annexure ii · web viewa detailed description on endotracheal suctioning, its indications,...

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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE ANNEXURE – II PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION 1. Name of the candidate and address (in block letters) SHAMNA MAJEED ABDUL MAJEED I YEAR M. Sc. NURSING LAXMI MEMORIAL COLLEGE OF NURSING BALMATTA MANGALORE 2. Name of the Institution LAXMI MEMORIAL COLLEGE OF NURSING BALMATTA MANGALORE 3. Course of Study and Subject M. Sc. NURSING MEDICAL SURGICAL NURSING 4. Date of Admission to the course 06.06.2011 5. Title of the Topic EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON KNOWLEDGE AND PRACTICE OF ENDOTRACHEAL SUCTIONING AMONG STAFF NURSES IN SELECTED HOSPITALS OF MANGALORE. 1

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Page 1: Annexure II · Web viewA detailed description on endotracheal suctioning, its indications, procedure, and complications, will be executed to the whole group. The demonstration of

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE

ANNEXURE – IIPROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1. Name of the candidate and address (in block letters)

SHAMNA MAJEED ABDUL MAJEED I YEAR M. Sc. NURSING LAXMI MEMORIAL COLLEGE OF NURSINGBALMATTAMANGALORE

2. Name of the Institution LAXMI MEMORIAL COLLEGE OF NURSINGBALMATTAMANGALORE

3. Course of Study and Subject M. Sc. NURSINGMEDICAL SURGICAL NURSING

4. Date of Admission to the course 06.06.2011

5. Title of the Topic

EFFECTIVENESS OF PLANNED TEACHING PROGRAMME

ON KNOWLEDGE AND PRACTICE OF ENDOTRACHEAL

SUCTIONING AMONG STAFF NURSES IN SELECTED

HOSPITALS OF MANGALORE.

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6. Brief resume of the intended work

6.1 Need for the study

Critical care is a term used to describe the care of hospital patients who are

extremely ill and whose clinical condition is unstable or potentially unstable.”1

Critical care units or intensive care units were designed to meet the special needs of

acutely ill patients and the critical care nurse is responsible for assessing the life

threatening conditions and instituting an appropriate treatment. Today the

technology and equipment available in intensive care units are extensive and

continually evolving. Patients may be receiving continual support from ventilator,

cardiac assisting device or dialysis machine. These invasive devices carry a risk for

infection, particularly in a patient with a compromised immunologic status, sepsis

and multiple organ dysfunctions may follow.2 Because of airway devices,

medications or physical pathology, many critically ill clients cannot communicate

their needs well, making their situation even more stressful.1

The patients in the intensive care units often require mechanical assistance

to maintain airway patency. Artificial airways are usually required for persons with

mechanical ventilation. The presence of endotracheal tube, however, presents a

threat to the integrity and normal functioning of the respiratory system. The tube

bypasses the body’s normal protective function of warming and filtering the air,

which may result in dried and tenacious secretions. In critically ill patients, the

action of ciliated cells in the respiratory tract and cough reflex in removing

secretions may also be compromised.4 Because of this, secretions tend to pool and

obstruct the airways, and aspiration is a potential hazard for the patient with an

endotracheal tube. So the mouth should be suctioned thoroughly and endotracheal

tube only when needed to prevent hypoxia and to prevent injury to bronchial and

lung tissues. Endotracheal suctioning is therefore important in order to reduce the

risk of consolidation and atlectasis that may lead to inadequate ventilation.3

Tracheal suctioning, which is an essential aspect of airway management has

been identified as a potential dangerous procedure which can lead to several

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complications and risks like hypoxemia, cardiac dysrhythmias, trauma, and

atlectasis and in extreme cases death. Other risk and complications include

infection, bleeding, pain and endotracheal tube becoming blocked or displaced,

hemodynamic instability related to hypoxia and vagal stimulation. Undesirable

fluctuation in intracranial pressure may also occur as result of reduction in cerebral

venous return. It is therefore imperative that professionals are aware of these risks

and are able to practice according to current best evidence.4

As demand of intensive care beds increase more nurse in acute and high

dependency ward areas are expected to provide safe care of patient with

endotracheal tube. The Audit commission (1999) suggested that general wards

nurses should be able to care for patients with endotracheal tube as long as they

have no other respiratory problems. However there is evidence that the practioners

are not adequately educated or experienced to care for patients with endotracheal

tube in general ward. These findings not only have serious legal implication but

they hamper the intent of comprehensive critical care, which aims to prevent the

readmission to intensive care units, facilitate discharge and share critical care skills.5

