INTRODUCTION:

“The conscious mind determines the actions; the unconscious mind determines the reactions; and the reactions are just as important as the actions.”.

- E. Stanley Jones

Health is the physically, mentally, socially and spiritually wellbeing. In humans, it is the general condition of a person’s mind, body and spirit, to get aware of their surroundings.¹

Consciousness is a state of being with two important aspects, wakefulness and awareness of self and environment. Unconsciousness is a condition of being unaware of one’s surroundings as in sleep or of being unresponsive to stimulation. ³

Traumatic brain injury (TBI) is the major cause for unconsciousness. Approximately 60 percent will make a positive recovery, and an estimated 25% will be left with a moderate degree of disability. Death or a persistent vegetative state will be the outcome in about 7 to 10 percent of cases. The remainder of patients will have a severe degree of disability.²

Unconsciousness is an abnormal state resulting from disturbance of sensory perception to the extent that the patient is not aware of what is happening around him. Period of unconsciousness may be momentary or may last for month, following a serious motor vehicle accident in which extensive brain damage has been sustained. To produce unconsciousness, a disorder must (1) disrupt the ascending reticular activating system, which extend the length of the brain stem and up into the thalamus, (2) significantly disrupt the function of both cerebral hemispheres, or (3) metabolically depress overall brain function, as in a drug overdose.¹

Unconsciousness is lack of response to sensory stimuli as a result of hypoxia, resulting from respiratory insufficiency or shock; from metabolic or chemical brain depressants, such as drugs, poisons, ketones, or electrolyte, imbalance; or from a form of pathologic condition, such as trauma, seizures, cerebral vascular accident or brain tumor or infection.4 Unconsciousness can be brief lasting for a few seconds to minutes or sustained, lasting for an hour or longer.¹

Sensory stimulation programme is based on environmental effect theory for the recovery of brain.⁵ Sensory stimulation are essential factors in stimulating the reticular activating system to maintain consciousness. Sensory stimulation programme (SSP) is a planned series of activities aimed to stimulate the senses of comatosed patients. The aim is to arouse a patient from coma and try to awaken them. Many types of efforts are made, including showing the patient to look at, playing music, speaking, touching and offering things to the patients to smell, taste and touch.⁶

Sensory stimulation programs for coma patients act by increasing environmental stimulation to the part of the brain that controls levels of consciousness, attention and concentration. It has been proposed that with intense and repeated stimulation and following very precise protocols, a patient could be awakened early from coma and returned to higher level of functioning. Some patients in coma awaken slowly and begin to respond normally.⁷ The program should commence as early as possible after development of coma. Therefore, improved health outcomes would be anticipated by reducing the time a patient spends in coma. The intensity of these programs varies. Sensory stimulation program ranges from 1hr or 2 cycles of stimulation daily (1hr. each) to hourly stimulation cycles, lasting from 15-20 minutes for 12-14hrs. per day, six days in a week.⁶

Some patients in coma awaken slowly and begin to respond normally. Sensory stimulation, application of planned, meaningful, multimodality sensory stimulation has been suggested as a measure to enhance outcome from coma. Nurses are encouraged to interact with comatose patients through all their sensory system. Nurses who work with coma patients would do well the sensory stimulation programme in their areas to see what they have to offer the comatose patients and their families.⁸

Unconsciousness more appropriately referred to as loss of consciousness or lack of consciousness. Glasgow coma scale (GCS) is a widely used scoring system to assess coma and impaired consciousness. Patient with a score of 8 or less is moderate and score of 13-15 are mild unconscious.⁹

Hospital Episode Statistics for 2002-2003, Department of Health, England states that 82% of hospital consultant episodes for unconscious and coma required hospital admission, among which 47% are men and 53% are women. According to a survey conducted in 2005 by National Institute of Mental health and Neuroscience, the incidence of mild unconsciousness was 131 cases per 1,00,000 people, 15 cases per 1,00,000 people were moderate unconscious and 14 severe cases per 1,00,000 people.¹⁰

The longer the patient remains in coma more they suffer from a longer term cognitive, behavioural and emotional impairment which prevents them from pursuing active and responsible lives after injury.¹¹ Although emergency care, diagnostic technology, medical intervention and nursing care have resulted in increased survival in increased survival in individuals after traumatic brain injury, arousal and cognitive recovery are not guaranteed.¹²

