RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,



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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE , KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

|1. |NAME OF THE CANDIDATE AND ADDRESS |SUGANDHI D’SOUZA |

| | |1 YEAR M.Sc NURSING |

| | |IKON NURSING COLLEGE |

| | |NO.32, BHEEMANA HALLI |

| | |BANGALORE MYSORE MAIN ROAD |

| | |BIDADI-562 109 |

| | |RAMANAGAR TALUK AND DIST |

|2. |NAME OF THE INSTITUTION |IKON NURSING COLLEGE |

| | |BANGALORE |

|3. |COURSE OF THE STUDY AND SUBJECT |1 Year M.Sc Nursing |

| | |Medical Surgical Nursing |

|4. |DATE OF ADMISSION |10-05-2010 |

|5. |TITLE OF THE TOPIC |“A study to evaluate the effectiveness of planned video assisted teaching |

| | |programme on Cardio Pulmonary resuscitation among the nurses working in |

| | |a selected hospital in Bangalore City”. |

6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION:

Cardio Pulmonary Resuscitation (CPR) is a critical component of basic life support and the established first line before advanced life support. Cardio pulmonary resuscitation as a potential life saver is associated with survival and has the potential to prevent sudden death. The American Heart Association (AHA) resuscitation guidelines recommended that all hospital staff who are in contact with the patients should have regular resuscitation training. Research shows that the quality of cardio pulmonary resuscitation has a direct impact on victims chance of survival. Cardio pulmonary resuscitation (CPR) is a procedure that should be used for patients, for whom there is a reasonable chance of restoring and prolonging life 1.

When sudden death impends, cardio pulmonary resuscitation is the final hope for survival, and involves external cardiac compression and mouth to mouth resuscitation, which maintain circulation until normal circulation and ventilation has been restored through definitive therapy. The necessary skills for conducting cardio pulmonary resuscitation should be taught for all the health professionals. 2

According to the American Heart Association statistics EMS treats nearly 3,00,000 victims out of hospital cardiac arrests each year in US. Less than 8% of people suffer cardiac arrest outside the hospital Scenario. Less than one third of out of hospital sudden cardiac arrest victims receive bystanders CPR. The American Heart Association trains more than 12 million people in CPR annually including health care professionals and General public.3

6.2 NEED FOR THE STUDY

“Learn and Live”

Cardio pulmonary resuscitation is the method of providing oxygen and blood circulation through the delivery of rescue breathing and chest compressions to victim of sudden cardiac arrest, which occurs when the heart loses its ability to pump blood and distribute oxygen through the blood. Cardiac arrest can occur due to many accidents like road traffic, falls, sports accidents, drowning, electrocutation etc. when the heart stops beating, the brain stop receiving fresh oxygen rich blood. The brain can survive only about 4-6 minutes without oxygen. This period of 4-6 minutes is therefore critical. To provide oxygen to the brain circulation is very important. This can be done by external chest compression

.

Everybody should learn cardio pulmonary resuscitation. Updating the knowledge and skills about cardio pulmonary resuscitation is a necessary option in the field of medicine. Emergencies can strike anyone anywhere. The only person may be available at the time could be you. Therefore we should posses Cardio pulmonary resuscitation skills no matter who you are. Fortunately a short period of training is required to learn cardio pulmonary resuscitation4.

There are no reliable national statistics on cardio pulmonary resuscitation because no single agency collects information about how many people get cardio pulmonary resuscitation? How many people don’t get it? Who needs it? How many people are trained etc. Many studies have examined cardio pulmonary resuscitation in specific communities while they show varying rates of success. All are consistent in showing benefits from early cardio pulmonary resuscitation5.

Heart diseases are the world’s largest killer. Claiming 7.5 million lives every year about every 29 seconds an Indian dies of heart problem. As many as 200000 new heart patients develop every day in India. 6 crore India suffer from heart disease and 30% more are at high risk. By 2020 India will have the largest coronary heart disease (CAD) burden in the world and will account for one third of all deaths. Many of them will be young. The risk of sudden cardiac death from coronary heart disease in adult is estimated to be one per thousand adult 35 years of age and older per year. About 75% to 80% of all out of hospital cardiac arrests happen at home. Hence being trained to perform basic life support (BLS) can make the difference between life and death of a victim.

Effective BLS provided immediately after Cardiac arrest can double a victims chance of survival. If more people know BLS more lives can be saved. Health behaviour is a major target of teaching and it is assumed that teaching helps in changing behaviour through cognitive and psychomotor changes6.

As we mark the 50th anniversary of modern-era cardio pulmonary resuscitation, we must acknowledge that, measurable progress aimed at its prevention. Cardiac arrest both in and out of the hospital continues to be a nature public health challenge. Over these 50 years scientific knowledge about arrest, pathophysiology and resuscitation mechanism has increase substantially. In our on going commitment to ensure optimal community based care for all victims of cardiac arrest, we must continue effectively to translate the science of resuscitation into clinical care and improved resuscitation outcomes. Each year cardio pulmonary resuscitation saves thousands of lives in United States of America. More than 10 million Americans are trained through American heart association and American Red Cross.

The cardiac arrest survival rate falls and estimated 7% to 10% for every minute without effective cardio pulmonary resuscitation. Cardio pulmonary resuscitation if not performed effectively within 4-6 minutes after cessation of breathing can lead to failed cardio pulmonary resuscitation meaning the cardio pulmonary resuscitation attempts were not successful in restoring life brain death. To prevent such disastrous condition all health team professionals should be able to effectively follow the chain of survival that is early recognition ( Early basic life support ( Early access to emergency services (Early defibrillation.

