Submitted To: Submitted By

SYNOPSIS

SUBMITTED TO: SUBMITTED BY:

Prof. Bosco Sunder Raj. J Mrs. R.Prema

Principal I year M.Sc Nursing

Miranda College of Nursing Miranda College of Nursing

Bangalore. Bangalore.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1)NAME OF THE CANDIDATE AND ADDRESS : MRS. R. PREMA

1ST YEAR M.SC., NURSING,

MIRANDA STAFF QUARTERS,

SLIG-45 BLOCK, 4TH PHASE,

YELAHANKA NEW TOWN

BANGALORE-560106.

2)NAME OF THE INSTITUTION : MIRANDA COLLEGE OF NURSING,

CA-29, 5TH PHASE, KHB COLONY

YELAHANKA NEW TOWN,

BANGALORE-560106.

3)COURSE OF STUDY AND SUBJECT : M.Sc NURSING

MEDICAL SURGICAL NURSING

4)DATE OF ADMISSION TO THE COURSE : 31/07/2008

5)TITLE OF THE STUDY : A STUDY TO ASSESS THE

EFFECTIVENESS OF STRUCTURED TEACHING PROGRAME ON KNOWLEDGE AND ATTITUDE REGARDING NURSING CARE OF PATIENT WITH INTER COSTAL DRAINAGE TUBE AMONG STAFF NURSES IN A SELECTED HOSPITAL, BANGALORE.

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6. BRIEF RESUME OF THE INTENDEDWORK

6.1NEED FOR THE STUDY:

Knowledge and good practice are very important in the field of nursing. Nurses should have good skills while caring the clients. Nurses who are working in the thoracic surgical units should possess good practice of taking care of clients with Inter Costal Drainage Tube. It is important that nurse can prevent the complication which arises during the care of chest drains. Nurses should know the purposes and understanding of water seal drainage system as well as the precautions which are to be practiced to prevent air and fluid entering the chest cavity causes collapse of the lung and life threatening respiratory insufficiency.1

Approximately one million pleural effusion cases are diagnosed each year in India. The clinical importance of pleural effusions ranges from incidental manifestations of cardiopulmonary diseases to symptomatic inflammatory or malignant diseases that require urgent evaluation and treatment. 2

Identified iatrogenic causes of pneumothorax in which air or gas is present in the pleural cavity as a result of therapeutic intervention. The four main pleural complications of traumatic haemothorax are the relation of clotted blood in the pleural space, increases the incidence of subsequent emphysema, pleural effusion and fibro thorax. 3

The treatment of choice for patients with traumatic haemothorax is the immediate insertion of the Inter Costal Drainage Tube. Chest tube should be removed as soon as they stop draining or case to function because they can serve as infection for pleural space. Traumatic pneumothorax can result from both penetrating and non penetrating chest trauma. Chest tubesare necessary for pneumothorax. If a haemothorax present, one chest tube is placed in the superior partto remove air and another to be placed in the interior part of haemothorax to remove the blood. 4

Use of antibiotics immediately before and then every 6 hours until the chest tube removal showed a drastic reduction in pleural infection. The study is intended to determine the existing knowledge and practice of nurses regarding the care of patients, having inter costal drainage tube and to prevent the complication of inter costal drainage tube. 5

Using of inter costal drainage tubes and chest drainage units is a complex and critical nursing function. By learning about their components and techniques needed to use those, can protect and helpful the patients to recover soon from serious pulmonary problem.6

Chest drains are a common feature of patients admitted to acute respiratory or cardio-thoracic surgery care areas. Anecdotally, there appears to be a lack of consensus among nurses on the major principles of chest drain management. Many decisions tend to be based on personal factors rather than sound clinical evidence. This inconsistency of treatment regimes, together with the lack of evidence-based nursing care, creates a general uncertainty regarding the care of patients with chest drains. This study aimed to identify the nurses' levels of knowledge with regard to chest drain management. The research objective of this study was to describe the nurses' levels of knowledge regarding the care of the patient with chest drains. The data were collected using survey method. The results of the study revealed deficits in knowledge in a select group of nurses.

