INTRODUCTION:

BACKGROUND OF THE STUDIES:

It is estimated that deaths from hypertension in India would register a sharp increase from over 4 million until late in 1990’s and exceed 7 million by the year 2015 in percentage terms, the increase accounts for over 60%¹

According to cardiologist at the Duke University Medical Center, situations are graver in India being the country with the highest number of people suffering from it. Presently 30% of the country’s urban population and 10% of the rural population is affected by it. Hypertension accounts directly for 57% of the deaths caused by strokes and 24% of those caused by heart attack in the country²

Approximately 65 million people in the United States are affected by hypertension (HTN).¹ Substantial improvements have been made with regards to improving awareness and treatment of hypertension. However, approximately 22% of adults are still unaware of their hypertension; up to 32% of people with hypertension are not receiving treatment; and, of those treated, up to 36% do not have their blood pressure (BP) controlled to less than 140/90mm Hg. With the advent of antihypertensives, the incidence of hypertensive emergencies has declined from 7% to approximately 1% of patients with hypertension.⁵ In addition, the 1-year survival rate associated with this condition has increased from only 20% to a survival rate of more than 90% with appropriate medical treatment.³

NEED FOR THE STUDY:

A diastolic arterial pressure above 120-130mmHg is called hypertensive crisis, and is classified for its therapeutic management in: Hypertensive emergency that causes damage to target organs, i.e., brain, heart, and kidney, which require an immediate decrease in arterial pressure through the use of intra-venous applied medication, although not necessarily down to normal values, and Hypertensive urgency, in which no acute damage is evidenced and treatment is focused on diminishing pressure values within the first 24 hours using oral or sublingual medication. Both conditions require strict surveillance and nursing care starting with the correct procedure to determine blood pressure.⁴

STATEMENT OF THE PROBLEM:

“A study to assess the effectiveness of structured teaching programme on knowledge of internship student nurses regarding hypertensive crisis and its management in selected hospital of Raichur”.

OBJECTIVES OF THE STUDY:

1. To assess the knowledge regarding hypertensive crisis and its management among internship student nurses.

2. To prepare and intervene the structured teaching programme regarding hypertensive crisis and its management among internship student nurses.

3. To evaluate the effectiveness of structured teaching programme regarding hypertensive crisis and its management among internship student nurses.

4. To find out the association between knowledge scores of the internship student nurses regarding hypertensive crisis and its management with the selected socio-demographic variables.

SELECTED VARIABLES:

Dependent Variables:

Knowledge of the internship student nurses regarding hypertensive crisis.

Independent Variables:

Structured teaching programme on hypertensive crisis and its management.

Hypothesis:

H₁:There will be a significant difference between pretest and post-test knowledge scores of hypertensive crisis and its management on internship student nurses.

H₂: There will be a significant association between the knowledge of the internship student nurses regarding hypertensive crisis and its management with the selected socio-demographic variables

METHODOLOGY:

Research Approach:

Research approach is the most significant part of any research. The appropriate choice of the research approach depends upon the purpose of the research study which was undertaken.⁹

An evaluative research was considered as the appropriate approach to evaluate the effectiveness of structured teaching programme on knowledge of internship student nurses regarding hypertensive crisis and its management.

Research Design:

The selection of research design is an important and essential step in research as it is concerned with the overall frame work of conducting the study by giving a plan, structure and strategy of investigation⁹.

After considering the entire factors related to the selected programme, the Investigator has selected one group pre test, post test pre experimental design for testing the effectiveness of structured teaching programme on knowledge of internship student nurses regarding hypertensive crisis and its management.

O_{1 X} O2

O₁_-(Pre test) Assessment of knowledge of internship student nurses regarding hypertensive crisis and its management.

X - (Treatment) Structured teaching programme on hypertensive crisis and its management to the internship student nurses

O₂- (Post test) Assessment of knowledge on internship student nurses regarding hypertensive crisis and its management.

Setting of The Study:

Setting refers to the physical location and conditions in which data collection has been taken place¹⁰

Raichur is one of the North Karnataka districts, it as an area of 60sqmt and located in Kalayan Karnataka, In Raichur there are number of hospitals functioning. Among them, Navodaya Medical College Hospital and Research Center, Raichur is selected for the study. It is a 740 bedded Hospital, having 240 staff nurses, it is situated in northern part of Raichur surrounded by AME’S Dentalcollege to east, Polytechnic College to west, and Hillocks in the north and RTO Office in the south

Population:

A population is a group whose members possess specific attributes that a researcher is interested in studing.⁴⁹

The target population is a group of population that the researcher has to study and to whom the study findings will be generalized. Accessible population is the group of population that the researcher finds easily.The population includes in the study are those who are doing internship in Navodaya Medical College Hospital and Research Center, The total strength comprises of 49 internship student nurses.

