RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCESs

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 / NAME OF THE CANDIDATE AND ADDRESS / Mr. RAGHURAMA C. B.
1st YEAR M.Sc NURSING STUDENT,
NISARGA COLLEGE OF NURSING,
#18 KIADB, INDUSTRIAL AREA, B. KATIHALLY,
B.M. ROAD, HASSAN, KARNATAKA.
2 / NAME OF THE INSTITUTION / NISARGA COLLEGE OF NURSING, HASSAN, KARNATAKA.
3 / COURSE OF STUDY AND SUBJECT / MASTER OF SCIENCE IN NURSING
MEDICAL-SURGICAL NURSING
4 / DATE OF ADMISSION TO THE COURSE / 01/O7/ 2011
5 / TITLE OF THE TOPIC / TO EVALUATE THE EFFECTIVENESS OF PLANNED TEACHING PROGRMME(PTP) ON THE KNOWLEDGE REGARDING CARDIO PULMONARY RESUSCITATION (CPR) AMONG PARA-MEDICAL STUDENTS.
5.1 / STATEMENT OF THE PROBLEM / “A STUDY TO EVALUATE THE EFFECTIVENESS OF PLANNED TEACHING PROGRMME (PTP) ON THE KNOWLEDGE REGARDING CARDIO PULMONARY RESUSCITATION (CPR) AMONG PARA-MEDICAL STUDENTS IN SELECTED COLLEGES AT HASSAN, KARNATAKA.”

6. BRIEF RESUME OF THE INTENDED WORK:

6.1. INTRODUCTION:-

“It is health that is real wealth and not pieces of gold and silver.”
Mohandas Gandhi

Cardiac arrest is the world’s second most killer disease.Next to the cancer it has a higher incidence and prevalence in the world. so it needs emergency treatment from health care professionals. Cardiac arrest is nothing but cessation of cardiac function either by asystole or fibrillation.1

Lifesaving is the act involving rescue, resuscitation and first aid. It often refers to water safety and aquatic rescue however it could include ice rescue, flood and river rescue, swimming pool rescue and other emergency medical services. Lifesaving also refers to sport where lifesavers compete skills, speed and team work.2

In order to maintain a sustain life; it is an obligatory for an individual to maintain intact vital physiological functions like breathing and circulation. If any sorts of insult physiological function there is a great threat to homeostatic balance and timely interventions are not implemented, may endangers the life of an individual.Whenever these vital functions are ceased, it is essential to restore the normal cardio-pulmonary function until advanced medical supports available. So in such circumstances Cardio Pulmonary Resuscitation [CPR] measure to be the most important intervention.1

Since CPR measure is the basic fundamental procedure that has to known by all medical personnel, Para-medical personnel and non-medical personnel too. But it requires competency and if this CPR measure is delayed or carelessly given, we may lose the victim.CPR is a life saving measure which helpful to save the lifeof a person one who has arrest in respiration and heart beat. It is a technique of Basic Life Support [BLS] for oxygenating the brain and heart till appropriate, definitive medical treatment to restore the normal heart and ventilatory action. It involves external cardiac massage [manual heart compressions], artificial ventilation by mouth to mouth respirations to restore the heart and lung functions.1

The common medical emergencies for CPR are fainting, wounds, chest pains & heart attack, cerebro vascular accident ( stroke ), seizures, poisonings, shock, asthmatic attack , musculoskeletal injury, burns etc.3

The vital parameters of CPR are called ABCs. “A” stands for an Airway, B stands for initiate Breathing, “C” stands for maintain Circulation. Thus CPR is to circulate oxygenated blood to the brain to prevent permanent tissue damage.3

6.2NEED FOR THE STUDY

“For those people, CPR with 911 is critical to their survival. In general, the better we have a population trained to deal with events (such as) sudden cardiac arrests, the better off everyone is.”

David Rodgers

Cardiopulmonary resuscitation (CPR) is an emergency procedure which is performed in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person in cardiac arrest. It is indicated in those who are unresponsive with no breathing or abnormal breathing.3

CPR involves chest compressions at least 5cm deep and at a rate of at least 100 per minute in an effort to create artificial circulation by manually pumping blood through the heart. In addition, the rescuer may provide breaths by either exhaling into the subject's mouth or utilizing a device that pushes air into the subject's lungs. This process of externally providing ventilation is termed artificial respiration. Its main purpose is to restore partial flow of oxygenated blood to the brain and heart. The objective is to delay tissue death and to extend the brief window of opportunity for a successful resuscitation without permanent brain damage.4

