Effectiveness of Structured Teaching Program on Knowledge and Practice of staff nurses regarding care of unconscious patients in a selected hospital, Alappuzha District, Kerala
*Corresponding Author E-mail: nishasnair9021984@gmail.com
ABSTRACT:
Introduction: The primary goal of caring for an unconscious client is to maintain a patent airway and to promote recovery and prevent complications. It is considered as one the most important aspects of critical care nurses. Purpose: The purpose of the study was to assess the knowledge and practice of staff nurse regarding care of unconscious clients in a selected hospital in Alappuzha district. Methods: The research approach used for this study was quantitative research approach and the design used was Quasi experimental research design. Convenient sampling technique was used for the study. The study sample consisted of 40 staff nurses. The tool consisted of a structured knowledge questionnaire and a self-reported practice checklist to assess the practice of staff nurses. Results: The data obtained were organized and analyzed using both descriptive and inferential statistics according to objectives and hypothesis of the study. The findings of the study revealed that 40% of the nurses had good knowledge and 15% had poor knowledge in pre test whereas 65% of the nurses attained good knowledge and 7.5% only have poor knowledge in post test. In practice scores, 37.5% of nurses doing adequate practice and 7.5% had poor practice when doing pre test whereas in post-test, 77.5% doing adequate practice and none of them were with poor practice. And also showed that there was no association between the selected demographic variables with the knowledge and practice score. Conclusion: The study findings conclude that despite the increase in number of nurses, the quality was deteriorating. Hence the development of skills and improving knowledge of nurses through structured teaching program is justified by this study to improve the quality of care to unconscious clients.
KEYWORDS: Effectiveness, Knowledge, Practice, Staff nurses, Unconsciousness.
INTRODUCTION:
Nursing is a noble profession, it involves encounter with a patient and his attendant during which a nurse observes, supports, communicates, ministers, teaches and provides care during illness with an aim of assisting in achieving patient optimal health.
The World Health Organization [WHO] estimates that 5 million deaths occur every year in Intensive Care Units (ICUs). In India, every year approximately 3.2 million ICU admissions are occurring in which 80% of patients are in coma stage and in that 48,000 deaths are occurring. In South India, the overall ICU admission is 56.6%. Globally, about 20 million people are admitted in the ICUs due to various causes1.
The patient’s state of consciousness is defined by both the behavior and the pattern of brain activity recorded by an EEG. In the deepest state of unconsciousness, the patient does not respond to painful stimuli, also corneal and papillary reflexes are absent. The patient cannot swallow or cough and is incontinent to urine and feces1. Nursing the unconscious patient can be a challenging experience. Unconscious patients have no control over themselves or their environment and thus are highly dependent on the nurses. The skills required to care for unconscious patients are not specific to critical care and theatres only as unconscious patients are nursed in a variety of clinical settings. Nursing such patients can be a source of anxiety for nurses. However, with a good knowledge base to initiate the assessment, planning and implementation of quality nursing care, nursing patients who are unconscious can prove highly rewarding, and the skills thus acquired can promote confidence in the care of all other patients as well2.
NEED AND SIGNIFICANCE OF THE STUDY:
It is often seen that the number of nurses trained is increasing but the quality of nursing care is deteriorating. Clinical experience is becoming a rare commodity. Hence, the development of nursing skills is difficult and therefore the new nurses with only knowledge and inadequate practice are not able to give effective care. Unconsciousness can be brief lasting a few minutes or sustained lasting for hours or longer and the patient have more chances of complications like airway obstruction, aspiration and respiratory tract infections which can lead to the common causes of death in unconscious patients. These patients have potential for injury, pressure sore and fluid volume deficit; alteration in bowel and bladder elimination leads to urinary incontinence and constipation. Important nursing care of an unconscious patient includes assessment, immediate management, airway, skin integrity, mouth care, bowel and bladder elimination, back care and psychological support3. A longitudinal study was conducted among 169 unconscious patients in neurology intensive care unit (NICU) in the setting of a developing country in the sub-Saharan Africa to study the morbidity, mortality and survival of unconscious patients in the NICU. The duration of the study was 15 months. Standard biological analysis was prescribed for each patient and survival was determined by Kaplan Meier method. The mean age of the patients was 58.04+/-17.55years with a sex ratio of 0.92. The mean time from installation of disorders and initial consultation was (8.88%). The mean duration of hospitalization was 8.89+/-9.53 days associated with mortality rate of 82.25% for a same period. Survival at day 90 was 10.65%. Mortality was related to infectious conditions (28.4%), renal failure (14.78%), cardiovascular failure (13.16%), cerebral engagement (12.43%), multi-visceral failure (11.24%), pulmonary embolism (1.18%) and unknown causes (18.34%) The study concluded that unconsciousness is associated with a high mortality rate in the context and suggests that early consultation, a good control of vascular risk factors and better management of infectious conditions should reduce this impact1. All these affect their attitude towards nursing and patient care. Inadequate physical structure for education and lack of clinical experience lead to producing incompetent future staff nurses. Nursing the unconscious patient can be a challenging experience. Unconscious patients have no control over themselves or their environment and thus are highly dependent on the nurse. The skills required to care for unconscious patients are not specific to critical care or theatres as unconscious patients are nursed in a variety of clinical settings. Nursing such patients can be a source of anxiety for nurses. However, with a good knowledge base to initiate the assessment, planning and implementation of quality care, nursing patients who are unconscious can prove highly rewarding, and the skills acquired can promote confidence in the care of all patients4.