Criteria for Selection of Sample:

Inclusive Criteria

The study includes internship student nurses of Navodaya College of Nursing who were

· Doing internship at Navodaya Medical College Hospital and Research Center

· Willing to participate in the study

· Available at the time of data collection

Exclusion Criteria:

The study excludes the internship student nurses who were not:

· Doing internship at Navodaya Medical College Hospital and Research Center

· Willing to participate in the study

· Available at the time of data collection

Sample Size:

Sample size is the number of items to be selected from the universe to constitute a sample.⁴⁹

Sample size for the study consists of 40 internship student nurses of NavodayaMedicalCollegeHospital and ResearchCenter.

RESULTS:

The data themselves do not provide us with answers to our research questions, ordinarily. The amount of data collected in a study is too extensive to be reliable described by mere perusal. In order to meaningfully answer the research questions, the data must be processed and analyzed systematically⁵³

OBJECTIVES OF THE STUDY:

1. To assess the knowledge regarding hypertensive crisis and its management among internship student nurses

2. To prepare and intervene the structured teaching programme regarding hypertensive crisis and its management among internship student nurses.

3. To evaluate the effectiveness of structured teaching programme regarding hypertensive crisis and its management among internship student nurses.

4. To find out the association between knowledge scores of the internship student nurses regarding hypertensive crisis and its management with the selected socio-demographic variables.

The analysis and interpretation of data is presented under the following sections.

Section I: Frequency and Percentage distribution of internship student nurses based on their Demographic Characteristics.

Section II Knowledge of internship student nurses.

1. Level of knowledge of internship student nurses regarding hypertensive crisis and its management.

2. Frequency and Percentage distribution of level of Knowledge of internship student nurses in pre-test and post-test regarding hypertensive crisis and its management.

3. Mean and Standard Deviation of pre-test and post-test knowledge scores of internship student nurses related to hypertensive crisis and its management.

Section III Comparison of pre-test and post-test scores for assessing the effectiveness of structured teaching programme on knowledge regarding hypertensive crisis and its management by using paired‘t’ test.

Section IV Association between the post-test knowledge scores of internship student nurses on hypertensive crisis and its management with their demographic variables by using “Chi-square”

Section – I:

This section deals with the frequency and percentage distribution of selected demographic characteristics of internship student nurses. The demographic characteristics included in the present study were: age, gender, religion, general education and clinical experience in ICU.

Table 1: Frequency and percentage distribution of Internship student nurses according to their age N=40

Sl. No	Age	Frequency (f)	Percentage (%)
a.	20-21 years	34	85.00
b.	22-23 years	5	12.50
c.	24 years and above	1	2.50

The data on age in Table-1 reveals that majority (34 i.e. 85.00%) of the internship student nurses were from the age group of 20-21 years followed by 12.50 per cent of internship student nurses from age group 22-23 years, one internship student nurse (2.50%) was from 24 years and above.

Table 2 Percentage distribution of internship student nurses by their gender N=40

Sl. No	Gender	Frequency	%
a.	Male	13	32.50
b.	Female	27	67.50

Table 2 shows the percentage distribution of internship student nurses, Majority of the internship student nurses (27 i.e. 67.50%) are females and 13 (32.50%) are males.

Table 3: Percentage distribution of internship student nurses by their religion. N=40

Sl. No	Religion	Frequency	%
a.	Hindu	16	40.00
b.	Muslim	1	2.50
c.	Christian	23	57.50

As far as religion is concerned, the table-3 demonstrates that 23 (57.5%) of the internship student nurses were Christians, followed by 16 (40.00%) Hindus and one Muslim (2.50%)

Table 4: Percentage distribution of internship student nurses by their General Education. N=40

Sl. No	General Education	Frequency	%
a)	PUC	38	95.00
b)	PUC+VN	0	0
c)	Degree	2	5.00
d)	Others	0	0

Table-4 represents that 38 internship student nurses (95.00%) completed their PUC, 2 internship student nurses (5.00%) had degree and no internship student nurses had completed vocational nursing in PUC and none were with any other formal education.

Table 5: Percentage distribution of internship student nurses by their Clinical Experience in ICU N=40

Sl. No	Clinical experience in ICU	Frequency	%
a.	a) 3 weeks	14	35.00
b.	b) 4 weeks	13	32.50
c.	c) 5 weeks	11	27.50
d.	d) 6 weeks	2	5.00

From the table-5 it is clear that majority (14 i.e. 35.00%) had 3 weeks experience in ICU, 13 internship student nurses (32.50%) had 4 weeks experience, 11(27.50%) had 5 weeks of experience and 2 internship student nurses (5.00%) had 6 weeks of experience.