Arousal is a pre-requisite for all the selective attention necessary for recognizing and processing information. Without arousal the more complex cognitive process such as sustained attention or concentration necessary for learning cannot occur.¹² With the current state of knowledge related to activation of recovery mechanism immediately following unconsciousness, it can be stated that early environmental stimuli via sensory stimulation program may enhance recovery processes. The clinical use of sensory stimulation program with comatosed patients has garnered success.¹³

A randomized controlled trial was conducted by Karma and Rawat on 60 pediatric patients who were in a coma due to non-traumatic causes. Sensory stimulation programme was given through 5 senses and the patients level of consciousness was measured using the Glasgow Coma Scale (GCS). The results showed that the study group demonstrated significant improvement, while the control group did not show much improvement. Thus, it suggests that sensory stimulation can improve the recovery of unconscious patients.¹⁴

It is very important that every student nurse’s in areas needing critical care such as High Dependency Units has enough knowledge to assess and intervene appropriately, he/she should also be able to communicate any change in patients’ condition for multidisciplinary intervention.

One of the nurse’s most challenging tasks is to provide care for an unconscious patient. This task requires skill, sound judgment, and the ability to make assessments and solve problems using only objective information.

NEED FOR THE STUDY:

“Inadequate Knowledge is most Hazardous Than Ignorence”

A person who is ill needs care, support and will power to come back, from time immemorial, there is a care taker who cares for the person who cannot care for himself or herself, which in other words can be termed as nursing.¹⁵

As the patient is unaware of himself and his environment there are more chances of complication like airway obstruction, aspiration and respiratory tract infections are common cause of death in unconscious patients. These patients are potential for injury, pressure sores and fluid volume deficit. Alteration in urinary elimination can lead to consumption. Thus, the comprehensive patient care starts at the time of admission and continuous until the regain of normal function by each individual patient has been achieved.¹⁶

The World Health Organization (WHO) estimates that 9 million deaths occurred in every year in Intensive Care Units. In India every year approximately 4.8 million ICU’S admissions are occurring. In which 69% patients are in unconscious stage. This indicates the importance of the study of the stage of unconsciousness. The researcher, in her clinical experience has observed that majority of nurses were lacking in the knowledge regarding the care of unconscious client. Thus, the researcher felt the need of updating the knowledge of nursing students by adopting a computer-based teaching technique and capture its effectiveness. Thus, this study may help the future nurses to take care of unconscious patients.¹⁷

A quasi-experimental study was conducted in U.S.A, with sample size of 24 patients and the sensory stimulation programme was given to patients each day for up to 7 days. The GCS scores were recorded as pre-test and post-test. The result showed that improvement was demonstrated in participants who receive auditory sensory stimulation. Hence it was concluded that sensory stimulation is effective in the recovery of unconscious patients.¹²

A person's level of consciousness (LOC) is the most sensitive indicator of brain function. Normal consciousness is a state of being fully aware of oneself and the environment, and the ability to react and respond appropriately. Any change in LOC is often the first clue to a deteriorating condition. Unconsciousness is a medical emergency. When a nurse/ nursing student find an unconscious patient, their first response should be to call a code, immediately. Don't worry about what caused the problem. They can help solve that mystery once the patient's condition is stabilized. Quickly begin assessing the patient's airway, breathing, and circulation, according to the American Heart Association (AHA) guidelines for basic life support. To do this, they will have to first place the patient supine on a hard surface. If the patient in bed, place him on a backboard; if he's slumped in a chair, they will have to ease him to the floor; if he's on the floor, carefully log-roll him onto his back. Open the airway using the head tilt–chin lift (or jaw thrust maneuver if suspect head trauma from a fall). If nurses can see an obstruction, try using a finger sweep to remove it. If see nothing, look, listen, and feel for breathing. When the unconscious patient is breathing spontaneously, nurses be able to see his chest rise and fall, and feel air moving out of his mouth and nose. Count his respirations and assess his carotid pulse. If both are adequate, place the patient in the recovery, or side-lying, position to prevent aspiration and airway obstruction. Stay with the patient and monitor his vital signs until help arrives.¹⁸