OBJECTIVES:
1. To assess the knowledge and practice of staff nurses working in a selected Hospital of Alappuzha district regarding care of unconscious patients.
2. To evaluate the effectiveness of structured teaching program on knowledge and practice of staff nurses working in a selected hospital in Alappuzha district
3. To determine the association between pre-test knowledge and practice score with selected demographic variables.
HYPOTHESIS:
H1: There will be significant difference between the pre-test and post-test knowledge and practice score of the study subjects.
H2: There will be positive association between the knowledge and practice score with selected demographic variables.
MATERIALS AND METHODS:
Quantitative research approach was used in this study. The design selected was one group pre-test and post-test design in quasi experimental research design. The study was conducted in St. Thomas Mission Hospital, Kattanam, Alappuzha, Kerala, India. The study population consisted of 40 registered staff nurses working in this hospital. Convenient sampling technique was used.
Data was collected using 3 tools.
Tool 1-(a) Demographic data:
A questionnaire schedule on socio-demographic Performa which comprised of 7 items.
Tool 1-(b) General information:
A questionnaire schedule on general information regarding the professional exposure.
Tool 2- Questionnaire to assess the knowledge:
Structured self-administered knowledge questionnaire on care of the unconscious patient. It consists of 31 questions covering the different aspects of unconsciousness.
Tool 3-A checklist to assess the practice:
A checklist to assess the practice of staff nurses consisting of 15 statements.
|
Demographic Data |
Variable |
Frequency |
% |
|
Age |
21-26 |
12 |
30 |
|
27-32 |
17 |
42.5 |
|
|
33-38 |
6 |
15 |
|
|
39-44 |
5 |
12.5 |
|
|
Gender |
Male |
1 |
2.5 |
|
Female |
39 |
97.5 |
|
|
Professional Qualification |
GNM |
20 |
50 |
|
B.Sc. |
20 |
50 |
|
|
Work experience |
0-1 yr |
8 |
20 |
|
2-3 yr |
10 |
25 |
|
|
4-5 yr |
4 |
10 |
|
|
>5 yr |
18 |
45 |
|
|
Marital status |
Married |
35 |
87.5 |
|
Single |
5 |
12.5 |
|
|
Area of residence |
Urban |
18 |
45 |
|
Rural |
22 |
55 |
|
|
Area of training |
Private sector |
40 |
100 |
The above table shows that among the study sample, 30% of the nurses belonged to the age group of 21-26 years, 42.5% to 27-32 years, 15% to 33-38% years and 12% to 39-44 years. It is clear 97.5% were females.
From the table, it is also clear that 50% of nurses are GNM and 50% area B.Sc. Nurses.
It reveals that 20% of the samples had a clinical experience below 1 year, 25% of them with 2-3 years, 10% with 4-5 years and 45% were above 5 years of experience.
Of these samples, 87.5% were married and 12.5% were single. It can be seen that all the 40 samples were trained under private institutions.
Figure 1: Comparison of pre-test and post test knowledge score
The above table shows that no sample had good knowledge in the pretest which has changed to 65% after the teaching session. 17% of the samples had average knowledge which changed to 27.5% and 57.5% of the sample had poor knowledge was changed to 7.5%.