Section – II:

This section deals with knowledge of Internship student nurses regarding hypertensive crisis and its management in selected hospital of Raichur. It is sub divided into,

a. Level of knowledge of Internship student nurses regarding hypertensive crisis and its management.

b. Frequency and percentage distribution of level of knowledge of Internship student nurses in pre test and post test regarding hypertensive crisis and its management.

c. Mean and Standard Deviation of pre test and post test knowledge scores of Internship student nurses regarding hypertensive crisis and its management.

Table 6: Level of knowledge of Internship student nurses on Hypertensive crisis and its management N=40

Sl. No	Level of Knowledge	Percentage	Range of score
a.	Low	0 to 50	0-20
b.	Average	51 to 75	21-30
c.	High	Above 75	31-41

Table-6 reveals the knowledge of sample on hypertensive crisis and its management. The knowledge of sample was assessed by using a structured self administered questionnaire with 41 items on hypertensive crisis and its management. The score was 41. The Internship student nurses who scored between 0-20 were considered to have low knowledge; the subjects with score between 21-30 were considered to have average knowledge and who scored 31-41 were considered to have high knowledge about hypertensive crisis and its management

Table 7: Frequency and Percentage Distribution of Level of Knowledge of Internship student nurses in Pre Test and Post Test Regarding Hypertensive crisis and its management. N = 40

Level of knowledge

Pre test

Post test

Frequency

High

knowledge

Average knowledge

Low

knowledge

100

Table - 7 represents the overall knowledge levels of Internship student nurses on hypertensive crisis and its management. In pre test surprisingly there were no single respondent with high knowledge and average knowledge. 40 respondents (100%) had low knowledge.

The scores of the post test indicated an increase in knowledge levels of the Internship student nurses, i.e. 18 participants (45.00%) had high knowledge followed by 22 respondents (55.00%) with average knowledge. Obviously, with full confidence the researcher observed an interesting change in post test, i.e. no single respondent with low knowledge.

Table – 8: Frequency and Percentage distribution of level of knowledge scores of internship student nurses in specific areas regarding Hypertensive crisis and its management in selected hospital of Raichur N= 40

Knowledge In specific areas of hypertensive crisis	Pre test						Post test
	Low < 50 %		Average 51– 75%		High > 75%		Low < 50 %		Average 51 – 75%			High > 75%
	F	%	F	%	F	%	F	%	F		%	F	%
Concept	38	95.00	2	5.00	-	-	-	-		11	27.50	29	72.50
Management	40	100	-	-	-	-	-	-		22	55.00	18	45.00
Prevention	40	100	-	-	-	-	3	7.50		21	52.50	16	40.00

Table - 8 illustrates the frequency and percentage distribution of knowledge levels of Internship student nurses in specific areas regarding hypertensive crisis and its management in selected hospital of Raichur in pre test and post test. The specific areas included were: concept, management and prevention.

In pre test, it was observed that 2(5.00%) respondents had average knowledge related to concept of hypertensive crisis, followed by low knowledge (38 i.e. 95.00%) and no respondent had high knowledge. In post test, 29 participants (72.50%) had high knowledge, 11 (45.00%) participants had average knowledge and not even a single respondent had low knowledge.

Related to management of hypertensive crisis, pre test revealed that 40 respondents (100%) had low knowledge and not even single respondent had average and high knowledge. In post test, 18 (i.e.45.00%) participants had high knowledge, 22 respondents (55.00%) had average knowledge and no participant had low knowledge.

Regarding to prevention of hypertensive crisis, in pre test, 40 respondents (i.e. 100%) had low knowledge and no participants had average knowledge and high knowledge. In post test, 16(40.00%) participants had high knowledge followed by 21 respondents (52.50%) with average knowledge and 3 participants (7.50%) low knowledge.

The findings with regard to knowledge in specific areas of hypertensive crisis and its management proved that the structured teaching programme was effective

Table – 9: Mean and Standard Deviation of pre test and post test knowledge scores of Internship student nurses regarding Hypertensive crisis and its management in selected hospital of Raichur N = 40

Specific areas	Pre test		Post test
Specific areas	Mean	Standard deviation	Mean	Standard deviation
Overall Knowledge scores	12.58	2.45	30.43	2.64
Concept	3.10	0.87	6.90	0.74
Management	7.90	1.19	17.33	1.75
Prevention	1.58	1.24	6.23	1.10

Table – 9 represents the Mean and Standard Deviation of pre test and post test knowledge scores of internship student nurses regarding hypertensive crisis and its management in selected hospital of Raichur. It clearly describes that the Mean score in pre test was increased from 12.58±2.45 to 30.43±2.64 in post test. This depicts that structured teaching programme on knowledge was effective in improving the overall knowledge of internship student nurses regarding hypertensive crisis and its management in selected hospital of Raichur.

