“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING

PROGRAMME ON KNOWLEDGE REGARDING CARDIO

PULMONARY RESUSCITATION AMONG DEGREE

STUDENTS IN SELECTED COLLEGES OF

TUMKUR”

PROFORMA FOR REGISTRATION OF SUBJECT

FOR DISSERTATION

DIVYA LUKOSE

MEDICAL SURGICAL NURSING

ARUNA COLLEGE OF NURSING

RING ROAD, MARALUR, TUMKUR.

2010-2011

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,

KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION.

1. Name of the Candidate : MRS. DIVYA LUKOSE

And Address MSc Nursing Ist Year

Aruna College of Nursing

Ring Road, Maralur

Tumkur.

2. Name of the Institution : Aruna College of Nursing

3. Course of Study And : M.Sc Nursing Ist Year

Subject Medical Surgical Nursing

4. Date of Admission : 10.06.2010

5. Title of the Topic : “A Study to assess the effectiveness of

structured teaching programme on

knowledge regarding Cardio Pulmonary

Resuscitation among degree students

in selected colleges of Tumkur”

6.0 BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“Our role is to develop techniques that allow us to provide emergency life saving

procedures to injured patients in an extreme, remote environment without the presence of

a physician”

Chris Hadfield

Cardio means “of the heart” and pulmonary means “of the lungs”. Resuscitation

is a medical word that means “to revive” or bring back to life. Sometimes cardio

pulmonary resuscitation (CPR) can help a person who has stopped breathing, and whose

heart may have stopped beating, to stay alive. People who handle emergencies such as

police officers, firefighters, paramedics, doctors and nurses are all trained to do CPR.

Many other teens and adults like lifeguards, teachers, child care workers, and may be

even your mom or dad know how to do CPR too1.

Sudden cardiac death is a major cause of death in today’s developed countries. In

most cases, defibrillation and other means of advanced life support are not immediately

available. In urban settings it takes an average of nearly ten minutes for professional help

to arrive. During this time victims can only rely upon CPR provided by educated

bystanders. Therefore a substantial burden of responsibility lies on the shoulders of

educators who need to pass on their knowledge and skills of CPR to their trainees in a

way simple enough to be remembered and recalled rapidly in a highly stressful moment.

It has been shown that correctly performed bystander CPR may positively influence short

and long- term survival of cardiac arrest victims2.

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The organizations are primarily responsible for basic cardiac life support

standards in the United States: The American Heart Association and American Red

Cross. These standards are taught to health care providers and general public by certified

instructors across the nation. All nurses should be prepared in CPR. The American Red

Cross offers courses in basic first aid.CPR is taught in most hospitals or community

colleges. Care should be started immediately to prevent complications. The nurse’s

safety should never be jeopardized when administering care3.

Every nurse and physician should be skilled in CPR because cardiac arrest, the

sudden cessation of breathing, and adequate circulation of blood by the heart, may occur

at any time or in any setting. Resuscitation measures are divided into two components,

basic cardiac life support and advanced cardiac life support. The American Heart

Association establishes the standards for CPR and is actively involved in teaching BCLS

and ACLS to health professionals. The American Heart Association recommends that

nurses and physicians working with patients be certified in BCLS and ACLS.

Certification involves attending formal classes and passing cognitive and motor skill

tests. CPR alone is not enough to save lives in most cardiac arrest. It is a vital link in the

chain of survival that supports the victim until more advanced help is available. The

chain of survival is composed of the following sequence: early activation of the EMS

system, early CPR, early defibrillation and early advanced care4.

6.1 NEED FOR THE STUDY

CPR is a rescue procedure to be used when the heart and lungs have stopped

working. There is a wide variation in the reported incidence and outcome for out of

hospital cardiac arrest. These differences are due to in part to differences in definition

and ascertainment of cardiac arrest as well as differences in treatment after its onset.

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Several authors described the problem of poor performance in CPR, even when

provided by medical professionals. Numerous investigations have reported the problem

of poor skills retention after various CPR courses. Studies reporting the need for

improvement of resuscitation techniques led to the recent changes in BLS and ALS

algorithms2.

