“A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED …



Rajiv Gandhi University of Health Sciences

Bangalore, Karnataka

Proforma for Registration of Subjects for Dissertation

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|1. |NAME OF THE CANDIDATE AND ADDRESS |: |Benny Barak |

| | | |M.Sc Nursing 1st Year |

| | | |H.K.E.S College of Nursing |

| | | |Basaveshwar Hospital Campus, Sedam Road, Gulbarga - 585105 |

| |NAME OF THE INSTITUTION |: |H.K.E.S College of Nursing |

| | | |Basaveshwar Hospital Campus, Sedam Road, Gulbarga - 585105 |

| |COURSE OF STUDY AND SUBJECT |: |M.Sc. NURSING, 1ST YEAR |

| | | |MEDICAL – SURGICAL NURSING |

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| |DATE OF ADMISSION |: |28/05/2010 |

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| |TITLE OF THE TOPIC |: |“A study to Assess the Effectiveness of planned Teaching |

| | | |programme on care of client with mechanical ventilatior |

| | | |among staff nurses working in selected hospitals, at |

| | | |Gulbarga” |

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6. Brief Resume of the Intended Work

INTRODUCTION

“NURSES ARE THE HEART BEAT OF HEALTH CARE “

Air flows from a region of higher pressure to region of lower pressure. During inspiration, air flows from the environment into the trachea, bronchi: bronchioles and alveoli. During expiration alveolar gas travels the same route in reverse. Disorders of the respiratory system are common and are encountered by nurses in every setting from the community to the intensive care unit1.

Adequate ventilation is dependent on free movement of air through the upper and lower airways. In many disorders the airways becomes narrowed or blocked as a result of disease, bronchoconstriction , a foreign body or secretions. Assessment and management of the patient with respiratory disorders are best accomplished when the approach is multidisciplinary and collaborative.1

The nurse may be expected to care for these patients in a setting outside the intensive care unit. The nurses should have thorough knowledge of the modes of ventilation, assessment, and trouble shooting of ventilators and assessment and care of the patients requiring mechanical ventilation.2

Mechanical ventilation is form of artificial respiration that uses breathing machine to assist patients with breathing. It is used when the lungs are not functioning properly. Mechanical ventilation is a method to mechanically assist or replace spontaneous breathing3.

Since a wide variety of ventilator are available. The ventilator selected depends on the severity of the disease process and the length of time that ventilators support is required. Two major types of ventilator are negative pressure ventilators and positive pressure ventilator.4

Mechanical ventilation is often a life saving intervention, but carries many potential complications including pneumothorax, airways injury, alveolar damage and ventilator associate pneumonia. It is used to support a single failing organ system (the lungs) and cannot reverse any underlying disease process5.

6.1 NEED FOR THE STUDY

According to Abraham Maslow’s hierarchy of human needs theory, the most fundamental basic needs of the human beings are air, water, food and sleep. Among these air or oxygen stands topmost. Breathing is a process of inspiration and expiration which provides required oxygen to the body to function physiologically well. But some of the critical or life threatening conditions such as stroke, major head injury, severe respiratory distress, can imbalance the normal respiratory function6.

In recent years, management of client with severe respiratory failure has been aimed at developing different modes of ventilation that will maintain oxygen level and minimize the complications7. A mechanical ventilator is a device with positive or negative pressure breathing facility which maintains ventilation and provides oxygen for a longer period of time to the client8.

Approximately 1.5 million persons receives mechanical ventilation annually in the United States, of these upto 25% requires prolonged mechanical ventilation. Where as in India there is no clear picture of incidence of mechanical ventilated clients9.

Care of mechanically ventilated clients is a major challenge as it carries many potential complications including pneumothorax, airway injury, alveolar damage, and ventilator associated pneumonia8.

Clients on mechanical ventilators are highly dependent and need comprehensive holistic care with constant attention, and care which includes airway maintenance, fluid electrolyte balance, nutritional needs, hygiene, elimination needs, coping, comfort, safety and infection prevention10.

Role of professional nurse in caring client with mechanical ventilator is challenging. Nurse should assume different responsibilities, show enough expertisation and skillful, to safeguard the client life and enhance the health condition of the client2.

Nurse working in ICU or with mechanically ventilated client should be able to handle different tasks and be aware of mechanical ventilator device, mode of action, trouble shooting, weaning and various parameters of ventilators such as Fraction of inspired oxygen (FiO2), Tidal volume, Oxygen saturation of Haemoglobin, (SPO2), Partial pressure of oxygen, (PaO2) Partial pressure of carbon dioxide (PaCO2).2

Nurse must be well trained and should develop sound knowledge and practical skills in taking care of client with mechanical ventilator in order to develop them as effective potential and competent nurse practitioner11.

Hence the investigator is interested to assess the knowledge of staff nurses regarding care of a client with mechanical ventilator. Based on their knowledge levels and needed curricular requirements, the investigator is interested to prepare planned teaching programme with the guidance of experts in the field and intervenes the planned teaching programme, demonstrates the apparatus to the group of staff nurses i,e. sample. Again, after giving a gap of seven days the investigator will assess their knowledge to see the effectiveness of planned teaching programme.

6.2 Review of Literature

A study was conducted on role of mechanical ventilation and development of multi-drug resistance organism in hospital acquired pneumonia in Sanjay Gandhi postgraduate institute of Medical Science at Lucknow during 2001. The respiratory specimens were collected from 148 mechanically ventilated patients and sent for cytology, bacterial culture and antimicrobial sensitivity. Result revealed that, overall rate of HAP was 53.9% mortality rate was 47.3% and attributable risk of mortality with ventilators was 72.3% and occurrence of VAP was 81.7%. Study also concluded that number of ICU isolates were MDR in comparison of those from the non ICU setting mechanical ventilation and duration of ICU stay emerged as important risk factors for development of HAP and VAP12.

A study was conducted on ventilatory management of respiratory failure in patient with severe Guillain Barre syndrome in post graduate institute of Medical Education and Research at Chandigarh in 2003. Total 11- adult patients of GBS of respiratory failure admitted in respiratory intensive care unit with mechanical ventilation support for a period of 2 months were studied over a period of years. Result revealed that, 7 patients developed ventilator associated pneumonia or sepsis and 8 patients died and 1 discharged13.

The quantitative study was conducted with aim of to assess the knowledge of health professionals about prevention of pneumonia associated to mechanical ventilation (PAMV) in two public Hospitals of Fortaleza Ceara State from June to July 2006. Data were collected by using likert scale among 104 professionals. Result obtained suggested that, knowledge of Health Professional of ICUS about prevention of PAMV was insignificant14.

A study was conducted to determine the factors that influence nurse sedation administration to mechanically ventilated patients. Data were collected by among 1250 members of the American Association of Critical Care nurses by using nurse sedation practice scale. Result revealed that, nurse attitude towards efficacy of sedation were mechanically ventilated patients was positively co-related with nurses report of their sedation practices. (r(s)=.28, p ................
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