Effectiveness of Self Instructional Module on Knowledge Regarding Dysrhythmias and its Management among Staff Nurses at selected Government Hospitals, Mysore
2Assistant Lecturer, Community Health Nursing Department, JSS College of Nursing, Mysore
3Nursing tutor, JSS School of Nursing, Mysore
*Corresponding Author Email:guruvishu@gmail.com
ABSTRACT:
Background and Objectives:
Abnormal heart function results in disturbances of either electrical or mechanical activity or both. Abnormal electrical activity may result in arrhythmias. Arrhythmia is an abnormal rate, rhythm or contour of any of the individual wave of electrocardiogram (ECG). Arrhythmias can lead to dramatic changes in circulatory dynamics such as hypotension, heart failure and shock. Recognizing and treating arrhythmias at an early stage can prevent death. The nurse should therefore be familiar with the identification of such arrhythmias. Instant recognition of lethal arrhythmias and immediate resuscitation saves the lives of many.
Methods:
One group pre-test and post-test without a control group using pre-experimental design was used, with purposive sampling technique. Information was collected from 50 Registered Staff Nurses using structured knowledge questionnaire. SIM was administered and post-test was conducted after 7 days using same questionnaire.
Results:
The overall pre test knowledge scores of Staff Nurses on Dysrhythmias and its management was found to be 45.9% and the overall post test knowledge scores was found to 78.3% and enhancement in the mean percentage knowledge score was found to be significant at 5% level for all the aspects under study. There was significant association between post test knowledge scores and selected demographic variables with study gender(χ 25.84), marital status(χ 24.58), witnessing ECG with arrhythmia( χ 24.58), type of family( χ 26.49), source of information( χ 211.62).
Interpretation and Conclusion:
Overall findings showed that there is knowledge deficit among staff nurses regarding Dysrhythmias and its management and SIM was effective in improving their knowledge..
KEYWORDS:
INTRODUCTION:
The heart, muscular pump of the circulatory system, has an electrical impulse that signals the heart’s four chambers to contract, each at the proper time.
The heart works in an endless contract- relax/ contract – relax cycle. An average heart beats 1,00,000 times a day, pumping some 2000 gallons of blood through its chambers and then back to the heart. Over a 70-year life span, that adds up to more than 2.5 billion heartbeats.1
Arrhythmia is a disturbance in regular heart rate and/or rhythm due to change in electrical conduction or automaticity. Some arrhythmias can be described as minor arrhythmias which do not usually need treatment, while other major arrhythmias which should be treated as soon as possible and life threatening arrhythmias which require immediate and emergency treatment. Cardiac arrhythmias are conduction disturbances that disrupt normal functioning of the heart, and are named according to the site of origin as sinus arrhythmias, atrial arrhythmias, atrioventricular block, or ventricular arrhythmias. Disturbances are due to three major mechanisms: 1- automaticity, 2-conduction, and 3- problems with reentry of impulses. Common causes of arrhythmias are acidosis, electrolyte imbalance, early cardiac failure, pain and anxiety.1,2
1. To assess the existing knowledge regarding Dysrhythmias and its management among Staff Nurses at selected government hospitals.
2. To evaluate the effectiveness of self instructional module on knowledge regarding Dysrhythmias and its management among Staff Nurses at selected government hospitals.
3. To find the association between selected socio demographic variables and post test knowledge score regarding Dysrhythmias and its management among Staff Nurses at selected government hospitals.
H1 – There will be a significant difference between pretest and post test knowledge score of Staff Nurses regarding Dysrhythmias and its management at selected government hospitals.
H2 – There will be a significant association between post test knowledge scores and selected socio demographic variables.
Research Variables:
a) Independent variable: Self instructional module on knowledge regarding Dysrhythmias and its management.
b) Dependent variable: Knowledge of Staff Nurses regarding Dysrhythmias and its management.
c) Attribute variable: Age, sex, qualification, marital status, income, type of family, year of experience etc.
CONCEPTUAL FRAMEWORK:
The conceptual model for the study is based on the general system theory by Ludwig Von Bertanlanffy (1969). General system theory provides a way of examining interrelationships which consist of input, throughput and output.