A descriptive study was conducted in Bagdad to assess the knowledge and practices of nurses regarding caring of unconscious patients in intensive care units. The study included 50 staff nurses, and the tool was structured knowledge questionnaire. 28 (56%) of nurses revealed that the inadequacy of knowledge and skills for nurses in the field of airway care, observation and record level of consciousness, and the application of sensory stimulation. Thus, it can conclude that there is a need for improving knowledge of staff nurses in application of sensory stimulation for unconscious patients.¹⁹

A descriptive study was conducted in selected hospitals in Mangalore to assess the knowledge of staff nurses regarding care of unconscious clients. The study sample was 60, the result showed that the knowledge of staff nurses was found to be adequate but in certain areas like safety needs of unconsciousness and sensory stimulation it was found to be inadequate. This study shows a need for educating staff nurses who are taking care of unconscious patients regarding sensory stimulation.²⁰

Unconscious patient may survive for days or months and often experience decreased quality of life. The outcomes ranges from recovery to death. Coma generally lasts a few days to few weeks, rarely more than 2 to 5 weeks. After this some patient gradually comes out of coma or some may progress to a vegetative state, and some may die. Some patients may remain in a vegetative state for years or even decades. The outcomes from coma and vegetative state depends on the cause, location, severity and extent of neurological damage.²¹

Because most acute cases of unconsciousness are potentially reversible, nurses need to quickly anticipate and facilitate diagnostic testing. The task may seem daunting, given the sheer number of causes. The top three include stroke, traumatic brain injury, and drug intoxication. But other common causes such as hypoglycemia, myxedema, hypoxia, renal or hepatic failure, infection, and seizures all have to be ruled out.²²Nursing management of unconscious patient is an emergency situation where the nurse will use Glasgow coma scale to assess the level of consciousness. Examination of airway patency provides adequate respiratory effect to client. Oxygen inhalation helps in correction of hypoxia, if oxygen saturation is below 95%. If carotid pulse is not palpated then resuscitation should be committed. Other major nursing functions are monitoring cardiovascular function, assessing elimination pattern, maintain proper nutrition, provide personal hygiene needs, skincare and provide safe environment. 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.²³

The goals of care for the patient with altered loss of consciousness include; Initial and ongoing assessment of the patient’s status, Maintenance of the clear airway, Protection from injury, Attainment of fluid volume balance, Achievement of intact oral mucous membrane, maintenance of normal skin integrity, absence of corneal irritation, attainment of effective thermoregulation, and effective urinary elimination. Additional goals include bowel continence, accurate perception of environmental stimuli, and maintenance of intact family support system and absence of complications.²⁴

Because the unconscious patients’ reflexes are impaired, the quality of nursing care provided literally may mean the difference between life and death. The nurse must assume responsibility for the patient until the basic reflexes (coughing, blinking and swallowing) return and the patient becomes.

It is therefore important for a nurse to know how and what to feed this patient. If the nurse does not know how to feed this patient, he may end up developing some complications such as aspiration pneumonia. Immobility is another problem it is important that a nurse performs passive range of motion to prevent development of contractures and also to promote circulation to all body parts. It is also important to turn the patient every two hours to prevent development of pressure sores a nurse may also apply talcum powder on pressure areas to prevent the pressure sore development.²⁵

Considering the above facts and review of literature, investigator felt that to provide the students nurses with adequate knowledge regarding sensory stimulation in unconscious client.

REVIEW OF LITERATURE:

A study was conducted in 2009 to study the effects of sensory stimulation programme on recovery in unconscious patients with traumatic brain injury. This quasi-experimental study examined the effect on sensory stimulation programme on unconscious patients and these patients were divided into control and experimental groups. SSP was directed to five sensory modalities including tactile, gustatory, olfactory, auditory and visual. Response to stimulation was assessed using the modified sensory modality assessment and rehabilitation technique score and the Glasgow coma score and results indicated that the sensory stimulation programme can enhance brain recovery in traumatic brain injury patients.²⁶