According to the medical records department of S.D.S. Tuberculosis and Rajiv Gandhi Institute of Chest Diseases, Bangalore Road, Traffic accidents, stab injuries, chest trauma and lung surgeries are the major cause for insertion of Intercostal Drainage Tube. The statistical data reported that approximately 400 to 500 patients with Intercostal Drainage Tube were treated in the hospital during the year 2006 – 2007 with 20:1 male predominance. Hence, staff nurse should be given adequate education regarding management of patients with Inter Costal Drainage Tube for a better prognosis of the patients ensuring positive results.

The researcher during her clinical experience came acrosscomplications like pneumothorax, surgical emphysema, lung collapse and respiratory failure due to mishandling of intercostals drainage tubes,which might also be due to lack of knowledge regarding nursing care of patients on ICD. The researcher felt that the staff nurses should have adequate knowledge and skill regarding rendering care on patients with ICD.This motivated the researcher to conduct this study so that the nurses will impart knowledge and attitude regarding ICD.Hence the investigator felt the need to prepare an information guide sheet on care of patients with inter costal drainage tubes for staff nurses.

6.2 Review of literature

Adescriptive study on nurses knowledge regarding care of patients with Inter costal drainage tube. The data were collected using exploratory descriptive survey method. The study revealed that deficient in knowledge in a selected group of nurses. Several service led options exists with regard to improving knowing in this area such as service study days as well as ward based tutorials.7

A study on critical care nurses to analyze the state of knowledge and practice in chest tube management. The author identified that the critical care nurses must develop standards of knowledge and practice from research derived recommendations. The authors analyze the body of research and recommend clinical practice changes andtimely research projects on chest tube management.8

A study on patient with haemothorax which occurred after the removal of small pig – tail chest tube (8.5F) that was inserted in the second intercostals space in the mid-clavicular line, for primary spontaneous pneumothorax management. The patient was successfully resuscitated and 0.85 lt. of blood was aspirated. There was no evidence for pre-existing haemothorax, no metal instrument was used and no precipitating factor was present. This study indicated that pig-tail drain insertion into the second intercostals space in the mid-clavicular line, and suggests that insertion in other sites is technically easy and potentially safer for pneumothrax drainage. 9

A retrospective analysis of the medical records and data on total amount of drainage, number of days of drainage, length of post operative stay was done. A total of 202 patients were selected for the study. Tubes were left in 826.7ml collected during that time. The investigator concluded that use of small caliber drains have been found to be an adequate means of drainage after open heart surgery. 10

An article stated on giant lung abscess treated by tube thoracostomy. In the treatment of a lung abscess 8 cm or larger tube thoracostomy is an effective form of drainage, safer than pulmonary resection and may yield a superior result, rather than being reserved as a desperation measure for risk patients, tube thoracostomy should be considered early in the hospital course. 11

A prospective randomized study was performed. The investigators reported a higher success rate with inter costal drainage tube (93% n=28) as compared with simple aspiration (67% n=33). A subsequent group of patients (n=35) is an uncontrolled phase of this study had only a 68.5% success rate with simple aspiration. The investigators conducted that thoracic drainage via inter costal drainage tube was significantly more effective in the treatment of pneumothorax than simple aspiration. 12

A national survey among chest physicians of their experience of harm associated with ICD was conducted in UK. A questionnaire was sent to 198 UK chest physicians at 148 acute hospital trusts, enquiring about current practice and any adverse incidents related to chest drains from 2003 to 2008 101. Of 148 trusts (68%) replied. 67 trusts reported at least one major incident involving ICD insertion. 31 Cases of ICD misplacement were reported with seven deaths. Misplaced drains were inserted in liver (10), peritoneal space (6), heart (5), spleen (5), subclavian vessels (2), colon (1), oesophagus (1) and inferior vena cava (1). 47 cases of serious lung or chest wall injuries with eight deaths and six cases of ICD placement on the wrong side with two deaths were reported. The study concluded that 67% of responding trusts had encountered major complications of ICD.13

