The Effectiveness of Planned Teaching Programme regarding Interpretation and Management of Lethal Arrhythmias in Terms of Knowledge and ability of Final Year B.Sc. Nursing Students

 

Narendra Kumar Kausik1*, Shatrughan Pareek2

1Principal, Govt. College of Nursing, Bikaner, Rajasthan

2Nursing Superintendent, NW Railway Divisional Hospital, Lalgarh, Bikaner, Rajasthan

*Corresponding Author E-mail: narendrakaushik52@gmail.com

 

ABSTRACT:

Introduction: In India coronary heart diseases appear a decade earlier compared with the age incidence in developed countries death from heart disease would double in India by 2015, as their growing incidence among the youth and woman according to world health organization. The electrocardiogram continues to be the gold standard for the diagnosis of cardiac arrhythmias and acute myocardial ischemia. Methodology:  Research approaches adopted for the study was Evaluative approach with Quasi experimental design. The research design selected for this study was a pretest post-test control group design. Non-probability sampling technique was used to obtain data. The study was conducted on B.Sc Nursing final year students at RAK College of Nursing, New Delhi and Govt. College of Nursing, Jaipur (Rajasthan). The sample size was 60. Results: The present study revealed that half of the subjects were 21 years of age and majority of the subjects (86.66%) were female. The mean post-test knowledge score of experimental group was 34.37 and “t” value was 11.07. The mean post test ability score of experimental group 12.7 was higher than mean post-test ability score of control group 2.4 and the “t” value was 9.54 for df 58 , was found Statistically significant at 0.05 and 0.01 level which represents the significant gain in knowledge and ability, through the planned teaching programme (PTP). Conclusion: The PTP was effective in increasing the knowledge and ability of student nurses regarding interpretation and management of lethal arrhythmias. There is a need of sound orientation and continuous educational program for student nurses and clinical nurses regarding lethal arrhythmias. It will be directly helpful in reducing the prevalence and incidence of cardiac mortality and the disease burden. Continuous growth and development of the professional is vital for the improvement of patient care.

 

KEYWORDS: Lethal arrhythmia, Management, Nursing Students, Planned teaching programme, Knowledge, Ability.

 

 

 

 

INTRODUCTION:

In 2000, Indian national survey revealed that 25% of men and 36 percent of women above the age of 20 were overweight! Current projections suggest that by the year 2020, India will have the largest cardiovascular disease burden in the world. Estimated 45 million are already patients of the disease, which is set to account for one third of all the deaths by year 2020. Sudden cardiac arrest strikes people, old or young, male or female, healthy or sick, without giving any warning; they show no prior symptoms. Sadly, less than 5% survive because of lack of emergency medical services. During sudden cardiac arrest, the electrical system of the heart short-circuits causing an abnormal rhythm known as lethal arrhythmia (ventricular tachycardia/ventricular fibrillation or a systole). Lacking proper blood flow, the person loses consciousness, stops breathing and will die unless promptly treated1-3. In 1902, a Dutch physiologist, Willem Einthoven, published the first ECG recorded with his 270-kg (600 lb) machine, the string galvanometer, for which he was awarded a Nobel Prize. Einthoven never could have imagined the explosion of knowledge his invention would spark. In the ensuing 100 years, technological advances included pacemakers, defibrillation, anti-arrhythmic drugs, invasive cardiac electrophysiology testing, implantable cardioverter defibrillators, radio-frequency ablation, trans-telephonic transmission of the ECG, and much more2,4. Today, an increasing number of people in the world are suffering from one or the other type of heart ailment. According to official statistics, heart attack claims 17 million lives worldwide annually. In India itself, cardio vascular diseases caused 2.4 million deaths in 1990. By 2015, the world health organization (WHO) estimates that heart attack will be the single greatest “killer” in India. In metro, 10 % of population is above 35years and has heart problems. Electrocardiography (ECG) is still regarded as the basic tool in the evaluation of cardiac diseases. It is performed in approximately 2 % of all office visits, and 30- 38 % of these ECGs will be abnormal. ECG may be an important tool in primary care and it can considerably reduce the number of unnecessary referrals.       However, studies have revealed insufficiencies in the ECG interpretation skills of primary care physicians. In critical care settings, bedside nurses play a critical role in arrhythmia identification and management. The current practice is that nurses gather data, and notify the physician, who makes treatment decisions based on the rhythm interpretation of the nurse, or institutes pharmacologic and counter shock therapies consistent with unit-specific protocols or algorithms5-7.