Figure 2: Comparison of pre-test and post test practice score
From the above table it is evident that the pretest practice score of 37.5% of was changed to 77.5% after the teaching session and 55% of moderate level was changed to 22.5% as well as 7.5% of the poor practice which became 0 % after the intervention.
Table 2: Comparison of pre-test and posttest knowledge on selected questions:
|
Sl. No. |
Statements |
Pre test (%) |
Post test (%) |
||
|
|
|
R |
W |
R |
W |
|
1 |
Unconsciousness is the lack of awareness of one's environment. |
90 |
10 |
100 |
0 |
|
2 |
The Glass-gow coma is scale used for assessing the neurological function of unconscious client. |
97.5 |
2.5 |
100 |
0 |
|
3 |
The prioritized nursing care of an unconscious patient. |
32.5 |
67.5 |
82.5 |
17.5 |
|
4 |
The measure taken to prevent the risk of aspiration in unconscious patient. |
55 |
45 |
77.5 |
22.5 |
|
5 |
The preferred position for unconscious patient. |
12.5 |
87.5 |
50 |
50 |
|
6 |
The frequency of changing position. |
10 |
90 |
72.5 |
27.5 |
|
7 |
The measure to prevent corneal ulceration in unconscious patient. |
65 |
35 |
90 |
10 |
|
8 |
The recommended number of ROM exercise in unconscious patient. |
35 |
65 |
67.5 |
32.5 |
|
9 |
A measure to prevention of foot drops in unconscious patient. |
32.5 |
67.5 |
80 |
20 |
|
10 |
A complication of prolonged immobility. |
50 |
50 |
85 |
15 |
The above table shows a remarkable improvement in the knowledge score on selected questions.
Table 3: Chi square test showing association of pretest knowledge score with selected demographic data
|
Demographic variable |
Pretest knowledge |
Df |
χ2 |
Inference |
||
|
Age |
21-26 27-32 33-38 39- 44 >45 |
2 3 1 1 0 |
10 14 4 4 1 |
4 |
0.265 |
Not significant |
|
Gender |
Male Female |
0 17 |
1 22 |
1 |
0.7621 |
Not significant |
|
Professional qualification |
GNM B.Sc |
4 5 |
16 15 |
1 |
0.132 |
Not significant |
|
Working experience |
0-1 year 2-3 year 4-5 year >5 year |
1 3 1 4 |
9 7 3 12 |
3 |
1.27
|
Not significant |
|
Marietal status |
Married Single |
8 1 |
27 4 |
1 |
0.017 |
Not significant |
|
Area of residence |
Urban Rural |
3 6 |
17 14 |
1 |
`1.28 |
Not significant |
|
Area of training |
Govt. Pvt. |
0 9 |
0 31 |
0 |
0 |
Not significant |
|
Working exposure to different department |
Critical care Ward All area Other area |
4 2 3 0 |
7 11 11 2 |
3 |
11.36 |
Significant |
|
Exposure to educational area |
CNE Inservice Conference None |
3 4 2 0 |
9 10 4 8 |
3 |
3.05 |
Not significant |
Table 4: Chi square test for association of pre test practice score with selected demographic variables
|
Demographic variables |
Pre test practice |
df |
χ2 calculated value |
Inference |
|||
|
Adequate |
Moderate |
Poor |
|||||
|
Age |
21-26 27-32 33-38 39-44 >44 |
3 5 2 2 0 |
9 11 2 2 1 |
1 1 0 1 0 |
8 |
3.5
|
Not significant |
|
Gender |
Male female |
0 15 |
1 21 |
0 3 |
2 |
3.02 |
Not significant |
|
Professional qualification |
GNM B.Sc |
6 10 |
13 9 |
1 1 |
2 |
1.72 |
Not significant |
|
Working experience |
0-1 year 2-3 year 4-5 year >5 year |
4 3 1 6 |
5 6 3 9 |
1 1 0 1 |
6 |
1.06 |
Not significant |
|
Marietal status |
Married Single |
12 1 |
21 4 |
2 0 |
2 |
0.826 |
Not significant |
|
Area of residence |
Urban Rural |
6 7 |
9 15 |
1 2 |
2 |
0.31 |
Not significant |
|
Area of training |
Govt Prvt. |
0 14 |
0 23 |
0 3 |
0 |
0 |
Not significant |
|
Experience to different department |
Critical care Ward All area Other area |
5 3 5 1 |
6 9 8 1 |
0 1 1 0 |
6
|
4.72 |
Not significant |
|
Exposure to educational programme |
CNE In-service Conference others |
3 5 5 1 |
7 8 2 6 |
2 1 0 0 |
6 |
10.36 |
Not significant |
The above table shows that there is significant association between the exposure to different department and the mean pretest knowledge score. There is no significant association between the pretest knowledge score and the other selected demographic variables.