A descriptive study was conducted in UK to explore the knowledge and

competence of nurses in performing tracheal suctioning. Twenty eight nurses where

observed using nonparticipant observation and structured observation schedule. The

study demonstrated that the majority of the subjects (n=14) failed to perform the

suctioning as accurately as they had reported. The mean score for knowledge was

11.1 and 10.3 for practice (maximum score 20). Knowledge and practice were

compared using spearman’s correlation coefficient (r=0.338) and found that was not

statistically significant (p>0.05). The study concluded that a poor level of

knowledge for many subjects this was reflected in practice. This study suggested

that nurse require support, education, and training relating to tracheal suctioning.5

Many researchers have identified that nurses are unaware of the current

suctioning recommendations and practice is often based on ritual and tradition as

opposed to empirical evidence. In a study by Day (2002) in UK, many nurses have

failed to demonstrate an acceptable level of competence and some of the

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practices observed were potentially unsafe.6 All nurses who perform suction must

have received approved training and demonstrated competence under supervision.

They should ensure that their knowledge and skills are maintained. Nurses should

also make sure that they under take role in accordance with their original protocols

policies and guidelines.4 Hence it was felt that planned teaching programme on

endotracheal suctioning would enable the staff nurses to improve their knowledge

and skill and also practice according to current research recommendations.

6.2 Review of literature

A descriptive study was conducted in Spain among 34 nurses to assess the

performance of tracheal suctioning by direct observation and knowledge on the

procedure was assessed using a self administered questionnaire. The total mean

score obtained for practice observation grid (p) was 12.09 for a maximum score of

19, while it was 14.24 in the knowledge questionnaire. When the total scores

obtained were compared; both in practice and knowledge, with the years of

experience in intensive care units, no statistically significant difference were found.

The study concluded that the nurses have scientific knowledge of the suctioning

procedure that is better than their practice competence.7

An experimental study was conducted to evaluate the effectiveness of

individual performance feedback on knowledge and practice of tracheal suctioning.

Ninety five qualified health care professionals (nurses and physiotherapist) in two

acute care hospitals in London were randomly allocated to receive either

individualized performance feedback or no additional feedback after a standardised

lecture and practical demonstration of tracheal suctioning. Randomisation was

stratified by profession, seniority and site. Data were collected in 2005 in a clinical

setting involving patients and a simulation setting. The outcome measures were

knowledge and practice of tracheal suctioning assessed by self-completion

questionnaire and structured observation. In both settings, intervention groups

performed statistically significantly better in terms of knowledge (p=0.014) and

practice (p=0.037) at final follow up. Those who received performance feedback

had statistically significantly higher knowledge (p=0.004) and practice (p<0.01)

4

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scores than the control group. Retention of knowledge and tracheal suctioning

practice is improved when training is followed by a performance feedback.6

A quasi experimental study was performed to assess the impact of

instruction on the knowledge and performance of NICU nursing staff in Shiraz

University of Medical Sciences in 2006 among fifty nurses. At first, their

knowledge and performance in neonatal endotracheal tube suctioning was

investigated using test and checklist. After specifying the experimental and control

group through systematic random allocation, the suctioning instruction was done for

experimental group and infection prevention instruction was done for control group.

Two days and 2 months after instruction, nurses' knowledge and performance were

assessed again. Data analysis was done using Chi- Square; The study result showed

that means for knowledge and performance of experimental group respectively two

days and two months after instruction was 16.56 and arrived from this score to

28.48 and 27.4 and from 20.6 arrived to 39.14 and 38.34. The study concluded that

instructing the principles of endotracheal tube suctioning improves the level of

knowledge and performance in nurses.8

A quasi experimental study was conducted to evaluate the teaching

intervention to improve the practice of endotracheal suctioning in intensive care

units among nurses in London. The study was a randomised controlled, single

blinded comparison of two research based teaching programmes, with 16 intensive

care nurses, using a non participant and self report questionnaire. Initial base line

revealed a low level of knowledge for many participants, which was also reflected

in practice, as suctioning was performed against of the research recommendations.

