INTRODUCTION:

Nurses take care of their patients, making sure that they can breathe properly, seeing that they get enough fluids and enough nourishment, helping them rest and sleep, making sure that they are comfortable, taking care of their need to eliminate wastes from the body and helping them to avoid the harmful consequences of being immobile, like stiff joints and pressure sores. The nurse often makes independent decisions about the care the patient needs based on his/her assessment.¹Glasgow Coma Scale not only identifies the neurological problem but also detects the initial signs of complications. It can be an indicator of the need for intervention or treatment in emergency conditions. The study conducted by Stern and Scale identified that, GCS enabled practitioners to assess consciousness in adults regularly and quickly and to determine trends that can be easily interpreted and explained to other team members.²

The Glasgow Coma Scale is the best measure of the overall brain dysfunction caused by traumatic brain injuries. There is a need for nurses to accurately assess and document a patient’s conscious level to detect neurological changes and initiate prompt action.³ Pain is the main symptom that leads people to seek health care. Many disciplines are involved in pain management; however, nurses play a pivotal role in the assessment, relief, evaluation and documentation of pain. If ineffectively managed, acute pain can lead to negative physiological and psychological ramifications including the development of chronic pain syndromes.⁴ The content of the documentation includes explanation about the patient’s condition, responses to illness and the care that is provided. The definitive purpose of pain assessment, recording and management promote quality of care. Patients may avoid to express their pain or consider pain an inevitable consequence of any diseases. Therefore, nurses should asses the patient’s pain and their knowledge about pain control methods. Optimal pain relief is reliant on nurse’s knowledge and understanding, systematic and consistent assessment and regular documentation of pain.⁵

One of the eminent risks of a bedridden elderly is the pressure injury, caused mainly by the lack of alternating decubitus, maintaining the patient for a long time in the same position. The Braden Scale appears as a resource, because it is a validated and easily applied instrument to assess the risk of pressure injury formation. Nursing Documentation is a crucial part of the nursing process as it is the essential way of communication within the health care team regarding patient care. Nurse’s knowledge about documentation is important as it is a legal requirement and main responsibility of nursing staff. The Code of Professional Conduct advises that good note-taking is a vital tool of communication between nurses.⁶

Knowledge of nurses in assessing and documenting the patient’s problems using the GCS seems to be inadequate and this is evidenced by a study done in Iraq on “assessment of nurse's knowledge concerning Glasgow Coma Scale in Neuro - Surgical Wards”, which revealed that all nurse’s knowledge was inadequate concerning the application of the Glasgow Coma Scale.⁷Research studies related to knowledge of documentation regarding Wong – Baker FACES pain rating scale and Braden scale are very little in number. I noticed the need for improving knowledge and practice of nurses regarding the GCS scale, Wong – Baker FACES pain rating scale and Braden scale. So I included these scales in my research study.⁸

OBJECTIVES:

· To assess the knowledge regarding documentation of selected assessment scales among ICU nurses of selected hospitals, Kollam.

· To assess the practice regarding documentation of selected assessment scales among ICU nurses of selected hospitals, Kollam.

· To evaluate the effectiveness of structured teaching programme on knowledge regarding documentation of selected assessment scales among ICU nurses of selected hospitals, Kollam.

· To evaluate the effectiveness of structured teaching programme on practice regarding documentation of selected assessment scales among ICU nurses of selected hospitals, Kollam.

· To find out the association between pre test knowledge score among ICU nurses with selected demographic variables.

· To find out the association between pre test practice score among ICU nurses with selected demographic variables.

MATERIAL AND METHODS:

Research approach: Quantitative research approach.

Research design: Quasi experimental, nonrandomized control group design.

Setting of the study: The study was conducted in ICUs of Bishop Benziger Hospital, Kollam and Upasana hospital, Kollam. The reason for selecting these hospitals was due to the feasibility and practicability.

Population: The population of this study consists of Nurses working in ICUs of selected hospitals, Kollam.

Sample: sample consisted of ICU nurses working in Bishop Benziger hospital, Kollam and Upasana Hospital, Kollam.

Sample size: In this study sample size was 60 (30 in experimental and 30 in control group).

Sampling Technique: purposive sampling technique.

TOOL/INSTRUMENTS:

Section A:

It consisted of demographic Proforma of ICU Nurses working in selected hospitals. It included age, gender, educational status and duration of clinical experience.