Many people may think you need to get a degree to get a healthcare job, but the

truth is many jobs simply require applicants to be CPR and First Aid certified Courses to

receive certification in CPR and First Aid are offered at colleges, technical schools, and

Red Cross facilities across the country. This makes getting certified easy and very

accessible to anyone. People can get both certifications as young as 16 years of age. This

means they can start getting credible work experience at an earlier age, which will only

help them out more down the road. And since the courses are so short, it does not have to

interfere with high school5.

Cardio pulmonary Resuscitation has been used extensively in the hospital setting

since its introduction over 3 decades ago. Saklayen M etal conducted study on in hospital

cardiopulmonary resuscitation. Survival in hospital and they reviewed that CPR records,

44% of the patient initially survived following CPR, and the 1 –year survival rate was 5%

patients with shorter durations of CPR and those administered fewer procedures and

medications during CPR survival longer than patients with prolonged CPR. Knowledge

of the likelihood of survival following CPR for subgroups of the hospital population

based on prearrest and intra arrest factors can help patients, their families, and their

physicians decide with compassion and conviction, in what situations CPR should be

administered6

. 3

Heart disease is the number one killer in the United States. Each year almost

330,000 Americans die from heart disease. Half of these will die suddenly, outside of the

hospital because their heart stops beating he most common cause of death from heart

attack in adult is a disturbance in the electrical rhythm of the heart or ventricular

fibrillation. It can be treated by applying an electrical shock to the chest. One way of

buying time until a defibrillator becomes available is to provide artificial breathing and

circulation by performing CPR7

In India the annual incidence of sudden cardiac death accounts for 0.55 per 1000

population. The survival rate of a sudden cardiac arrest is almost less than 1%. Sudden

cardiac death constitutes 40-45% of cardiovascular deaths and out of this almost 80% are

due to heart arrhythmia disturbances or arrhythmia8.

In April 2008, the American heart association took steps to simplify the process

of helping victims of cardiac arrest by introducing “hands only” CPR. About one third of

people who suffer a cardiac arrest at home or at a public place actually receive help,

bystanders could be afraid to initiate CPR for fear that they will do something wrong or

won’t know what to do. Others may be reluctant to perform mouth to mouth breathing

for fear of contracting an infection. The American heart association proposed the new

guidelines in order to allow bystander who have not been trained in conventional CPR or

who may fear making mistake a way to offer help9.

In the light of above, the investigator found it desirable to assess the knowledge

and skill in CPR technique among the degree students and also to update the knowledge

and improvement in skill. The way to learn CPR is to practice CPR. Educating the

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students and creating awareness in helping them to learn more about CPR and it help to

prevent death occurring due to cardiac arrest. Early initiation of CPR improves the

chance of successful resuscitation and survival.

6.2 REVIEW OF LITERATURE

. Literature review is a critical summary of research on a topic of interest,

often prepared to put a research problem in context10.

A study was conducted regarding awareness and attitudes of Chinese students

towards cardiopulmonary resuscitation in China (2010). Study was conducted among

3500 students from the city of Wuhan in China randomly according to the stratified

cluster sampling technique. There were 3248 questionnaires answered and 2763

questionnaires were considered valid. Few respondents reported that they had heard

(28%) and studied (27%) of CPR and only 3% of the respondents had attended a CPR

course. The two major sources of information about CPR for Chinese students were

television and books. Most respondents expressed a desire to learn CPR (77%) and were

willing to disseminate CPR (73%). The result of the study was shows that dissemination

of CPR among Chinese students has not been executed satisfactory. The finding

highlights the importance of CPR dissemination and efforts should be made to provide

more convenient, effective and attractive ways for the Chinese public, especially

students, to learn CPR11.