The Quantitative research approach adopted to assess the level of knowledge regarding Neurological Assessment of Patients with Brain Stroke in Selected Nursing college. The present study was one group pre-test and post-test, design and convenient sampling technique was followed which included 60 samples were used. It shows that over all knowledge level of respondents regarding neurological assessment of patients with brain stroke among B.Sc.(N) students. The pre-test results of the respondents 57(95%) have below average knowledge level and 3(5%) have average knowledge level. The post test results show that below average knowledge was 3 (5%) have average knowledge level was 49(81.7%) and above average knowledge level was 8(13.3%). The study concluded that majority of the student nurses in pre-test have below average knowledge and post-test majority of student’s nurses 49(81.7%) have knowledge regarding neurological assessment.²⁷

A study done by Academic Medical Centre, Amsterdam, the Netherlands recently to determine the effect of computer-based medical teaching (CBMT) as a supplementary method to teach clinical problem-solving during the training period of nursing students in neurology. Randomized controlled blinded study was done. 103 Students were assigned at random to a group with access to CBMT and a control group. CBMT consisted of 20 computer-simulated patients with neurological diseases and was permanently available during five weeks to students in the CBMT group. The ability to recognize and solve neurological problems was assessed with two free-response tests, scored by two blinded observers. As a result, its id identified that Computer aided teaching can be an effective method for teaching clinical problem-solving, when used as a supplementary teaching facility during a clinical training. The increased ability to solve problems learned by CBMT had no demonstrable effect on the performance with other neurological problems especially with unconscious patients.²⁸

STATEMENT OF PROBLEM:

A study to assess the effectiveness of computer assisted teaching on knowledge regarding sensory stimulation in unconscious client among nursing students in selected nursing institutions at Bengaluru.

OBJECTIVES OF THE STUDY:

1. To assess the level of pre-test knowledge score regarding sensory stimulation in unconscious client among nursing students.

2. To evaluate effectiveness of computer assisted teaching program on knowledge regarding sensory stimulation in unconscious client among nursing students after the intervention.

3. To find out the association between the pre-test knowledge score of sensory stimulation in unconscious client and their selected socio-demographic variables of nursing students.

METHODOLOGY:

The research design selected for the present study was one group pre-test and post-test pre-experimental design. This study attempted to assess the effectiveness of computer assisted teaching on knowledge regarding sensory stimulation in unconscious client among nursing students in selected nursing institutions at Bengaluru. It was classified as pre-experimental, as there was no control group and randomization. This design was selected because it seemed most appropriate to ascertain the effectiveness of computer assisted teaching in terms of change of knowledge scores of the nursing students if exposed to computer assisted teaching on sensory stimulation in unconscious client.

Fig: 1 pre-experimental one group pre-test post-test design

RESULTS:

A total of 60 B.SC.& GNM nursing students studying in K.N.N. School and College, Bengaluru were selected by random sampling technique. Obtained data were summarized in frequencies and percentages. Data
described in this section include age, gender, religion, monthly income, type of family, source of information, practice in care of unconscious client in hospital.

Table -1: percentage and frequency distribution of personal characteristics of students.

Sl. No	Characteristics	Category	Students
Sl. No	Characteristics		frequency	percentage
1	Age in Years	20-21	48	80%
		22-23	8	13.33%
		Above 23	4	6.67%
2	Gender	Male	9	15%
2	Gender	Female	51	85%
3	Religion	Hindu	37	61.67%
		Muslim	8	13.33%
		Christian	15	25%
		Others	0	0%
4	Course of Study	3rd year GNM	30	50%
4	Course of Study	4th Year BSc	30	50%
5	Monthly Income of Family	Below 20,000/month	28	46.67%
		20001 to 25000/month	4	6%
		25001 to 30000/month	8	13.33%
		Above 30000/month	20	33.33%
6	Type of Family	Single Parent	7	11.67%
		Nuclear Family	53	88.33%
		Joint Family	0	0%
		Extended Family	0	0%
7	Prior knowledge about sensory stimulation of an Unconscious client.	Yes	60	100%
		No	0	0%
	If yes, Source of Information from	Electronic /Print Media	5	8.33%
		Teachers	42	70%
		Friends & Neighbours	7	11.67%
		Any other source	6	10%
8	Practice in Care of Unconscious client in Hospital	Yes	11	18.33%
8	Practice in Care of Unconscious client in Hospital	No	49	81.67%

Fig-3: Cylinder diagram representing the percentage distribution of nursing Students based on age

Fig-4: Cone diagram representing the percentage distribution of nursing students based on gender

Fig-5: Pie diagram representing the percentage distribution of the nursing Students based on religion.