Section B:

It consisted of structured knowledge questionnaire for assessing the knowledge regarding documentation of selected assessment scales. The knowledge questionnaire had 30 multiple choice questions of which only one was the appropriate answer. The maximum score for the correct answer was one and zero for wrong answer.

Section C:

It consisted of check list for assessing the practice of ICU nurses regarding documentation of selected assessment scales, with 20 yes/no questions. The maximum score for correct performance was one and zero for incorrect performance.

Conceptual framework:

The theoretical framework for the present study was developed from Imogene King’s theory of goal attainment.

Data analysis process:

· Baseline characteristics were analysed by using frequency and percentage.

· Knowledge regarding documentation of selected assessment scales among ICU nurses were analysed using frequency and percentage distribution before and after structured teaching programme.

· Practice regarding documentation of selected assessment scales among ICU nurses were analysed by using frequency and percentage distribution before and after structured teaching programme.

· Effectiveness of structured teaching programme on knowledge and practice regarding documentation of selected assessment scales among ICU nurses would be analysed using paired and unpaired t test.

· Association between pretest knowledge, pretest practice and selected variables would be analysed using Chi square test.

Figure 1: Percentage wise distribution of sample according to duration of clinical experience

Analysis and interpretation:

Table 1: Comparison of mean pre test and post test knowledge score of nurses regarding documentation of selected assessment scales in experimental group.

	Mean	SD	‘t’ value	Significance
Pre test	14.30	4.91	8.59	S
Post test	23.60	5.67	8.59	S

Table value t (29) =2.05

*S=significant

Table 2: Comparison of mean post test knowledge score of ICU nurses regarding documentation of selected assessment scales in experimental and control group.

Group	Mean	SD	‘t’ value	Significance
Experimental	23.6	5.67	6.53	S
Control	14.76	4.74	6.53	S

Table value t (58) =2.00

S = significant

Effectiveness of structured teaching programme on practice regarding documentation of selected assessment scales among ICU nurses.

Table 3: Comparison of pre test and post test practice score of nurses regarding documentation of selected assessment scales in experimental group.

	Mean	SD	‘t’ value	Significance
Pre test	10.36	3.16	13.85	S
Post test	16.90	2.64	13.85	S

Table value t (29) = 2.05

S = significant

Table 4: Comparison of mean post test practice score of nurses regarding documentation of selected assessment scales in experimental and control group.

Group	Mean	SD	‘t’ value	Significance
Experimental	16.90	2.64	7.34	S
Control	10.63	3.85	7.34	S

Table value t (58) = 2.00

S= significance

Association between pre test knowledge score regarding documentation of selected assessment scales among ICU nurses and selected demographic variables:

The association between pre test knowledge score with selected demographic variables was assessed using chi-square test. Calculated chi square value of demographic variables such as age, gender, duration of clinical experience in years were more than table value at 0.05 level of significance. There was significant association between pre test knowledge scores and selected demographic variables.

Association between pre test practice score regarding documentation of selected assessment scales among ICU nurses and selected demographic variables:

The association between pre test practice score with selected demographic variables was assessed using chi-square test. Calculated chi square value of demographic variables such as age, educational status were less than table value at 0.05 level of significance. Calculated chi square value of demographic variable duration of clinical experience in years is more than table value at 0.05 level of significance. So there was no significant association between pre test practice scores and selected demographic variables such as age and educational status, and there was significant association between pre test practice scores and selected demographic variable such as duration of clinical experience in years.

RESULTS:

The result of the study showed that, the pretest knowledge score of sample was 14.3 and posttest knowledge score was 23.6 and calculated ‘t’ value (8.59) was greater than the table value (2.05) at 0.05 level of significance. So there was significant difference between mean pre test and post test knowledge score regarding documentation of assessment scales among ICU nurses in experimental group.

Mean post test knowledge score of sample in experimental group was 23.6 and in control group was 14.76. Calculated ‘t’ value (6.53) is greater than table ‘t’ value (2.00) at 0.05 level of significance, there was significant difference between post test knowledge score regarding documentation of assessment scales among ICU nurses in control group and experimental group. calculated chi square value of demographic variables such as age, gender, duration of clinical experience in years were more than table value at 0.05 level of significance. There was significant association between pre test knowledge scores and selected demographic variables.