The mean score of sample regarding to concept of hypertensive crisis and its prevention was increased from 3.10±0.87 to 6.90±0.74. Related to management in pre test it was 7.90±1.19 were it increased to 17.33±1.75 in post test. And in prevention of hypertensive crisis it increased from 1.58±1.24 to 6.23±1.10.

On the whole, post test mean scores were higher than pre test mean scores in all the specific areas of hypertensive crisis and its management in selected hospital of Raichur.

Section – III:

This section deals with the comparison of pre test and post test knowledge scores for assessing the effectiveness of structured teaching programme on knowledge regarding hypertensive crisis and its management by using paired ‘t’ test.

Table – 10: Comparison of knowledge scores of Internship student nurses before and after structured teaching programme on knowledge regarding hypertensive crisis and its management in selected hospital of Raichur. N= 40

Specific areas of hypertensive crisis and its management in selected hospital of Raichur	Mean difference	Standard error of mean difference	Paired ‘t’ test
Over all knowledge.	17.85	0.590	30.25
Concept	3.80	0.180	21.14
Management	9.43	0.354	26.60
Prevention	4.65	0.281	16.55

(Table value of‘t’ for 39 df at 0.05 level of significance is 2.0227)

Table – 10 summarizes the comparison of pre test and post test knowledge scores of Internship student nurses on hypertensive crisis and its management in selected hospital of Raichur.The mean difference in scores related to concept was 3.80(SE D=0.180) with paired ‘t’ value 21.14. Regarding management the Mean difference was 9.43(SE D=0.354) with paired ‘t’value 26.60. The Mean difference score for prevention was 4.65 (SE D=0.281) with paired ‘t’ value 16.55.

The overall Mean difference was 17.85(SE D=0.590) with paired ‘t’ value of 30.25. Thus, it was revealed that the post test mean score was significantly higher than the pre test mean score. The table value of paired ‘t’ test at 39 degrees of freedom and at 0.05 level of significance was 2.0227. Since the calculated value was higher than the table value, the research hypothesis H₁ was accepted. Hence, there was a significant difference between the pre test and post test knowledge scores of the internship student nurses on hypertensive crisis and its management in selected hospital of Raichur.

Section – IV:

This section includes the association between post test knowledge score of internship student nurses on hypertensive crisis and its management with their Demographic variables by using “Chi-square”.

Table 11 reveals the association between age of the internship student nurses with their post test knowledge scores. 19(55.8%) internship student nurses were in the age group of 20-21 years who had average knowledge and 15(44.2%) respondents had high knowledge. 2 (40%) internship student nurses were in the age group of 22-23 years had average knowledge and 3(60%) had high knowledge, followed by 1(100%) internship student nurses in the age group of 24 years and above had average knowledge and no respondent had high knowledge.

Chi square test was done to find out the association between age of internship student nurses with their post test knowledge score. The calculated χ2 value was 0.146. The table value of χ2 at 5% level of significance with 1 d.f was 3.84.The calculated value of χ2was less than the table value.

Table 12: Association between gender of internship student nurses with post test knowledge score N = 40

Gender	Low knowledge		Average knowledge		High knowledge		Total
Gender	F	%	F	%	F	%	Total
Male	0	0	5	41.6	7	58.4	12
Female	0	0	17	60.7	11	39.3	28

(χ2 = 0, df = 1, p>0.05, Not significant)

Table 12 shows the association between gender of internship student nurses with their post test knowledge scores, 28 were female internship student nurses, among them 17(60.7%) had average knowledge, followed by 11 (39.3%) who had high knowledge. 12 were male internship student nurses, among them 5(41.6%) had average knowledge and 7(58.4%) had high knowledge.

Chi square test was calculated to find out the association between gender of internship student nurses with their post test knowledge scores on hypertensive crisis and its management. The calculated χ2 value 0. The table value of χ2 at 5% level of significance with 1 d.f was 3.84.