Fig-6: Bar diagram representing the percentage distribution of nursing students based on course of study.

Fig-7: Bar diagram representing the percentage distribution of nursing students based on monthly income.

Fig-8: Pyramid diagram representing the percentage distribution of nursing Students based on type of family

Fig-9: Cone diagram representing the percentage distribution of nursing students based on source of information.

Fig-10: Pyramid diagram representing the percentage distribution of nursing Students based on practical knowledge in hospitals.

Aspect Wise Assessment of Pre-test Knowledge of Nursing Students on Sensory Stimulation of an Unconscious Client.

Table-2: Frequency and percentage distribution of pre-test level of knowledge on sensory stimulation of an unconscious client among nursing students. n=60

Knowledge Level	Category	Classification of Nursing Students based on their pretest knowledge level

		Frequency	Percentage (%)
Inadequate	<= 50% Score	43	71.67
Moderate	51 to 75% Score	17	28.33
Adequate	> 75 % Score	0	0
Total		60	100

Fig-11: Cylinder diagram representing percentage distribution of nursing students based on pre-test level of knowledge score

Table: 3 Aspect wise pre-test knowledge score of nursing students on sensory stimulation in unconscious client.

No	Knowledge Aspects	Max Score	BSc and GNM Students knowledge
No	Knowledge Aspects	Max Score	Mean	SD	Mean %
1	Anatomy & Physiology	3	1.78	0.88	59
2	Meaning and Types	5	2.9	0.98	58
3	Etiology and clinical manifestations	5	3.4	0.95	68
4	Assessment	6	2.7	1.27	54
5	Sensory stimulation	17	6.73	2	40
	Total	36	17.51	6.08	55.8

Aspect Wise Assessment of Post-test Knowledge of Nursing Students on Sensory Stimulation of an Unconscious Client.

Table-4: Frequency and percentage distribution of post-test knowledge on sensory stimulation of an unconscious client among students n=60

Knowledge Level	Category	Classification of Nursing Students based on their pretest knowledge level
Knowledge Level	Category	Frequency	Percentage (%)
Inadequate	<= 50% Score	0	0
Moderate	51 to 75% Score	3	5
Adequate	> 75 % Score	57	95
Total		60	100

Table: 5 Aspect Wise Post-test Knowledge Score of Students on Sensory Stimulation in Unconscious Client. n=60

No	Knowledge Aspects	Max Score	BSc and GNM Students knowledge
No	Knowledge Aspects	Max Score	Mean	SD	Mean %
1	Anatomy and Physiology	3	2.87	0.39	95.56
2	Meaning and Types	5	4.08	0.82	81.67
3	Etiology and Clinical manifestations	5	4.33	0.62	86.67
4	Assessment	6	4.97	1.00	82.78
5	Sensory Stimulation	17	14.58	1.54	85.78
	Total	36	30.83	4.37	86.49

Comparison of pre-test and post-test level of knowledge on sensory stimulation of an unconscious client among nursing students

Table-6: Comparison of pre-test and post-test knowledge level on sensory Stimulation in unconscious client.

Knowledge Level	Category	Classification of Nursing Students based on their pretest knowledge level
		Pretest		Post test
		f	%	f	%
Inadequate	<= 50% Score	43	71.67	0	0
Moderate	51 to 75% Score	17	28.33	3	5
Adequate	> 75 % Score	0	0.00	57	95
Total		60	100.00	60	100.00

Data given in the table-6 shows that after administration of computer assisted teaching when the post-test score was calculated there was improvement in the knowledge levels of the nursing students. Data given clearly depicts that, before computer assisted teaching, 43(71.67%) were having inadequate knowledge level; whereas after computer assisted teaching none of them exhibited inadequate level of knowledge. Similarity before computer assisted teaching none of the nursing students had adequate level of knowledge, whereas after computer assisted teaching 57(95%) of nursing students exhibited adequate level of knowledge. The same data is representing by pyramid diagram in fig:16.