A study was conducted regarding effectiveness of emergency response planning

for sudden cardiac arrest in United States high schools with automated external

defibrillators in USA (2009). A cohort of US high schools with atleast 1 onsite automated

external defibrillators use in sports. A school representative completed a comprehensive

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survey on emergency planning and provided details of any sudden cardiac arrest incident

occurring within 6 months of survey completion. A case of sudden cardiac arrest victims

included 14 high schools student athletes (mean age 16 years; range, 14 to 17 years) and

22 older nonstudents (mean age 57 years; range is 42 to 71 years) such as employees and

spectators. Of the 36 sudden cardiac arrest cases, 35 (97%) were witnessed, 34 (94%)

received bystander CPR and 30 (83%) received an automated external defibrillator shock.

23 sudden cardiac arrest victims (64%) survived to hospital discharge, including 9 of the

14 students and 14 of the 22 older non students. The result of the study shows that school

based automated external defibrillator programs provides a high survival rate. High

schools are strongly encouraged to implement onsite automated external defibrillator

programs as part of a comprehensive emergency response plan to sudden cardiac arrest12.

A study was conducted regarding retention, retention, retention: targeting the

young in CPR skills training in USA (2009). The prospective investigation was

conducted and set out to determine whether young students have the physical and

cognitive skills to implement CPR. In this investigation, the average time from the last

class of CPR instructions to the evaluation session was 120 days. It is not clear whether

such a large gap in time between initial instruction and skills testing may have affected

testing performance, except that good performance could indicate good retention. As the

investigator demonstrated, students as young as 9 years are able to effectively learn CPR

skills. The students aged 9 to 10 years could compress the chest to the depth recommend

by the guidelines, but 45% of students aged 13 to 14 years old could. Studies also have

found that with retraining, CPR performance can improve in school aged children and

distributing CPR training kits to students aged 12 to 14 years resulted in another 2.5

persons trained per students13.

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A study was conducted regarding community CPR training Greece (2008). There

is a lack of information about the status and characteristics of community CPR training in

Greece. The purpose of the study was to evaluate the knowledge of basic aspects of CPR

practice, characteristics of training an areas in need of improvement to increase CPR

competence in the community. Using a random digit dialing telephone survey, 390

residents of large country were interviewed. Weighting methods were used to estimate

population statistics. Results indicated a low prevalence of current training and lack of

basic CPR knowledge, reflecting the limited extent of and access to training. Results

suggest the need for a standardized, widespread CPR program14.

A study was conducted regarding attitudes toward the performance of bystander

CPR in Japan (2007). Early initiation of bystander CPR improves the chance of

successful resuscitation and survival. A total of 4223 individuals (male 50%) completed

the questionnaire, including high school students, teachers, emergency medical

technicians, medical nurses and medical students. About 70% of the subjects had

experienced CPR training more than once. Only 10-30% of high school students,

teachers and health care providers reported willingness to perform chest compression

plus mouth to mouth ventilation, especially on a stranger or trauma victim. The study

result shows that most lay people and health care providers are unlikely to perform chest

compression plus mouth to mouth ventilation, especially on a stranger or trauma victim.

These findings suggest that mouth to mouth ventilation training should be deemphasized

and the awareness of chest compression alone should be emphasized because for

whatever reason, people do not want to perform mouth to mouth ventilation15.

A nationwide survey of CPR training conducted in Sweden about foreign born

and unemployed are not reached by training programmes (2006). The sample was

selected at random and stratified to correlate to the geographic distribution of the

population. The mean age was 46 (16) years, 54% of the respondents were females and

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11% were people of foreign origin. 45% had participated in some form of CPR training.

Younger respondents, those living in rural areas, those born in Sweden, employee’s

students and military conscripts were trained more frequently in CPR. The results shows

that held of the non trained population was willing to learn CPR but frequently did not

know that such courses existed or were they were held. Elderly people, people of foreign

origin or those not included in the work force were less likely to have participated in CPR

training16.

A study was conducted regarding teaching basic life support to 12-16 year olds in

Barcelona schools views of head teachers, in 2006(Spain). The aim of the study was to

determine the opinion of head teachers on the educational and logistical characteristics

required for a basic CPR programme for secondary school teenagers to succeed. The

results shows that one hundred out 227 (44%) surveys were sent back.:63% from private

and 37% from public secondary schools with 85% of head teachers being interested in

incorporating a basic CPR in the school curriculum. Interested head teachers did not

differ in age, sex or king of degree compared to their non interested counterparts. Overall

it was considered that the programme could increase the students self esteem (86%) and

be useful for saving lives (72%). It was also felt that both theoretical (77%) and practical

classes (97%) should be given by health care providers. In Barcelona, most secondary

schools surveyed were highly interested in a basic CPR for their teenagers in grades 3 or

4. Teachers would prefer health care providers to give the programme but would be

willing to teach basic CPR theory if trained previously17.