Table 13: Association between Religion of Internship student nurses with their post test knowledge score N = 40

Religion	Low knowledge		Average knowledge		High knowledge		Total
Religion	F	%	F	%	F	%	Total
Hindu	0	0	9	56.25	7	43.75	16
Muslim	0	0	0	0	1	100	1
Christian	0	0	13	56.5	10	43.5	23

(χ2 = 1.387, df =1, p>0.05, Not Significant)

Table 13 reveals the association between religions of internship student nurses with their post test knowledge score. 16 internship student nurses belonged to Hindu religion, among them 9(56.25%) had average knowledge, 7(43.75%) had high knowledge. one internship student nurse was Muslim i.e. (100%) with high knowledge. 23 internship student nurses were Christians, among them 13(56.5%) had average knowledge followed by 10(43.5%) with high knowledge.

Chi square test was done to find out the association between religion of internship student nurses with their post test knowledge score on hypertensive crisis and its management. The calculated χ2 value 1.387. The table value of χ2 at 5% level of significance with 1 d.f was 3.84.

Table 14: Association between general educational status of internship student nurses with their post Test knowledge score N=40

Educational Status	Low knowledge		Average knowledge		High knowledge		Total
Educational Status	F	%	F	%	F	%	Total
PUC	0	0	20	52.6	18	47.4	38
PUC+VN	0	0	0	0	0	0	0
Degree	0	0	2	100	0	0	2
Others	0	0	0	0	0	0	0

(χ2 =0, df =1, p<0.05, Significant)

Table 14 reveals the association between educational status of the internship student nurses with their post test knowledge score. 38 internship student nurses had completed their PUC, among them 20(52.6%) had average knowledge and 18(47.4%) had high knowledge. 2 internship student nurses completed their degree and had average knowledge. No participant was with vocational nursing and other formal education

Chi square test was done to find out the association between educational status of internship student nurses with their post test knowledge score. The calculated χ2 value was 0. The table value of χ2 at 5% level of significance with 1 d.f was 3.84.

Table 15: Association between clinical experience in ICU of Internship student nurses with their post test knowledge score

N= 40

Clinical Experience in ICU	Low knowledge		Average knowledge		High knowledge		Total
Clinical Experience in ICU	F	%	F	%	F	%	Total
3 weeks	0	0	9	64.3	5	35.7	14
4 weeks	0	0	7	53.8	6	46.2	13
5 weeks	0	0	6	54.5	5	45.5	11
6weeks	0	0	0	0	2	100	2

(χ2 = 4.018, df = 1, p > 0.05, Significant)

Table 15 shows the association between the clinical experiences in ICU of internship student nurses with their post test knowledge score. 14 internship student nurses were having 3 weeks clinical experience in ICU, among them 9(64.3%) had average knowledge and 5 (35.7%) had high knowledge. 13 were having 4 weeks clinical experience in ICU, among them 7(53.8%) had average knowledge followed by 6(46.2%) who had high knowledge. 11 internship student nurses were having 5 weeks clinical experience in ICU, among them 6 (54.5%) had average knowledge followed by 5(45.5%) with high knowledge. 2 internship student nurses were having 6 weeks clinical experience in ICU and had high knowledge i.e. (100%).

Chi square test was computed to find out the association between total work experiences of internship student nurses with their post test knowledge score on hypertensive crisis and its management in selected hospital in Raichur. The calculated χ2 value 4.018. The table value of χ2 at 5% level of significance with 1 d.f was 3.84. Since the calculated value of χ2 was more than the table value, the researcher has not failed to support the research hypothesis.

CONCLUSION:

The following conclusions were drawn on the basis of findings of the present study

In pretest, among 40 internship student nurses, surprisingly there was not even single respondent with high knowledge and average knowledge, 40 respondents (100%) had low knowledge. Where as after implementation of programme. The scores of the Post test indicated increase in knowledge levels of the Internship student nurses i.e. 18 participants (45.00%) had high knowledge followed by 22 respondents (55.00%) with Average knowledge.

Paired ‘t’ test value was 2.0227. This showed that the structured teaching programme on hypertensive crisis and its management among internship student nurses was effective in enhancing the knowledge on hypertensive crisis and its management among the internship student nurses.

Significant relationship was found between the post test knowledge score of internship student nurses on hypertensive crisis and its management with Experience in ICU.

Significant relationship was not observed between the post test knowledge score on hypertensive crisis and its management with the variables like age, gender, religion and general education.

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Received on 22.04.2022 Modified on 12.05.2022

Int. J. of Advances in Nur. Management. 2022; 10(4):363-369.

DOI: 10.52711/2454-2652.2022.00080

Age in years	Low knowledge		Average knowledge		High knowledge		Total
Age in years	F	%	F	%	F	%	Total
20-21 years	0	0	19	55.8	15	44.2	34
22-23 years	0	0	2	40	3	60	5
24 years and above	0	0	1	100	0	0	1