Following teaching, significant improvements were seen in both knowledge and

practice. Four weeks later these differences were gradually sustained and provide

evidence of effectiveness of the educational intervention. The study raised concern

about all aspects of endotracheal suctioning and highlights the need for change in

nursing practice with clinical guidelines and focused based education.9

A quasi experimental study was conducted in 2002 to assess the

effectiveness of planned teaching programme on knowledge and practice of

5

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endotracheal suctioning among staff nurses in different ICU of St. John’s National

Academy of Health Science, Bangalore. Using purposive sampling technique data

were collected from 50 nurses using knowledge questionnaire and non-participant

observation check lists. After pre-test was over a teaching was administered. Post

test for knowledge, from 5th day after teaching and post test for practice was taken

only after 12 days of teaching. Results showed that the post test knowledge and

practice score obtained were significantly higher than the pre-test scores.10

6.3 Statement of the problem

Effectiveness of planned teaching programme on knowledge and practice of

endotracheal suctioning among staff nurses in selected hospitals of Mangalore.

6.4 Objectives of the study

1. To determine the knowledge of staff nurses regarding endotracheal

suctioning.

2. To determine the practice of staff nurses on endotracheal suctioning.

3. To evaluate the effect of planned teaching programme in terms of gain in

knowledge and practice score.

4. To find out the correlation between knowledge score and practice score on

endotracheal suctioning among staff nurses.

5. To find out the association of knowledge and practice with selected

demographic variables.

6.5 Operational definitions

1. Effectiveness: Effectiveness refers to producing intended results.11

In this study, effectiveness refers to the extent to which the planned

teaching programme can improve the knowledge and practice of

endotracheal suctioning among staff nurses.

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2. Planned teaching programme: Planned teaching programme refers to

series of studies and lectures in accordance with a plan.11

In this study, planned teaching programme refers to systematically

organised teaching strategy on endotracheal suctioning, its indications, steps

and techniques, and its complications.

3. Knowledge: It means the facts/condition of knowing something with

familiarity gained through experience or association.11

In this study, knowledge refers to awareness of nurses regarding

endotracheal suctioning as measured by structured questionnaire.

4. Practice: Practice refers to habitual or customary performance.11

In this study, practice refers to drilling or reinforcing the already

learned skills of nurses in performing the endotracheal suctioning as

measured by observation checklist.

5. Endotracheal suctioning: It is a practice performed to maintain a clear

airway and optimise respiratory function in patients with an artificial airway

such as endotracheal tube who cannot cough or void pulmonary secretions.12

6. Staff nurses: Staff nurses are those who are working in ICU of selected

hospital of Mangalore.

6.6 Assumptions

The study assumes that:

The staff nurses have inadequate knowledge and practice regarding

endotracheal suctioning.

Planned teaching programme will improve the knowledge and practice of

staff nurses.

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6.7 Delimitations

The study is delimited to:

1. The staff nurses who are working in selected hospital of Mangalore.

2. Staff nurses who are working in intensive care unit areas.

6.8 Hypotheses

All hypotheses will be tested at 0.05 level of significance.

H1: The mean post-test knowledge score will be higher than the mean pre-test

knowledge score.

H2: The mean post-test practice score will be significantly higher than the mean

pre-test practice score.

H3: There is a significant correlation between knowledge and practice.

H4: There is a significant association of knowledge and practice with

demographic variables.

7. Material and Methods

7.1 Source of data

Staff nurses working in selected hospitals of Mangalore.

7.1.1 Research design

One group pre-test post-test design is selected for the study.

E = O1 X O2

E = Experimental group

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O1 = Assessment of knowledge and practice of endotracheal suctioning

before the intervention.

X = Planned teaching programme on endotracheal suctioning.

O2 = Assessment of knowledge and practice of endotracheal suctioning

after the intervention.

7.1.2 Setting

The study will be conducted in selected hospitals in Mangalore.

7.1.3 Population

Staff nurses working in ICU of selected hospitals of Mangalore.

7.2 Method of data collection

7.2.1 Sampling procedure

Purposive sampling technique will be used to select the sample.

7.2.2 Sample size

The sample would comprise of 30 staff nurses.

7.2.3 Inclusion criteria for sampling

Staff nurse who are working in intensive care units.