Fig: 13 Pyramid diagram representing comparison of percentage distribution of pre and post-test knowledge of nursing students on sensory stimulation of an unconscious client.

Table-7: Aspect wise comparison of pre and post-test knowledge score of nursing students on sensory stimulation in unconscious client. n=60

No	Knowledge Aspects	Max Score	BSc and GNM Students knowledge
			Pretest		Post test
			Mean	Mean %	Mean	Mean %
1	Anatomy and Physiology	3	1.78	59	2.87	95.56
2	Meaning and Types	5	2.9	58	4.08	81.67
3	Etiology and Clinical manifestations	5	3.4	68	4.33	86.67
4	Assessment	6	2.7	54	4.97	82.78
5	Sensory Stimulation	17	6.73	40	14.58	85.78
	Total	36	17.51	55.8	30.83	86.49

Data given in the table-7 shows that aspect wise comparison of pre and post-test knowledge score of nursing students on sensory stimulation in unconscious client. The total mean pretest knowledge score was 17.51 and the total mean % pre-test knowledge score was 55.8%. The total mean post-test knowledge score was 30.83 and the total mean % post-test knowledge score was 86.49%. The same data is representing by cone diagram in fig: 14.

Fig: 14 Cone diagram representing aspect wise comparison of mean percentage distribution of pre and post-test knowledge scores of students on sensory stimulation in unconscious client.

Knowledge Enhancement and Testing of Hypothesis:

Table-8: Enhancement of overall knowledge score of the nursing students compared with the means of pre-test and post-test knowledge scores. n=60

Over all Pretest and Posttest knowledge
Aspects	Max Score	Mean	Mean %	SD	Paired 't' Test
Pre test	36	17.51	55.80	6.08	*25.91
Post test	36	30.83	86.49	4.37
Enhancement	36	13.32	30.69	±1.71

*Significant at 5% level, t (0.05, 59df) =2

The mean post-test knowledge score of nursing students (30.83±4.37) as given in table-7 is higher than that of the mean pre-test knowledge score (17.51±6.08). The computed ‘t’ value is higher than the table value at 0.05 level of significance. Hence the hypothesis H1 stated that there will be significant difference between the means of pre-test and post-test knowledge score of the students exposed to computer assisted teaching on sensory stimulation of an unconscious client at 0.05 level of significance is ‘accepted’.

ASSOCIATION OF PRETEST LEVEL OF KNOWLEDGE AND THEIR SELECTED DEMOGRAPHIC VARIABLES OF NURSING STUDENTS:

Table 9: Association of pretest level of knowledge of nursing students and their selected demographic variables of nursing students. n=60

Overall knowledge
			Below Median		Above Median		Chi square
Sl. No.	Characteristics	Category	Freq.	%	Freq.	%
1	Age in Years	20-21	25	41.7	23	38.33	1.53 df = 2 *NS
		22-23	3	5	5	8.33
		Above 23	3	5	1	1.67
2	Gender	Male	5	8.33	4	6.67	0.064 df = 1 *NS
2	Gender	Female	26	43.33	25	41.67	0.064 df = 1 *NS
3	Relegion	Hindu	19	31.67	18	30	2.56 df = 2 *NS
		Muslim	6	10	2	3.33
		Christian	6	10	9	15
		Others	0	0	0	0
4	Course of Study	3rd year GNM	14	23.33	16	26.67	0.6 df=1 *NS
4	Course of Study	4th Year Bsc	17	28.33	13	21.67	0.6 df=1 *NS
5	Monthly Income of Family	Below 20,000	13	21.67	15	25	0.876 df=3 *NS
		20001 to 25000	2	3.33	2	3.33
		25001 to 30000	4	6.67	4	6.67
		Above 30000	12	20	8	13.33
6	Type of Family	Single Parent	2	3.33	5	8.33	1.69 df=1 *NS
		Nuclear Family	29	48.33	24	40
		Joint Family	0	0	0	0
		Extended Family	0	0	0	0
7	Prior knowledge about sensory stimulation in Unconscious client	Yes	31	51.67	29	48.33
		No	0	0	0	0
	If yes, Source of Information	Electronic /Print Media	3	5	2	3.33	3.55 df=3 *NS
		Teachers	23	38.33	19	31.67
		Friends & Neighbours	4	6.67	3	5
		Any other source	1	1.67	5	8.33
8	Practice in Care of Unconscious Patient in hospital	Yes	8	13.33	3	5	2.4 df=1 *NS
8	Practice in Care of Unconscious Patient in hospital	No	23	38.33	26	43.33	2.4 df=1 *NS

Data given in the table shows association between overall knowledge score and demographic variables of students such as age, gender, religion, course of study, monthly income, type of family, source of information and practice in care of unconscious client in hospital.