The above table shows that there is no significant association between the mean pretest practice score and the selected demographic variables.
DISCUSSION:
A study to assess the knowledge of staff nurses regarding care of unconscious patients who are working in a selected hospital Mangalore. The samples consisted of 80 registered staff nurses, selected by purposive sampling. The result revealed area wise analysis of staff nurses knowledge regarding care of unconscious patients shows the highest means of knowledge score was 5.32 which is around 59.16% of the total score for area on ‘care of skin’. The mean score for the area ‘fluid and electrolyte management’ was 3.41 which is around 68.25% of the total score of that area. The lowest mean score was .52 which is around 17.5 of total score of the area of ‘unconscious conditions’5.
A study was conducted on 100 staff nurses working at Narayana Medical College Hospital were selected by using purposive sampling method to assess the knowledge regarding the care of unconscious patients shows that regarding the level of knowledge among staff nurses, 17(17%) had adequate knowledge, 76(76%) had moderate knowledge and 7(7%) had inadequate knowledge regarding care of unconscious patients6.
The present study finding shows that no sample had good knowledge in the pretest which has changed to 65% after the teaching session. 17% of the samples had average knowledge which changed to 27.5% and 57.5% of the sample had poor knowledge was changed to 7.5% and also regarding the practice score the pretest practice score of 37.5% of was changed to 77.5% after the teaching session and 55% of moderate level was changed to 22.5% as well as 7.5% of the poor practice which became 0 % after the intervention.
CONCLUSION:
The present study entitled “Effectiveness of structured teaching program on the knowledge and practice of staff nurses regarding the care of unconscious patients” was an attempt to study the knowledge and practice level of staff nurses. The purpose of the study was also to improve the existing knowledge and practice if found not up to the mark. The pre-test knowledge and practice levels were compared with selected demographic variables. It was also revealed that there were no significant associations between the selected demographic variables except exposure to different departments had a positive association with the pre-test knowledge score. The study revealed that there were significant differences between the pre-test and post-test knowledge and practice scores. So in this study as it was found effective, structured teaching programs to enhance the knowledge and practice of staff nurses caring for unconscious patients are recommended.
REFERENCES:
1. Ceena Albin. A Study to Assess the Effectiveness of Planned Teaching Programme on selected Neurological Assessment in terms of Knowledge and Practice among staff nurses working in selected units of selected hospitals of Ahmedabad city, Gujarat state. Int. J. of Advances in Nur. Management. 2020; 8(2):118-122. doi: 10.5958/2454-2652.2020.00028.1.
2. Prakash Srinivasam, International Journal of Community Health Nursing,; Vol 6. Issue 1; Published by Mc Med International, 2019: 7-20.
3. Khemnar Archala. An exploratory study to assess the knowledge and attitude of staff nurses regarding care of unconscious patients in selected hospital, Pune city, Maharashtra; Vol 5 Issue 4, 2019:1238-1241
4. Yacouba Njankouo Mapoure, F Sène Diouf, et al; A prospective longitudinal study of coma in the intensive care unit in an African setting: case of Dakar, Senegal]; May 2009:Revue medicale de Bruxelles 30(3):163-9.
5. “A study to assess the knowledge of the staff nurses regarding care of unconscious patients in a selected hospital, Manglore” ; International Journal of Research and Engineering. Issue 1, Volume 1 16 .
6. A Study to Assess the Knowledge Regarding Care of Unconscious Patients among Staff Nurses at NMCH, Nellore, Andhra Pradesh; April 2019; International Journal of Scientific Research in Science and Technology; DOI:10.32628/IJSRST1962122.
Received on 05.08.2022 Modified on 08.09.2022
Accepted on 12.10.2022 ©A&V Publications All right reserved
Int. J. of Advances in Nur. Management. 2022; 10(4):370-374.
DOI: 10.52711/2454-2652.2022.00081