7.2.4 Exclusion criteria for sampling.

1. Staff nurses who were not willing to participate in the study.

7.2.5 Instruments intended to be used

1. Demographic proforma.

2. Structured knowledge questionnaire on endotracheal suctioning.

3. Observation checklist on endotracheal suctioning.

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7.2.6 Data collection method

Prior to data collection permission will be obtained from the hospital

authority for conducting the study. Subject will be selected according to the

selection criteria. The setting will be the ICU of selected hospital.

Interventions

1. A pre-interventional knowledge of endotracheal suctioning will be assessed

by a structured questionnaire for the whole group.

2. A pre-interventional practice of endotracheal suctioning will be assessed by

using an observation checklist.

3. A detailed description on endotracheal suctioning, its indications, procedure,

and complications, will be executed to the whole group.

4. The demonstration of endotracheal suctioning, steps, and after-care will be

shown to 5 subjects at a time.

5. Subjects are allowed to perform the endotracheal suctioning on following

days.

6. The post-interventional knowledge of the whole group will be assessed

using the same structured questionnaire.

7. The post-interventional practice of each individual will be assessed by using

the same observation checklist.

7.2.7 Plan for data analysis

Analysis will be done by using the descriptive and inferential statistics.

7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly.

Yes. Endotracheal suctioning.

7.4 Has ethical clearance been obtained from your institution in case of 7.3?

Yes, ethical clearance has been obtained from the concerned authority.

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8. Bibliography

1. Black JM, Hawks JH. Medical surgical nursing. 7th ed. Philadelphia:

Elsevier Publishers.

2. Lewis SM, Collier IC, Heitkemper MM. Medical surgical nursing:

assessment and management of clinical problems. 4th ed. Philadelphia:

Mosby; 1996.

3. Pederson CM, Rosendahl, Nielsen M. Endotracheal suctioning of the

adult intubated patients-what is the evidence? Intensive and Critical

Care Nursing 2009 Feb;25(1).

4. Higgins D. Tracheal suctioning. Nursing Times 2005 Feb

22;101(8):36.

5. Day T, Farrell S, Hayes S. Tracheal suctioning an exploration of

nurse’s knowledge and competence in acute and high dependency ward

area. Journal of Advanced Nursing 2002.

6. Day T, Lies N, Griffiths P. Effect of performance feedback of tracheal

suctioning knowledge & skills: randomised controlled trail. Journal of

Advanced Nursing 2009.

7. Gongalez AN, Mingo MA. Assessment of practice competence &

scientific knowledge of ICU nurses in tracheal suctioning. Enfermaria

Intensia 2009 Jul-Sep;15(3).

8. Shirazi HZ, Karger M, Edraki M. The effect of instructing the

principles of endotracheal tube suctioning on knowledge and

performance of nursing staff working in neonatal intensive care units

Shiraz university of medical science. IJME 2010;9(4):365-70.

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9. Day T, Wainwrigh SP, Wilson-Barenett J. An evaluation of teaching

intervention to improve the practice of endotracheal suctioning in

intensive care units. Journal of Clinical Nursing 2001 Sep;10(5).

10. Mathew B. Effectiveness of planned teaching programme on

knowledge and practice of endotracheal suctioning. Nurses of India

2005 Dec.

11. Illustrated Oxford Dictionary. Great Britain: Dorling Kindersley Ltd.;

2003.

12. Smeltzer SC, Bare B. Text book of medical surgical nursing. 11 th ed.

Philadelphia: Elsevier publishers.

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9. Signature of the candidate

10. Remarks of the guide

11. Name and designation of (in block letters)

11.1 Guide MRS. SHAMBAVIASSISTANT PROFESSORDEPT. OF MEDICAL SURGICAL

NURSINGLAXMI MEMORIAL COLLEGE

OF NURSINGBALMATTA, MANGALORE

11.2 Signature

11.3Co-guide (if any) DR. LARISSA MARTHA SAMSPRINCIPAL AND H.O.DDEPT. OF MEDICAL SURGICAL

NURSING.LAXMI MEMORIAL COLLEGE OF NURSING, MANGALORE

11.4Signature

12 12.1Head of the department DR. LARISSA MARTHA SAMSPRINCIPAL AND H.O.DDEPT. OF MEDICAL SURGICAL

NURSING.LAXMI MEMORIAL COLLEGE

OF NURSING, MANGALORE

12.2 Signature

13. 13.1 Remarks of the Chairman and Principal

13.2 Signature

13