The chi-square values computed for knowledge scores and demographic variables:

Age (c2= 1.53), gender (c2=0.064), religion (c2=2.56), course of study ( c2 =0.6), monthly income (c2=0.876), type of family (c2=1.69), source of information (c2=3.55), Practice in taking care of unconscious client in ward (c2=2.4), were found to be less than table value at 5% level of significance which indicate that there is no significant relation between these demographic variable with the pretest knowledge score of students on sensory stimulation in unconscious client. Hence the null hypothesis was retained.

CONCLUSION:

The present study assessed the knowledge of nursing students on sensory stimulation in unconscious client through computer assisted teaching and found that majority (71.67%) of the nursing students had inadequate knowledge and (28.33%) had moderately adequate knowledge in the pre-test. In post-test 95% of nursing students had adequate knowledge and rest of 5% students had moderately adequate knowledge. It shows that there is a significant improvement in knowledge of nursing students after the CAT. Thus, CAT is effective in improving the knowledge of nursing students on sensory stimulation in unconscious client. The CAT has enhanced the knowledge of nursing students, which is essential to taking care of unconscious client especially improving the knowledge related to sensory stimulation.

NURSING IMPLICATION:

The investigator observed that following implications drawn from the study are of vital concern for nursing education, nursing practice, nursing administration and nursing research which provide way towards better improvement in knowledge of nursing students regarding sensory stimulation in unconscious client and implementing computer assisted teaching as a effective teaching strategy.

NURSING EDUCATION:

One of the leading functions of nursing is imparting education with newer knowledge. Nurse educator should make appropriate use of their knowledge to improve the standards of nursing as a profession. Nurse educators should make use of the computer assisted teaching, which is prepared for use as a teaching tool. This tool reduces their lecture hours and teaching will be effective. The students will be motivated to concentrate in better way through the computer assisted teaching. It will help the students learn and understand the subject and concept faster as compare to lecture method alone. Teaching with assistance of computer should be planned according to the needs and understanding level of the beneficiaries for the effectiveness.

NURSING PRACTICE:

The nursing practice has been undergoing many evolutions in the recent past. The expanded role of the professional nurse emphasizes the activities which promotes health and prevention better among the people. Computer assisted teaching programme conducted by the nursing personnel both in the hospital and community areas helps in providing adequate health service to the patients and caregivers of unconscious client.

NURSING ADMINISTRATION:

The nurse administrator should take interest in providing information through teaching with assistance of computer on sensory stimulation in unconscious client for nursing students who came for clinical experience. Planning, organization of such programmes requires efficient team work, planning for manpower, money material and methods and minutes to conduct successful education programs, both at the hospital and community level. The nurse administrators should educate and train the student nurses and update knowledge of staff nurses regarding sensory stimulation in unconscious client and should provide appropriate final nursing education with help of various methods of teaching.

NURSING RESEARCH:

There are different situations and place where the problems are identified which needs a systemic evaluation. The chosen area demands conduct of more research and findings that is to obtained and should be drawn out as a protocol in teaching student nurses with various effective teaching strategies which improves their understanding in about care and sensory stimulation in unconscious client.

Despite, literatures, books and journals offering nursing procedures the protocol of holistic care of patients with evidence-based nursing is yet to brought out. Such studies would help in enhancing in improving the knowledge and understanding of nurse’s quality in client care.

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Received on 18.06.2025 Revised on 24.07.2025

Accepted on 23.08.2025 Published on 31.10.2025

Available online from November 10, 2025

Int. J. of Advances in Nursing Management. 2025;13(4):208-218.

DOI: 10.52711/2454-2652.2025.00039

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