CPR is a critical component of basic life support and the established first line before advanced life support. CPR as a potential life saver is associated with survival and has the potential to prevent sudden death. The American Heart Association (AHA) resuscitation guidelines recommended that all hospital staff who are in contact with the patients should have regular resuscitation training.5

Research shows that the quality of CPR has a direct impact on victims’ chance of survival. CPR (CPR) is a procedure that should be used for patients, for whom there is areasonable chance of restoring and prolonging life.5

A study was conducted in U.S.A. in 2005 to identify beneficiaries 65 years of age or older who underwent CPR in U.S. hospitals. They had examined temporal trends in the incidence of CPR and the rate of survival after CPR, as well as patient- and hospital-level predictors of survival to discharge. In this study the methodology used was epidemiological study. The results revealed that 433,985 patients who underwent in-hospital CPR; 18.3% of these patients (95% confidence interval [CI], 18.2 to 18.5) survived to discharge. The overall incidence of CPR was 2.73 events per 1000 admissions. It was concluded that the proportion of in-hospital deaths preceded by CPR increased, whereas the proportion of survivors discharged home after undergoing CPR decreased.6

A study was conducted in Sungkyunkwan University School of Medicine, Seoul, Korea to investigate the level of basiclifesupport (BLS) skillretention of medicalinterns. In this study methodology used was CPR records-specifically, the number of CPR experiences and the feedback given by the CPR team leaders. The results showed that 56 subjects were enrolled in the 6 month group and 36 in the 12 month group. For non-compression skills, the points for skills declined from 12 to 6 points in the 6 month group and from 12 to 6 points in the 12 month group and the declines in both groups were statistically significant. For compression skills, in the 12 month group, the hands-off time improved from 9.9 s to 8.7 s, with statistical significance.7

A retrospective and comparative study was conducted in Hungary, on training nurses for CPR using problem based approach. 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 problem-based learning and conventionaltraining favouring PBL-instructed students. Students who received PBL training had better final CPR exam grades than traditionally trained peers. The only significant difference among schools was found for PBL training. There was no difference across schools in the final CPR grades when traditional training was concerned.PBL was a superior instruction method for CPR training.8

Based on the long working experience regarding CPR, the investigator realized that there is a great need of increasing the awareness among Para-medical students regarding CPR to decrease the mortality rate of patients who have cardiac arrest. Investigator believes that by broadening training and encouraging the public and the health care professionals to perform CPR will save thousands of life. If the Para-medical professionals are educated and trained we can save many lives because they are the people who are closely monitoring the patients in hospital and in community settings.Hence the investigator decided to develop PTP regarding CPR to enhance the knowledge of Para-medical students at selected colleges at Hassan.

6.3. STATEMENT OF THE PROBLEM:-

“A STUDY TO EVALUATE THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME [PTP] ON THE KNOWLEDGE REGARDING CARDIO PULMONARY RESUSCITATION [CPR] AMONG PARA-MEDICAL STUDENTS IN SELECTED PARA-MEDICAL COLLEGES AT HASSAN, KARNATAKA.”

6.4. OBJECTIVES OF THE STUDY:-

1. To assess the pre test knowledge regarding CPR among Para-medical students in selected Para-medical colleges at Hassan.

2. To develop and administer planned teaching programme (PTP) regarding CPR.

3. To evaluate the effectiveness of PTP regarding CPR among Para-medical students in selected Para-medical colleges at Hassan.

4. To find out the association between post-test knowledge score of Para-medical students with their selected socio-demographic variables.

6.5. HYPOTHESIS:-

Research hypothesis:

H1: There will be a significant difference between pre-test and post-test knowledge scores among Para-medical students regarding CPR.

H2: There will be a significant association between post test knowledge score with the selected socio-demographic variables.

6.6.ASSUMPTIONS:-

  • It is assumed that Para-Medical Students may have some basic knowledge regardingCPR.
  • PTP is an accepted teaching strategy in improving knowledge of Para-Medical Students.

6.7.OPERATIONAL DEFINITIONS:-

6.7.1. Evaluate:In this study it involves ascertain the difference between pre-test and post-test scores with appropriate statistical methods.

6.7.2 Effectiveness: In this study, it refers to the extent to which the PTP on CPR has achieved the desired effect in improving the knowledge of Para-medical students as assessed bysemi-structured questionnaire.

6.7.3. Planned Teaching Programme (PTP): In this study, it refers to systematically planned group instructions by lecture cum discussion method designed to provide information regarding CPR.