 

METHODOLOGY:

Experimental approach is adopted in this study, since the study aims at evaluating the effects of a planned teaching programme regarding interpretation and management of lethal arrhythmias in terms of knowledge and ability of final year B. Sc. Nursing students. The research design selected for this study was a pretest post-test control group design. The independent variable was the planned teaching programme regarding interpretation and management of lethal arrhythmias. The dependent variables were Knowledge and ability to interpret and management of lethal arrhythmias. The study was conducted at R.A.K. College of Nursing Lajpat Nagar New Delhi and SMS College of Nursing Jaipur Rajasthan. Sample consists of B.Sc. nursing final year students of Indian nursing council recognized institutions and following INC curriculum for B.Sc. programme. Reliability of the structured knowledge questionnaire was computed by using Kudar Richardson formula 20. It was found to be (r=0.73). In the present study the sampling technique was Simple random sampling by lottery with replacement of first and consequent elements drawn. Sample is drawn out by using multistage sampling technique colleges of nursing selected by using convenient sampling technique , group of students selected by using purposive sampling technique and samples size selected by using complete enumeration (except not willingness ) technique, These were randomly assigned to control and experimental group .The sampling criteria were followed in selection of the sample. The sample size was 60.

 

 

RESULTS:

Table 1. Demographic variables of subjects in terms of frequency and percentage. N= 60

Demographic variables

Experimental Group (30)

Control Group (30)

Total (60)

Frequency

Frequency

Frequency

%

Age in years

20

3 (10%)

7(23.33%)

10

16.67%

21

15(50%)

15(50%)

30

50%

22

11(36.67%)

6(20%)

17

28.33%

23

1(3.33%)

2(6.67%)

3

5.00%

 

SEX

MALE

4(13.33%)

4(13.33%)

8

13.33%

FEMALE

26(86.67%)

26(86.67%)

52

86.67%

 

 

TABLE 2: Mean, mean difference, standard deviation, standard error of mean difference and “t” value of post-test knowledge score of control and experimental group.  N=60

Groups

Post-Test

 Mean score

MD

SDD

SE MD

“t” value

Control

22.3

12.07

1.67

1.09

11.07*

Experimental

34.37

df58                     significant at both level t 58 ==2.00 at p<0.05

 

TABLE 3: Mean, mean difference, standard deviation of difference, SDMD and “t” value of posttest ability score of control and experimental group.    N=60

Groups

Mean

MD

SDD

SE MD

“t” value

Control

2.4

 

10.3

 

3.22

 

1.08

 

9.54*

Experimental

12.7

 df58  significant at both level (t 58 ==2.00 at p<0.05) (t58 ==2.66 at p<0.01)

 

DISCUSSION:

Arrhythmias are abnormal heart rhythms due to problems in heart anatomically or pathologically heart conduction which causes a decreased cardiac output, a variation in heart rate thus affecting tissue perfusion6. The present study revealed that half of the subjects were 21 years of age and majority of the subjects (86.66) were female. The mean post test knowledge score of experimental group (34.37) was higher than mean posttest knowledge score of control group (22.3) and “t” value was 11.07 was more than table value. The mean post test ability score of experimental group (12.7) was higher than mean post-test ability score of control group (2.4) with a mean difference of 10.3. The “t” value of 9.54 for df 58 was found to be Statistically significant at 0.05 and 0.01 level. The mean post-test knowledge scores and ability scores were significantly higher than mean pretest knowledge scores and ability scores of experimental group, indicating that the PTP was effective in increasing the knowledge and ability of the students regarding interpretation and management of lethal arrhythmias. Melita Sheilini and Elsa SD communicated that student nurses have poor knowledge regarding ECG monitoring and interpretation. The present study also revealed that student nurses have poor knowledge and ability regarding lethal arrhythmia8. Keller & Raines have found that student nurses have a poor level of knowledge when interpreting complete heart block and about how to provide care for arrhythmia patients. Similar results have been reported from the present study7. The findings of the studies conducted by Henderson, M.C. and Vishakantamurthy et al revealed that nursing personnel lack practical knowledge about management of dysrrhythmias and a formal training programme will enhance their knowledge regarding management and interpretation of dysrrhythmias; the findings are supporting the present study9,10. Shatughan Pareek et al revealed that structure teaching program was effective strategy in upgrading the knowledge, the present study also communicated that PTP was effective in enhancing the knowledge11.

 

CONCLUSION:

The study revealed that there was a poor knowledge regarding interpretation and management of lethal arrhythmias among nursing students. Knowledge regarding arrhythmias is important for the nurses. The PTP was effective in enhancing the knowledge of nursing students regarding interpretation and management of lethal arrhythmias. Deficit in ability to interpret and to manage the lethal arrhythmias among nursing students was varying. The PTP was effective in improving the ability of nursing students regarding interpretation and management of lethal arrhythmias.

 

 

REFERENCES:

1.       Nancy. A reference manual for nurses on coronary care nursing.,2nd ed. Devai; Kumar publishing house; 2002.P.18-22.

2.       www.wikipedia/ lethal arrhythmia

3.       Kleimann CS, Nehgme RA. Cardiac arrhythmias in human fetus. Pediator Cardia 2004 May-Jun, 25(3); 234-51.

4.       Bennett FT,Bennett KR,Markov AK. Einthoven's triangle: lead errors and an algorithm for solution. Am J Med Sci. 2005; 329(2):71-7.

5.       Docherty B, Douglas M. Cardiac care: 3. ECG interpretation--ventricular arrhythmias. Prof Nurse. 2003 ;18(8):459-61.

6.       Diehl, T.S. (2011) ECG Interpretation Made Incredibly Easy. Philadelphia, Chris Burghardt.

7.       Keller, K.B. & Raines, D.A. Arrhythmia knowledge: a qualitative study. Heart Lung .2005;34: 309-316.

8.       Melita Sheilini, Elsa SD. Effectiveness of Educational Intervention on ECG Monitoring and Interpretation among Nursing Students. IOSR Journal of Dental and Medical Sciences. 2014;13(12):1-5

9.       Henderson MC, Lamb MJ. Comparison of two methods for teaching advanced arrhythmias to nurses. J Continuing Edu Nur. 1993; 24(5):221-226.

10.     Vishakantamurthy, Muruli Mohan, Manasa M. Effectiveness of Self Instructional Module on Knowledge Regarding Dysrhythmias and its Management among Staff Nurses at selected Government Hospitals, Mysore. Int. J. Adv. Nur. Management .2014; 2(4): 244-247

11.     Pareek Shatrughan, Mehta Santosh, Goyal Harindarjeet. A structured teaching programme to assess the knowledge and practices of cancer patients regarding Radiotherapy induced skin reactions: A Quasi Experimental study. Int. J. Nur. Edu. and Research. 2017; 5(2): 198-202.

 

 

 

 

 

 

 

Received on 09.10.2018       Modified on 08.11.2018

Accepted on 20.11.2018       ©A&V Publications All right reserved

Int.  J. of Advances in Nur. Management. 2018; 6(4): 277-279.

DOI: 10.5958/2454-2652.2018.00062.8