All the health team members should be expert in giving cardio pulmonary resuscitation. If the nurses are educated and trained we can save many lives because they are the people who are closely monitoring the patients. Investigator believes that by broadening training and encouraging the public and the health care professionals specially the nurses to perform cardio pulmonary resuscitation will save thousands of life. Health team members should be equipped with the skills of cardio pulmonary resuscitation not only to practice in the hospital setting, but act as a good Samaritan where ever required7.

STATEMENT OF THE PROBLEM

“A study to evaluate the effectiveness of planned video assisted teaching programme on cardiopulmonary resuscitation among nurses working in the selected hospital in Bangalore city.

OBJECTIVES

1. To assess the existing knowledge of the nurses on cardiopulmonary resuscitation.

2. To administer planned video assisted teaching for nurses on cardio pulmonary resuscitation.

3. To assess the post test knowledge of the nurses on cardiopulmonary resuscitation.

4. To find out the effectiveness of planned video assisted teaching programme on cardiopulmonary resuscitation by associating pre-test knowledge with their post-test knowledge.

5. To associate pre-test knowledge with their selected demographic variables of the nurses.

6.5 OPERATIONAL DEFINITIONS

Evaluation:

It refers to the assessment of pre-test and post test knowledge score of the nurses.

Effectiveness:

It refers to the extent to which the planned video assisted teaching programme enhances the knowledge of the Nurses in cardiopulmonary resuscitation.

Planned Video Assisted Teaching Programme :

It refers to planned and organized video assisted teaching programme which provides information and knowledge regarding cardiopulmonary resuscitation.

Cardio Pulmonary Resuscitation:

Cardio pulmonary resuscitation is a technique of basic life support for the purpose of oxygenating the brain and heart until appropriate definitive medical treatment can restore the normal heart and ventilator action.

Nurses:

It refers to nurses who are having GNM & BSC (N) qualification and working in the common wards, ICU, emergency medicine etc, and has below 5 years of experience in the clinical area.

6.6 ASSUMPTIONS OF THE STUDY

• Nurses may have basic knowledge regarding cardiopulmonary resuscitation.

• Video assisted teaching programme may enhance the knowledge of the nurses regarding cardiopulmonary resuscitation.

6.7 HYPOTHESIS:

• H1: There will be significant co-relation in the level of knowledge of the nurses on cardiopulmonary resuscitation before and after planned video assisted teaching programme.

• H2: There will be significant association between the pre test and post test knowledge of the subjects on cardiopulmonary resuscitation with their selected demographic variables.

6.8 REVIEW OF THE LITERATURE:

Review of literature is an essential step in the development of a research project. It involves the systemic identification; location scrutinizing and summery of written materials that contain information on the research problem. It helps to develop an insight into the area of investigation and directs the researcher to develop a plan.

Literature review is done for the study is presented under the following heading

1. Studies related to general information regarding CPR .

2. Studies related to the knowledge of nurses regarding CPR.

3. Studies related to the effectiveness of teaching programme among nurses.

1. Studies related to general information regarding CPR.

The study was conducted at Washington University School of Medicine in St. Louis to rule out only giving Cardiac compression by the bystanders without giving breath, there were improved survival rates. They combined the data from the three studies in a meta analysis and were able to analyze survival rate in more than 3.700 cardiac arrest patients who received either standard CPR or Chest compression only. Those smaller studies had suggested chest compression –only CPR may improve survival. One noted a 14% increase in survival to hospital discharge, while 2nd reported a 24% improvement in 30 days survival. But analyzing all three studies the team determined that survival improved by 22% when bystanders called 911 and were advised by the dispatches to do chest compression-only CPR8.

A study was conducted to evaluate the effect of compression-only CPR. Data was collected from emergency medical services division of public health for seattle and king country and colleagues. 1941 adults out of hospital cardiac arrest, dispatches randomly provided CPR directions to bystanders for compressions either alone or with rescue breathing. No significant differences were observed in the proportion of patients who survived to hospital discharge or survive with the favourable neurology outcome. Compression along was linked to a nonsignificant trend towards a higher proportion of patients surviving to hospital discharge for those with a cardiac cause of arrest or shockable rhythms9.

The study was conducted to analyze survival rate using the two main approaches. The daily telegraphs suggested we should “Skip the Kiss”. When giving the kiss of life. While BBC News emphasized that the study “backs chest compression in resuscitation”. The new study which does not constitute official guidance examined a form of CPR that uses chest compression but not breathing into the mouth. This is known as compression-only CPR10.

The study was conducted to know the quality of CPR in an important predictor of outcome from cardiac arrest. Mechanical chest compression devices provide an alternative to manual CPR. Physiological and animal data suggest that mechanical chest compression devices are more effective than manual CPR. Consequently there has been much interest in the development of new technique devices to improve the efficacy of CPR. The review will consider the evidence and current indication for the use of some of the more common mechanical devices developed to increase the safety and efficacy of CPR Administration11.

The study was conducted with 7 emergency departments used AHA recommended new CPR including increased compressions, full chest wall recoil and use the impedance threshold device (ITD). When subjects were treated with new CPR techniques including the use of an ITD, the hospital discharge rates went from 7.9% to 15.7% or double the survival rate of the control group and more than double the national survival rate of 5%. These results strongly support the wide spread use of the AHA’s new 2005 CPR guidelines12.

2. Studies related to knowledge of nurses regarding CPR.

A study was done to assess the knowledge in 35 cardio pulmonary resuscitation staff of a hospital which was affiliated to the Golestan University of Medical Sciences. Simple sampling with a before-after method was applied. Data collection was done by a questionnaire of 43 questions about knowledge which was completed by the participants before and after teaching and after two months duration. Educational lectures were held by expert professions. The data were analyzed by the wilcoxan test (P ................
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