METHODOLOGY:
Research Approach:
In view of the nature of the problem selected and objectives to be accomplished an experimental approach was considered appropriate for the present study.
Research Design:
Polit and Hungler (1999) stated that, research design incorporates the most important methodology decisions that a researcher makes in conducting a research study. It depicts the overall plan for organization of scientific investigation. Pre- experimental one group pre-test and post-test design was selected in order to evaluate the effectiveness of Self instructional module on knowledge regarding Dysrhythmias and its management among Staff Nurses at selected government hospitals, Bengaluru.3,4
Setting of the Study:
The study was conducted in Government Hospital, mysore. The criteria for selecting these setting were geographical proximity, feasibility for conducting the study, availability of the required sample and familiarity of the investigator with these settings.50 nurses working in different wards of Government Hospital,were selected for the study.
Population:
The target population of the study was registered Staff Nurses working at Government Hospital, mysore, Karnataka. A total number of 50 subjects were chosen for the study.
Sample and Sampling Technique:
The sample consists of a population of Registered Staff Nurses selected to participate in a research study. In the study, a purposive sampling method through non-probability sampling approach was used for selection of Nurses.
Description of the Tool:
In the present study the following tools were used.
Part-I: consisted of 12 items related to socio-demographic data of the subjects such as Gender, Age, Religion, Marital status, type of family, income, Professional Educational qualification, general qualification, Total clinical experience in years, Area of clinical experience, Have they ever witnessed an ECG with abnormal rhythm and in which disease condition, Source of information regarding care of patients with cardiac emergencies.
Part-II: Structured knowledge questionnaire consisted of 40 items on knowledge regarding Dysrhythmias and its management. Each item of the questionnaire has one correct answer, every correct answer would fetch one mark, and the total score of the knowledge questionnaire is 40.
Section-A: Consisted of 8 (20%) items regarding general information on Dysrhythmias and interpretation of ECG.
Section-B: Consists of 16 (40%) items on types of Dysrhythmias and its identification
Section-C: Consists of 16 (40%) items regarding management of Dysrhythmias.
Each correct answer was given a score of ‘one’ mark and wrong answers ‘zero’ score.
To find out the association with the selected variables, the knowledge aspect was categorized into three groups.
Below 50% = Inadequate knowledge.
51–75% = Moderate knowledge.
Above 75% = Adequate knowledge.
RESULTS:
The data obtained was analysed in terms of achieving the objectives of the study using descriptive and inferential statistics.
Findings:
· Findings of the study reveal 36% of respondents were in the age group of 21-25 years followed by 36% in the age group of 26-39 years and 28% in the age group of 41-55 years. Majority (84%) of nurses were found to be females as compared to males (16%) in the study.
· Distribution based on the marital status reveals that 60% of nurses were married and 40% of the respondents were unmarried. Majority (88%) of Staff Nurses were diploma holders in nursing.
· With respect to General educational qualification it was observed that 48% of the respondents have not done any general qualification, 22% of respondents had done other courses, 20% of respondents had done degree, and 10% of respondents had done post graduation.
· Clinical experience wise 32% of the nurses had clinical experience below 3 years, 38% of the nurses had clinical experience between 3-20 years and 30% had clinical experience above 20 yrs.
· Among the 50 Staff Nurses majority 44% had experience in Emergency/Casualty followed by 26% in Medical ward, 24% with Surgical ward experience and least 6% with OT experience.
· Religion wise distribution of the Staff Nurses reveals that majority 82% of nurses were Hindus, and only 18% were Christians. Majority i.e., 68% of them belonged to nuclear family. Regarding income, 28% of Staff Nurses had income below 10,000, 44% of them had income between Rs. 10,000-30,000 and 28% had above Rs. 30,000.
· Out of 50 Staff Nurses 60% had not witnessed ECG with Arrhythmia, and only 40% of them had witnessed ECG with Arrhythmia, majority, i.e., 28% had witnessed in ischemic heart disease.