Chest drains are a common feature of patients admitted to acute respiratory or cardio-thoracic surgery care areas. Anecdotally, there appears to be a lack of consensus among nurses on the major principles of chest drain management. Many decisions tend to be based on personal factors rather than sound clinical evidence. This inconsistency of treatment regimes, together with the lack of evidence-based nursing care, creates a general uncertainty regarding the care of patients with chest drains. This study aimed to identify the nurses' levels of knowledge with regard to chest drain management. The research objective of this study was to describe the nurses' levels of knowledge regarding the care of the patient with chest drains. The data were collected using survey method. The results of the study revealed deficits in knowledge in a select group of nurses.14

Tygerberg Hospital (TBH) in the Cape Town metro pole conducted a study with an aim to determine the complications and errors commonly encountered during the placement of ICDs for trauma. The audit ran for the 3-month period 1 January to 31 March 2008, included all patients with chest trauma referred to the TBH trauma unit with an ICD in situ, and patients with chest trauma in whom an ICD had been placed by TBH trauma unit staff were included in the study. A total of 3989 patients with trauma injuries were seen in the front room trauma bay during the study period. The study concluded that an overall complication rate of 9.5% was seen. Insertional complications numbered 7 (27%), with 19 (73%) positional complications.15

Statement of the Problem:

A study to assess the effectiveness of structured teaching programme on knowledge and attitude regarding care of patients with inter costal drainage tube among staff nurses in a selected Hospital, Bangalore.

6.3. Objectives of the Study:

(i)To assess the level of knowledge regarding nursing care of patients with inter costal drainage tube among staff nurses at selected Hospital, Bangalore.

(ii)To assess the level ofattitude regarding nursing care of patients with inter costal drainage tube among staff nurses at selected Hospital, Bangalore

(iii)To determine the effectiveness of STP by comparing scores obtained by staff nurses before and after STP

(iii)To associate the post level of knowledge and attitude regarding nursing care of patients with inter costal drainage tube.

6.3.1. Assumptions:

Staff Nurses have existing knowledge regarding nursing care of patients with Inter Costal Drainage Tube.

The use of STP will help the staff nurses to update their knowledge and enable them to provide efficient care to patients with intercoastal drainage tube

6.3.2. Operational Definition

Knowledge: Refers to the level of understanding of staff nurses reading care of Inter Costal Drainage Tube as measured by correct response to the Knowledge questionnaire.

Assess: It refers to the knowledge of staff nurses regarding care of patients with Inter costal Drainage tube.

Staff Nurses: Staff nurses refers to registered nurses working in a selected Hospital, Bangalore

Care: Refers to the ability of the nursing personnel in application of knowledge read to the individual patients for benefit of health:

Inter Costal Drainage Tube: The tube inserted in between the ribs to reach the pleural space to remove air or fluid.

Structured teaching programme: In this study it refers to systematically well planned set of instruction, focused on a group designed to provide information regarding care of patients with Inter costal Drainage Tube through lecture cum discussion method.

Attitude:It refers the feelings and belief towards nursing care of patient with intercostal drainage tube as measured by five points likert scale in the attitude part of the questionnaires.

HYPOTHESIS:

• There will be significant difference in the level of knowledge regarding nursing care of patients with intercoastal drainage tube
• There will be significant difference in the level of attitude regarding nursing care of patients with intercoastal drainage tube
• There will be significant association on the post level of knowledge and attitude regarding nursing care of patients with intercoastal drainage tube

7. MATERIALS AND METHODS:

7.1. Source of Data : Data will be collected from staff Nurses who are

working in Mahaveer Jain Hospital Bangalore.

7.2. Method of Collection of Data:

7.2.1. Definition of the study subject:

Staff nurses:Refers to registered nurse

Working inMahaveer Jain Hospital
7.2.2 Inclusion and Exclusion Criteria:

(a)Inclusion Criteria

:(i)Staff Nurses who are working inMahaveer Jain Hospital Bangalore .