Pretest practice score of sample were 10.36 and posttest practice score was 16.9. And calculated ‘t’ value (13.85) is greater than the table value (2.05) at 0.05 level of significance. So there is significant difference between mean pre test and post test practice score regarding documentation of assessment scales among ICU nurses in experimental group. Mean post test practice score of sample in experimental group was 16.9 and in control group was 10.63. Calculated ‘t’ value (7.34) is more than table ‘t’ value (2.00) at 0.05 level of significance. There was significant difference between post test practice score regarding documentation of assessment scales among ICU nurses in control group and experimental group.

Calculated chi square value of demographic variables such as age, educational status were less than table value at 0.05 level of significance. Calculated chi square value of demographic variable duration of clinical experience in years is more than table value at 0.05 level of significance. So there was no significant association between pre test practice scores and selected demographic variables such as age and educational status, and there was significant association between pre test practice scores and selected demographic variable such as duration of clinical experience in years. This study showed that structured teaching programme was very effective in improving knowledge and practice regarding documentation of selected assessment scales among ICU nurses.

DISCUSSION:

A study was conducted in Belgaum “to assess the effectiveness of Self-Instructional Module on Knowledge and Skills Regarding Use of Glasgow Coma Scale in Neurological Assessment of Patients among Nurses Working in Critical Care Units of KLE in Dr. Prabhakar Kore Hospital and Medical Research Centre. Quantitative research design was used and 55 sample were collected by purposive sampling technique. ⁹When compared with present study, it reveals that both studies were quantitative research study. Nurses were sample in both studies. Sample size was 60 in present study and 55 in referent study. In both studies samples were collected by using purposive sampling technique. Both the studies are hospital-based studies. The tool used for both studies were knowledge questionnaire and check list. The intervention for the present study includes, structured teaching programme while in the reference study it was self instructional module. Both study results showed that, SIM and structured teaching programme were very effective in increasing the knowledge and skill/practice of nurses.

REFERENCES:

1. Prigmore S. Assessment and nursing care of the patient with dyspnoea. Nursing Times. 2005 Apr 1; 101(14): 50-3. Available from: https://www.nursingtimes. net/clinical-archive/respiratory.

2. Nguyen Thi Hien. The Accuracy of Glasgow Coma Scale Knowledge and Performance among Vietnamese Nurses. Perspectives in Nursing Science, June 2011; 8(1): 54-6. Available from: https: space.snu.ac.kr/bitstream/10371/86541/1/2011.

3. Salottolo K, Levy AS, Slone DS, Mains CW, Bar-Or D. The effect of age on Glasgow Coma Scale score in patients with traumatic brain injury. JAMA Surgery. 2014 Jul 1; 149(7): 727-34.

4. Tong J Gan, poorly controlled postoperative pain: prevalence, consequences and prevention. Journal of Pain Research. 2017; 10: 2287-98. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5626380/

5. Mahama F, Ninnoni JP. Assessment and management of postoperative pain among nurses at a resource-constraint teaching hospital in Ghana. Nursing Research and Practice. 2019 Jul 18; 432-6. Available from: https://doi.org/10.1155/209/9091467

6. Wood C. The importance of good record-keeping for nurses. Nursing Times. 2003; 99(2): 26. Availablefrom: https://www.nursingtimes.net/roles/practice-nurses/the-importance-of-good-record-keeping-for-nurses-14-01-2003/

7. Ehwarieme, Nurse’s knowledge of Glasgow Coma Scale in neurological assessment of patients in a selected tertiary hospital in Edo state, Nigeria. Africa Journal of Nursing and Midwifery. 2016; 18(2): 74-86.

8. Jordi Miró, PhD, Elena Castarlenas. Validity of Three Rating Scales for Measuring Pain Intensity in Youths with Physical Disabilities. European Journal of Pain. 2016; 20(1): 130-37. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4591090/

9. Teles M, Bhupali P, Madhale M. Effectiveness of self-instructional module on knowledge and skills regarding use of Glasgow coma scale in neurological assessment of patients among nurses working in critical care units of KLE Dr. Prabhakar Kore hospital and medical research centre, Belgaum. Journal of Krishna Institute of Medical Sciences University. 2013 Jan 1; 2(1): 98-104.

Received on 08.11.2024 Revised on 10.12.2024

Accepted on 03.01.2025 Published on 18.02.2025

Available online from March 10, 2025

Int. J. of Advances in Nursing Management. 2025;13(1):51-54.

DOI: 10.52711/2454-2652.2025.00011

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