6.7.4. Knowledge: In this study, it refers to the understanding and awareness of para medical students regarding CPR.

6.7.5. Cardio Pulmonary Resuscitation [CPR]: In this study, CPR refers to a desperate lifesaving effort to restore circulation and respiration within a few minutes in a patient or an otherwise healthy individual who has suffered from cardio-respiratory arrest.

6.7.6. Para-Medical Students: In this study it refers to the students who are studying in different Para-medical colleges at Hassan.

6.8CRITERIA FOR SAMPLE SELECTION:-

6.8.1. Inclusion criteria:

  • The Students who are studying in selected Para-Medical Colleges at Hassan.
  • The Para-Medical Students who are willing to participate in the study.
  • The students who are present during the period of data collection

6.8.2. Exclusion criteria:

  • The Para-Medical Students who are not willing to participate in the study.
  • The Para-medical students who are absent or on leave at the time of data collection.

6.9LIMITATIONS OF THE STUDY:-

This study is limited to

  1. 60 Para-Medical Students studying in selected Para-Medical Colleges at Hassan.
  2. Data will be collected within 4-6 weeks of period.

6.10 SIGNIFICANCE OF THE STUDY:-

  1. This study will evaluate the effectiveness of PTP regarding CPR on the knowledge of Para-Medical Students.
  2. The increased knowledge of Para-Medical Students regarding CPR imparts a positive attitude and improved skill by treating patients with CPR.
  3. Thus improve the outcome of care of patients with CPR.
  4. CONCEPTUAL FRAME WORK

This study based on “General system theory”.(Modified Ludwig von Bertalanffy General system Theory 1968)

6.12 REVIEW OF LITERATURE

The review of literature is defined as broad, comprehensive in depth, systematic and critical view of scholarly publications, unpublished scholarly print material, audio-visual materials and personal communications.

Review of literature provides the basis for future investigation, feasibility of study and indicates constraints of data collection. Review of literature is extensive, exhaustive examination of publication relevant to research project. It is under taken to establish the need for the study methodology, development of a tool and planned teaching programme.

Review of literature is divided in to following sub topics:-

1) Reviews related to incidence and prevalence of cardiac arrest and cardio-vascular diseases.

2) Reviews related to knowledge of CPR among medical and para-medical professionals.

3) Reviews related to Effectiveness of teaching programme regarding CPR.

4) Reviews related to role of nurse in CPR.

1) Reviews related to incidence and prevalence of cardiac arrest and cardio-vascular diseases:-

A study was conducted in Lulea, Sweden to describe trends in incidence, outcome, and background characteristics among people who suffered an out-of-hospital cardiac arrest with validated myocardial infarction aetiology (OHCA-V). In this study People from the northern Sweden MONICA myocardial registry (1989-2007) with OHCA-V (n = 2977) were divided in two age groups (25-64 and 65-74 years). Both those who were resuscitated outside hospital and those who died before resuscitation was started were included.The younger age group was studied during 1989-2007 and the older group during 2000-2007. The incidence of OHCA-V decreased in both the younger group (men p < 0.0001, women p = 0.04) and the older group (men p < 0.0001, women p < 0.0007, respectively). The results revealed that The proportion with a history of ischemic heart disease prior to the event decreased (p < 0.0001). The proportion of previous myocardial infarction decreased (p < 0.0001), diabetes mellitus increased (p = 0.001), coronary interventions increased (p < 0.0001), and survival after OHCA-V increased (p < 0.0001) in the younger group but not in the older group. Long-term survival after OHCA-V was better in the younger than in the older group (p = 0.026). Conclusion: The incidence of OHCA-V decreased in both sexes. It was concluded that the proportion surviving after OHCA-V was small but increased, and long-term survival (≥28 days) was better in the younger age group. Primary preventive measures may explain most of the improvements.9

A study was conducted byregarding the survival of out-of-hospital cardiac arrest with early initiation of cardiopulmonaryresuscitation. The prevalence rate of results revealed that records on 1,297 people with witnessed out-of-hospital cardiac arrest, caused by heart disease and treated by both emergencymedical technicians (EMTs) and paramedics, to determine the early initiation of cardiopulmonary resuscitation (CPR) by bystanders independently improved survival. CPR for 579 patients (bystander CPR); for the remaining 718 patients, CPR was delayed until the arrival of EMTs (delayed CPR). Survival was significantly better (P less than 0.05) in the bystander CPR group (32%) than in the delayed-CPR group (22%). Multivariate analysis revealed that the superior survival in the bystander-CPR group was due almost entirely to the much earlier initiation of CPR (1.9 minutes for the Bystander-CPR group and 5.7 minutes for the delayed CPR group; P less than 0.001). There were significantly more people with ventricular fibrillation(VF) in the bystander-CPR group (80%) than in the delayed-CPR group (68%); and, for people in VF, the survival rate was significantly better if they had received bystander-CPR (37% versus 29%). It was concluded that early initiation of CPR by bystanders significantly improves survivalfrom out-of-hospital cardiac arrest.10