:(ii) Staff nurses who can understand Kannada and English.

: (iii)Staff Nurses who are willing and present during data collection.

(b)Exclusion Criteria: (i)Staff nurses who are not willing to

participate during data collection.

(ii) Staff nurses who are not present during the time of data collection.

(iii)Staff nurses who are sick & who are on leave during the time of data collection

7.2.3. Research Design:Pre experimental design will be adopted in this study

7.2.4. Setting : Mahaveer Jain Hospital

7.2.5 Sampling Techniques : The non probability convenient sampling will be used

to collect the data.

72..6. (a) Sample Size:50 Staff Nurses.

(b) Duration of study :30 Days.

7.2.7. Tool of Research:The investigator will develop structured

Questionnaire to assess the

Knowledge and modified 5 point Likert scale to

assess the attitude regarding nursing care of patient

with Inter Costal drainage tube

7.2.8. Collection of Data :The Investigator herself collects the data

by administering structured questionnaire and

attitude scale.

7.2.9. Method of Data analysis :Descriptive, inferential statistical

and presentationtechniques and related statistical methods willbe

Used.

7.,3. Does the study require any investigation to be conducted on patients or other human or animals? If so please describe briefly?

Yes. Study will be conducted on staff nurses regarding knowledge towards care of Inter Costal Drainage Tube.

7.4. Has ethical clearance has been obtained from your institution in case of 7.3?

Yes. Informed Consent will be obtained from concerned authority and subjects prior to the study.

 Privacy, confidentiality and anonymity will be guarded

Scientific objectivity of the study will be maintained with honestly and impartiality

8. LIST OF REFERENCES:

1. Buunner, Suddarth, Text booksof medical and surgical nursing, 11th ed New Delhi. Lippiocott 2008 p. 760-764.

2. Davies CWH, Gleese FV Davies, RJO, Guidelines for the management of pleural effusion thorax BMJ 2003 (58(18) 18-20

3. Light WR Pieural diseases, pneumothorax 3rd ed. USA. William and Wilkins company 1995 p. 223-234

4. Angelilo Thomas, Minimal access Cardio Thoracic Surgery 1st ed. United States W.B. Saunders Company: 2001. P. 1246 – 1248.

5. Vinsant GO Brunner, RG Role of antibiotics using in patients with an isolated chest injury North American Journals 2002 46(7) 25.9.

6. Lazzara Debvorah. Eliminate the air of mystery from the Chest. Nursing Journal 2002; 32 (6) 36-43

7. Lehwaldt D.Timmins F.Nurses Knowledge of Chest drain care an exploratory descriptive survey nurs crit care 2005 Jul-Aug. 10(4) 192-200

8. Gordon PA, Norton JM Mercell, R.Refining Chest tube management analysis of the State Knowledge and practice Dimens crit care Nurse 2004 Jan. Feb. 14.6-12

9. Markis D.Hatthabi M.Scherpereel A.Laffitte JJ Marquette CH Patient with primary spontaneous pneumothorax Emerg Med J.2007 Mar. 24(3) 17

10. Lancey AR Gaca Chatene, Vandere, Salm TJ The use of smaller

11. Mengoli L.Giant lung abscess treated by tube thoracostomy journal of Thorcic and Cardiovascular Survery 2002 (96)(2) 182-94.

12.Millar. A.Harvey J.Guide lines for the management of spontaneous pneumothorax,British Medical Journal 2002: 307: 114-6

13.Ann Harris, B Ronan O'Driscoll, Peter M Turkington, Survey of major complications of intercostal chest drain insertion in the UK,Postgrad Med J 2010;86:68-72

14.Daniela Lehwaldt,Fiona Timmins, Nurses knowledge of chest drain care: an exploratory descriptive study, British Association od crirical care nurses,2005

15. David Martiz, Lee Wallis, Timothy Hardcastle, Complications of tube thoracostomy for chest trauma,February 2009,Vol.99,No.2