A study was conducted regarding basic CPR program for high school students

(PROCES). Results from the pilot program in Spanish (2005). They administered 20

question test before and after the program. Students were 14 years old in 38%, 15in 38%

and 16 or more in 24%. Before the resuscitation program, the mean mark (20 points) was

8.5 (2.4). After program, marks improved up to 13.5 (3.2) (p<0.001). Participants who

8

had previously taken a first aid course or were in the 4 th course obtained significantly

better marks than the rest. These differences disappeared after program completion.

Students rated the theoretical part as 79 (1.1), the skill part as 8.2(1.2) and emergency

physicians classes as 8.4(1.1). Conclusion of the study was the basic CPR program

useful tool for teaching and improving teenagers knowledge and skills in basic CPR with

no exceptions associated with teenagers characteristics18.

A study was conducted regarding knowledge of CPR among the public in

Hongkong; telephone questionnaire survey in Hongkong (2003). Telephone interview

method was used for this study. Study was conducted among 357 people, approximately

12% had received CPR training. CPR knowledge in Hongkong was poor, even among the

previously trained and especially with regard to circulatory maintenance. The most

common reason for not taking CPR training was lack of time. Intensified educational

efforts and exploration of new approaches to improve this first stage in the chain of

survival are warranted19.

A study was conducted regarding CPR training in Washington state public high

schools in USA (2003). Conducted a state wide survey of all 310 public high schools in

Washington state. The response rate was 89% (276) schools from a combination of mail

and telephone surveys; 35% (n=97) reported that they did not provide any CPR student

training. Of the 132 schools that provided CPR student training. 23% trainees less than

90% of their students 70% did not have any teacher trained to teach CPR or had only one

teacher with such training. Schools perceived the greatest benefit of CPR training as

providing students with the skill to save a life (43%). The most frequently identified

barriers were logical: limited time to teach the curriculum (24%) , lack of funds (16%)

and instructor scheduling difficulties (17%) . Less than 5% of respondents voiced any

opposition to CPR training and that opposition was for logistical reasons. To increase

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CPR training, the single best strategies suggested were: increase funding, provide time in

the curriculum have more certified instructors and make a CPR students training with

requirements20.

A study was conducted regarding community competence in cardio pulmonary

resuscitation in Australia (2002).The aim of this study was to determine community

application of CPR skills in an emergency, and thus assess the value of training

programmes in raising community competence. A cross sectional telephone survey of the

Western Australian population was chosen randomly (n=803). An urban sub-sample

(n=100) performed a practical demonstration of CPR skills using a simulated collapse

scenario using a recording manikin as the victim. Performance was assessed by two

observers using pre-determined criteria. Of all respondents, 64% had been trained in

CPR. This study provides a comprehensive data base of CPR training and performance,

and highlights future directions to ensure appropriate and cost-effective training .Specific

factors to be addressed include increasing frequency of teaching, and emphasizing early

activation of the emergency medical system21.

A study was conducted a survey on emergency, cardiac arrest! I can we teach the

skills? In Avon and Gloucestershire college of health, Glenside Centre, England (1997).

Students were able to improve knowledge levels, but did not uniformly improve practical

skills. Following this the college formed a resuscitation team whose members coordinate

CPR training in the curriculum, using uniform teaching packs which follow the ERC

guidelines and resuscitation equipment purchased by the college as the result by the

research findings. In addition to maintaining uniform content, sessions are compulsory

and students CPR skills are tested, with a 70% competency level set as pass. Student

results and attendance are stored on a college data base, along with tutor information

10

regarding updating CPR skills. To achieve these developments, the college had to

consider time allocation within the curriculum, training of tutors, funding of resources of

compulsory training programme, which supports a ratio of one tutor to six students22.