A study was conducted in Los Angeles, USA to evaluate the association between socioeconomic status and the incidence of sudden cardiac arrest. In this study the methodology chosen was population based registry. A total of 9235 sudden cardiac arrest samples were included in this study. The results revealed that the incidence of sudden cardiac arrest in the lowest socioeconomic quartile was nearly double that in the highest quartile (incidence rate ratio [IRR] 1.9, 95% confidence interval [CI] 1.8-2.0). This disparity was greater among people less than 65 years old (IRR 2.7, 95% CI 2.5-3.0) than among those 65 or older (IRR 1.3, 95% CI 1.2-1.4). After adjustment for study site and for population age structure of each census tract, the disparity across socioeconomic quartilesfor all ages combined was greater in the United States (IRR 2.0, 95% CI 1.9-2.2) than in Canada (IRR 1.8, 95% CI 1.6-2.0) (p<0.001 for interaction).Based on the results they have concluded that the incidence of sudden cardiac arrest at home or at a residential institution was higher in poorer neighborhoods of the US and Canada.11

An anonymized patient study was conducted in emergency medical service (EMS) in Germany to investigate the socio-economic factors regarding the impact of response time reliability [RTR] on CPR incidence and resuscitation success using return of spontaneous circulation [ROSC] return after cardiac arrest[RACA].In this study 2330 prehospital patients who underwent CPR were included.. The results proved thatthe incidence of sudden cardiac arrest differs from 36.0 to 65.1 / 100,000 inhabitants / year. They have identified two EMS systems (RTR<70%) reaching the patients within eight minutes in 62.0 and 65.6% while the other five EMS systems (RTR>70%) achieved 70.4 up to 95.5%. EMS systems arriving relatively later at the patients side (RTR<70%) less frequently initiate CPR and admit fewer patients alive to hospital (calculated per 100,000 inhabitants / year)( CPR incidence [1/100.000 I/Y] RTR>70%: 57.2; RTR<70%: 36.1; p < 0.01; OR 1.586 (99% CI: 1.383 to 1.819) ( admitted to hospital[1/100.000 I/Y] RTR>70%: 24.4; RTR<70%: 15.6; p < 0.01; OR 1.57 (99% CI: 1.274 to 1.935)).Using ROSC rate and the multi-variate RACA score to predict outcome, the two groups did not differ, but ROSC rate were higher than predicted in both groups (ROSC [%] RTR>70%: 46.6; RTR<70%: 47.3; n.s.; OR 0.971 (95% CI: 0.787 to 1.196)) ( ROSC RACA [%] RTR>70%: 42.4;RTR<70%: 39.5; n.s.; OR 1.127 (95% CI: 0.911 to 1.395)). This study demonstrates that onthe level of EMS systems, faster ones will more often initiate CPR and will increase number of patients admitted to hospital alive.12

2) Reviews related to knowledge of CPR among medical and para-medical professionals:-

A study was conducted in Washington, USA to determine survival of out-of-hospital cardiac arrest with early initiation of cardiopulmonary resuscitation. In this study methodology undertaken was multivariate analysis. The total of 1,297 people with witnessed out-of-hospital cardiac arrest, caused by heart disease and treated by both emergency medical technicians (EMTs) and paramedics, were examined to determine whether or not early cardiopulmonary resuscitation (CPR) initiated by bystanders independently improved survival. The results revealed that the superior survival in the bystander-CPR group was due almost entirely to the much earlier initiation of CPR (1.9 minutes for the Bystander-CPR group and 5.7 minutes for the delayed-CPR group; P less than 0.001). There were significantly more people with ventricular fibrillation (VF) in the bystander-CPR group (80%) than in the delayed-CPR group (68%); and, for people in VF, the survival rate was significantly better if they had received bystander-CPR (37% versus 29%). They have concluded that early initiation of CPR by bystanders significantly improves survival from out-of-hospital cardiac arrest, and they suggest that it may do so by prolonging the duration of VF after collapse and by increasing cardiac susceptibility to defibrillation.13