· With respect to source of information on care of patient with cardiac emergencies majority of nurses i.e., 48% had got from medical personals and least i.e, 12% had got through electronic media.
· The present study confirms that the overall knowledge in pre-test is 45.9%, which is less. This shows that there is lack of knowledge regarding Dysrhythmias and its management and in post test the overall knowledge increased to 78.3% after the administration of SIM.
· The present study confirmed that there was a considerable improvement of knowledge after the administration of self instructional module and is statistically established as significant. The overall mean percentage knowledge score in the pre-test was 45.9% and 78.3% in the post-test with 32.4% mean percentage knowledge enhancement.
· Among the demographic variables analyzed in this study gender, marital status, witnessing ECG with arrhythmia, type of family, source of information found to have high significant association with knowledge scores. There was no significant association between age, professional educational qualification, general qualification, Clinical Experience, Area of Clinical Experience, religion, income/month.
Aspect wise Mean Pre test and Post test Knowledge on Dysrhythmias and its management
|
No. |
Knowledge Aspects |
Respondents Knowledge (%) |
Paired ‘t’ Test |
|||||
|
Pre test |
Post test |
Enhancement |
||||||
|
Mean |
SD |
Mean |
SD |
Mean |
SD |
|||
|
I |
General Information on Dysrhythmias and Interpretation of ECG |
51.0 |
18.0 |
80.8 |
10.5 |
29.8 |
21.3 |
9.89* |
|
II |
Types of Dysrhythmias andits Identification |
39.5 |
21.4 |
76.8 |
10.9 |
37.3 |
16.9 |
15.61* |
|
III |
Management of Dysrhythmias |
49.8 |
12.9 |
78.6 |
9.0 |
28.9 |
15.8 |
12.93* |
|
|
Combined |
45.9 |
13.1 |
78.3 |
6.3 |
32.4 |
11.8 |
19.42* |
* Significant at 5% level, t (0.05,49df ) = 1.96
CONCLUSION:
· The overall mean and mean percentage of pre-test knowledge scores on Dysrhythmias and its management was found to be 18.36 and 45.9% respectively which indicates the lack of knowledge among respondents in pretest.
· The overall mean and mean percentage of post-test knowledge scores on Dysrhythmias and its management was found to be 31.32 and 78.3% respectively which indicates that the nurses gained knowledge after administering the self instructional module.
· Based on the aspect wise pretest knowledge assessment, the highest knowledge(51%) was found on general information on Dysrhythmias and Interpretation of ECG and least knowledge (22.7%) was found on types of Dysrhythmias and its Identification and in post test the nurses gained a mean percentage knowledge of 76.8% on types of Dysrhythmias andits Identification. On general information and management, 80.8% and 76.5% were gained respectively.
· Among the demographic variables analyzed in this study gender, marital status, witnessing ECG with arrhythmia, type of family, source of information found to have high significant association with knowledge scores but there was no significant association between age, professional educational qualification, general qualification, total clinical experience, area of clinical experience, and witnessing arrhythmia in particular disease condition, religion, income/month.
RECOMMENDATIONS:
On the basis of the findings of the study following recommendations have been made:
· A similar study can be done on a large sample to generalize the findings.
· An experimental study can be undertaken with a control group for effective comparison of the result.
· A study can be conducted by including additional demographic variables.
REFERENCES:
1. Zipes D. Production of cardiac arrhythmias. AORNJ. 2003 Oct; 38(4): 572-81.
2. Black JM, Hawks JH, Keene AM. Medical surgical nursing: clinical management for positive outcomes. 8th edition. New Delhi: Harcourt pvt ltd;2006. p. 1550 -1552.
3. Polit DF, Beck CT. Nursing Research. 8th ed. Newyork: Lippincott Willams and Wilkins; 2010. p.136.
4. Sharma SK. Nursing research and statistics. Haryana: Elsevier; 2011. p. 288-297
Received on 01.09.2014 Modified on 24.09.2014
Accepted on 05.10.2014 © A&V Publication all right reserved
Int. J. Adv. Nur. Management 2(4): Oct. - Dec., 2014; Page 244-247