6.3 STATEMENT OF THE PROBLEM

A study to assess the effectiveness of structured teaching programme on

knowledge regarding cardio pulmonary resuscitation among degree students in selected

colleges, Tumkur.

6.4 OBJECTIVES

To assess the knowledge level regarding cardio pulmonary resucitation among

degree students in selected colleges.

.

To educate the degree students in selected colleges with structured teaching

programme regarding cardiopulmonary resuscitation.

To evaluate the effectiveness of structured teaching programme on knowledge

regarding cardio pulmonary resuscitation among degree students in selected

colleges.

To find out the association between knowledge regarding cardio pulmonary

resuscitation among degree students with selected socio demographic variables.

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6.5 OPERATIONAL DEFINITION

Assess: It is the organized, systematic and continuous process of collecting data

from the degree students regarding cardio pulmonary resuscitation.

Effectiveness: It refers to the extent to which the structured teaching programme

on cardio pulmonary resuscitation has improved the knowledge of students after

the implementation of the structured teaching programme as evidenced by the

differences in the pretest and post test.

Structured Teaching Programme: It refers to systematically developed

instruction designed to provide information regarding cardio pulmonary

resuscitation to degree students.

Cardio pulmonary resuscitation: it is a simple technique used to restore and

maintain breathing and circulation in cardiac arrest victims.

Knowledge: The sum of what is known regarding cardio pulmonary resuscitation.

Degree students: who are undergoing the degree in selected colleges, Tumkur.

6.6 HYPOTHESIS

H1 There will be significant difference between pretest and post test knowledge

score regarding cardio pulmonary resuscitation.

H2 There will be significant association between the knowledge with selected

demographic variables of the degree students such as age, sex, religion, previous

information regarding cardio pulmonary resuscitation.

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6.7 ASSUMPTION

It is assumed that most of the degree student may have some

knowledge regarding cardio pulmonary resuscitation.

It assumed that there will be enhancement in the knowledge of the

degree students after administration of STP.

6.8 DELIMITATION

The study was conducted only on degree students

The study was limited to 60 samples

The study was limited to selected colleges in Tumkur

7.0 MATERIALS AND METHODS

The purpose of this study is to determine the effectiveness of structured teaching

programme on knowledge regarding cardio pulmonary resuscitation among degree

students in selected colleges at Tumkur.

7.1 SOURCES OF DATA

Research approach : Evaluative approach

Research Design : One group pretest and post test

pre-experimental design

Setting of the study : Selected colleges of Tumkur

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Population : Degree students

Sample Size : 60 students

Sampling Technique : Purposive sampling

Selected Variables

Independent variable : Structured Teaching Programme

Dependent variable : Knowledge on cardio pulmonary

resucitation

Demographic variable : Age, Sex, religion, previous information

regarding CPR

Sampling criteria

Inclusion criteria

Student who are studying degree in selected colleges

Students who are willing to participate

Exclusion criteria

Students who are not willing to participate

Students who are not available at the time of study.

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7.2 METHODS OF DATA COLLECTION

7.2.1 Tools for data collection : Structured questionnaire

Tool 1 Part A : Proforma for collecting demographic data

Part B : A Structured questionnaire to assess the

knowledge regarding cardio pulmonary

resuscitation

Tool 2 : Structured teaching programme on cardio

pulmonary resuscitation

7.2.2 METHODS OF DATA ANALYSIS AND INTERPRETATION

Data will be analyzed according to the objectives of the study using

descriptive and inferential statistics and will be presented in the form of tables,

graphs and diagrams.

7.2.3 Duration of the study : 6 weeks

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7.3 Does the study requires any investigation or intervention to be conducted on

the patient or other human being or animals. If so please describe briefly

Yes, in the form of structured teaching programme.

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

Yes, Ethical clearance has been obtained from the institutions ethical

committee.

16

8.0 LIST OF REFERENCES

1. http://kidshealth.org/kid/watch/er/cpr.html.

