFINITION
Assess
In this study, it refers to the measures taken to find out the knowledge and skill of nursing students regarding Basic Life Support.
Structured Teaching Programme
It refers to the systematically developed instruction, which is administered repeatedly in a given time interval, including lecture, discussion, and demonstration designed for a group of nursing students to provide information and practice regarding Basic Life Support.
Knowledge
In this study, it refers to the level of understanding of nursing students regarding Basic Life Support.
Skill
An ability that is needed to do a job or an activity in a way that is more accurate especially by training and practice.
Basic life support
Basic Life Support is the provision of treatment designed to maintain adequate circulation and ventilation to the patient in cardiac arrest, without the use of drugs or specialist equipment.
Progressive Improvement
In this study, it refers to the continuous improvement in knowledge and skill due to repeated trials. Repeated teaching and training will be provided to the students in specific intervals of time to improve their knowledge and skill in administering Basic Life Support.
6.6 HYPOTHESIS
H0: There is no significant difference between the mean pre- test knowledge scores and post-test knowledge scores.
H1:The mean post-test knowledge scores of student nurses exposed to repeated structured teaching programme will be higher than the mean pre-test knowledge score as measured by knowledge questionnaire at 0.05 level of significance.
H0: There is no significant difference between the mean pre-test skill scores and post-test skill scores.
H1: The mean post-test skill scores of student nurses exposed to structured teaching programme will be higher than the mean post-test skill scores as measured by observation check list at 0.05 level of significance.
6.7 VARIABLES IN THE STUDY
INDEPENDENT VARIABLE: -Structured teaching programme
DEPENDENT VARIABLE: -Knowledge and skill of student nurses in administering Basic Life Support.
DEMOGRAPHIC VARIABLE: -Age, sex, class, course, parental income, and place of living.
7.0 MATERIALS AND METHODS
7.1.1 Sources of Data: / Data will be obtained from first year nursing students from a selected college of nursing, Bangalore.7.1.2 Research Approach: / Research approach used in this study is an evaluative approach.
7.1.3 Research design: / Research design used for this study is aQuasi-experimental time series design.
7.1.4 Population: / Nursing students.
7.1.5 Sample: / The samples for the study are first year nursing students from a selected college of nursing, Bangalore.
7.1.6 Research setting: / The research setting for this study is a selected college of nursing, Bangalore.
7.1.7 Sampling technique: / Non - probabilityPurposive sampling technique.
7.1.8 Sample size: / Sample size consists of sixty-first year nursing students from a selected college of nursing, Bangalore.
7.1.9 Sampling Criteria
Inclusion criteria: / First year nursing students who are willing to participate in this study.
Exclusion criteria: / Nursing students, who are not interested to participate in this study.
7.2.1 TOOL FOR DATA COLLECTION