2. Frkovic, Alan Sustic, Fred Zeidier, Alen Protic, Kritian Desa, “A brief reeducation in

cardio pulmonary resuscitation after six months the benefit from timely repetition”.

Signavitae 2008: 3(2):24-28.

3. Harkness A Gail, Dincher R Judith, “Medical surgical Nursing”, 9th edition, Mosby

publishers, Page no 499-500.

4. Lewis Sharon Mantik, Collier Idolia Cox, Heitkemper Margaret, “Medical surgical

Nursing”, volume-1, 4th edition, Mosby publishers, Page no 991-992.

5. http://www.mlatc.edu

6. SaklayenM, Liss H, Markert R, “In hospital Cardiopulmonary Resucitation.survival in

1 hospital”, Department of medicine 1995 july 74(4):163-75. Available from url:

http://www.pubmed.com

7. http://www.emedicine health.com/cardiopulmonary resuciation-cpr/article-em.htm.

8. Wockhardt hospital guide to wellness, February 8, 2010 available on www.google.com

9. Melissa Conrad,stopper, “Hands only CPR no more mouth to mouth?” Nurse education

in practice volume 10, issue 5, page no 291-297.

10. Denise K Polit & Chery Tatano Beck, “Nursing Research”, 8th edition, London,

Lippincott Williams&wilkins, 2008, pp757

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11. Zi –qiao chen, Yan etal, “Awareness and attitudes of Chinese students towards

cardiopulmonary resuscitation”, emerg.med.j.doi:10, emerg.med.j doi:10. Cardio

pulnonary1136/emj.2009.079558.

12.Drenzner JA, Rao AL, Heistands J, Bloomingdale M.K, Harmon, “Effectiveness of

emergency response planning for sudden cardiac arrest in united states high schools with

automated external defibrillators”, circulation 2009 aug 11:120(6):518-25.

13. Lynn p roppolo and Paul e pepe, “Retention: targeting the young in CPR skills

training”, critical care 2009 volume 13:185 doi: 10.1186/cc 7997.

14. Halzakis KD, Krissotakis EI, “Community cardio pulmonary resuscitation training in

Greece”, res nurs Health 2008 apr;3(2):165-71.

15. Tanguchi T, Omi w, Inaba H, “Attitudes toward the performance of bystander

cardiopulmonary resuscitation in Japan”, Resuscitation 2007 oct;75/1:82-7.

16. Axelsson AB, herlity J, Holmberg S, Thorn AB, “A nation wide survey of CPR

training in Sweden: foreign born and unemployed are not reached by training

programme”, Resuscitation 2006 ul:70(1);90-7.

17. Miro o, Jimenez-fabregaz, Espiqol G, Culla A, Diaz N, Abad J etal, “Teaching basic

life support to 12-16year olds in Barcelona Schools; views of head teachers”,

Resuscitaton 2006 jul:70(1) 107-16.

18.Miro o, Jimenez –fabrega z, Diaz N, Coll-Vinet B, Milla J, Espinosa G,Alvarez

HTetal, “Basic cardiopulmonary resuscitation program from high school students

resuscitation results from the pilot program”, Medchin (bari) 2005 jan 15;124(1).

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19. Dr. BMY chung, “Knowledge of cardiopulmonary resuscitation among the public in

telephone questionnaire survey”, Hongkong Med J vol.9 no 5 oct 2003.

20. Reder S, Quan L, “Cardio pulmonary resuscitation training in Washington state

public high schools”, Resuscitation 2003 march 56(3):283-8.

21. Celenza T, Gennat HC, O Brein d, Jacobs IG, Lynch DM, Jelinek AK, “Community

competence in cardio pulmonary resuscitation”, 2002, nov 55 (2):157-65.

22. Moule p knight C, “Emergency, Cardiac arrest! Can we teach the skill?” Nurse educ

today 1997 apr 17(2):99-105.

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9. Signature of Candidate :

10. Remarks of the Guide :

11. Name & Designation :

11.1 Guide :

11.2 Signature :

11.3 Co-Guide (if any) :

11.4 Signature :

11.5 Head of Department :

11.6 Signature :

12. 12.1 Remarks of the Principal :

12.2 Signature :