Download A study to evaluate the effectiveness of self instructional module on

PROFORMA FOR REGISTRATION
OF
SUBJECT FOR DISSERTATION
Mrs. Lovera Suresh
Mrs. Anju Malik
Head of the Department
1st year M. Sc. Nursing
Paediatriac Nursing
Medical Surgical Nursing
2012-14
Sarvodaya College of Nursing,
Oriental College of Nursing,
Bangalore – 560 079
Bangalore – 560 010
1
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE,
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1
NAME OF THE CANDIDATE AND
Mrs. ANJU MALIK
1st YEAR M.Sc NURSING,
ADDRESS
ORIENTAL COLLEGE OF NURSING,
#43/52,2nd MAIN, INDUSTRIAL
TOWN,WEST OF CHORD ROAD, RAJAJI
NAGAR
BANGALORE – 560010.
2
Oriental College Of Nursing
NAME OF THE INSTITUTION
Bangalore.
3
1st year M.Sc nursing
COURSE OF THE STUDY AND
Medical Surgical Nursing.
SUBJECT
4
DATE OF ADMISSION OF COURSE
5
TITLE OF THE TOPIC
15.06.2012
“A study to evaluate the effectiveness of self
instructional module on knowledge regarding care
of patients on anticoagulant therapy among staff
nurses in a selected hospital, Bangalore.”
6
BRIEF RESUME OF THE
INTENDED WORK
7
6.0 Introduction
Enclosed
6.1 Need for the study
Enclosed
6.2 Review of literature
Enclosed
6.2.1 Statement of the Problem
Enclosed
6.3 Objectives of the study
Enclosed
6.3.1 Operational definitions
Enclosed
6.3.2 Assumptions
Enclosed
6.3.3 Hypothesis
Enclosed
6.3.4 Sampling Criteria
Enclosed
MATERIALS AND METHODS:
7.1 Sources of data – Data will be collected among staff nurses in a selected hospital,
Bangalore
7.2 Method of data collection: Self administered questionnaire
7.3 Does the study require any investigation or interventions to be conducted on the
patients or human beings or animals? Yes
7.4 Has ethical clearance being obtained your institution? Yes
8
LIST OF REFERENCES: Enclosed
2
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE,
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1
Mrs. ANJU MALIK
NAME OF THE CANDIDATE
1st YEAR M.Sc NURSING,
AND ADDRESS
ORIENTAL COLLEGE OF NURSING,
#43/52,2nd MAIN, INDUSTRIAL
TOWN,WEST OF CHORD ROAD,
RAJAJI NAGAR
BANGALORE – 560010.
2
NAME OF THE INSTITUTION
Oriental College Of Nursing
Bangalore.
3
COURSE OF THE STUDY AND
Medical Surgical Nursing.
SUBJECT
4
DATE OF ADMISSION OF
15.06.2012
COURSE
5
1st year M.Sc nursing
“A study to evaluate the effectiveness
TITLE OF THE TOPIC
of self instructional module on
knowledge regarding care of patients
on anticoagulant therapy among staff
nurses in a selected hospital,
Bangalore.”
3
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE,
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1.
NAME OF THE
Mrs. Anju Malik
CANDIDATE & ADDRESS
1st Year M.Sc. Nursing
Oriental College of Nursing,
#43/52,2nd Main, Industrial
Town,West of Chord Road,
Rajaji Nagar
Bangalore – 560010.
2.
3.
4.
NAME OF THE
Oriental College of Nursing,
INSTITUTION
Bangalore – 560010
COURSE OF STUDY AND
1st Year M.Sc. Nursing
SUBJECT
(Medical Surgical Nursing)
DATE OF ADMISSION OF
15-06-2012
COURSE
5.
“A
TITLE OF THE STUDY
study
to
evaluate
the
effectiveness
of
self
instructional
module
on
knowledge regarding care of
patients
on
anticoagulant
therapy among staff nurses in
a selected hospital, Bangalore.”
4
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“Education is the most powerful weapon which you can use to change the
world.”
Nelson Mandela
Systemic activities to prevent or cure health problems in humans are
delivered by health care providers. The medicine man, the priest, the herbalist and
magicians, all tried to bring relief to the sick in an almost complete absence of
scientific medical knowledge. As the world becomes modernized, the advent of
new technologies discovered many methods of treating diseases and illness.1 The
global burden of disease study suggests that by the year 2020 India will have more
individuals with Athero thrombotic Cardiovascular diseases than any other
region.1
By 2020 Heart disease will become the leading cause of both death and
disability worldwide. Compared to the year 2000, the number of years of
productive life lost to Cardiovascular disease will be increasing in 2030 by 20% in
USA, 30% in Portugal, 57% in china, 64% in Brazil and 95% in India. And by
2040, women in countries like Russia, Brazil, India, China and South Africa will
represent higher proportion of deaths due to cardiovascular disease than men. The
WHO predicts 11.1 million deaths will occur from Coronary heart disease (CHD)
by 2020.2
In India, it is likely to have 100 million heart patients (60% of world’s heart
patients by the year 2020).5 According to an observation made by president of
Cardiological society of India, it has been predicted that these diseases will
increase rapidly in India and this country will host more than half cases of heart
disease in the world within next 15 years.3
5
Thrombosis is common in cardiovascular diseases such as Atrial Fibrillation
(AF), Heart failure, Coronary artery syndromes, Stroke and even Cancers. As
Thrombus consists of platelets and fibrins, optimum Antithrombotic prophylactic
therapy can and should be directed towards both. Antithrombotic therapy refers to
the use of medications which interfere with blood clot formation. The use of
Antithrombotic drugs has become an important and vital part of treating Acute
Myocardial Infarction (AMI), unstable angina pectoris, Coronary artery disease,
Peripheral vascular disease and Stroke.4
A study was conducted on Thrombosis and Acute coronary lesions in
sudden Cardiac Ischemic death. The sample comprised of 100 subjects who died
of Ischemic Heart Disease in less than 6 hours, out of them 74% had Coronary
thrombi, and 21% had Plaque fissuring. The study revealed that these findings
have implications for the prevention of sudden cardiac deaths by Antithrombotic
therapy.5
A study was conducted on Assessment of healthcare professional’s
knowledge about Warfarin-Vitamin K drug-nutrient interactions. The study
sample included 160 randomly selected healthcare providers (40 in each
physicians, pharmacists, dietitians and nurses). A 98 item questionnaire was used
in this study. It concluded that the healthcare professionals appear to have
demonstrated some proficiency in their respective areas of expertise but they
exhibited less knowledge than others. Therefore, additional training and
integration of knowledge and expertise about drug-nutrient interactions among
healthcare professionals are essential to provide appropriate patient counseling
and optimal therapeutic outcomes.6
6.1 NEED FOR STUDY
Medication errors are especially significant for nurses, since nurses are
often at the sharp end of the medication administration process. Nurses perform an
important role regarding patient safety in health care settings. Lack of drug
knowledge and lack of important patient information causes medication errors.
6
Regardless of what is ordered, nurses need to be able to recognize when a
prescribed dose of a medication is too high. In administering medications, nurses
are accountable for knowing why the medication is being used, what possible side
effects to monitor for and what a therapeutic dosage would be. Because the lack of
knowledge of drugs can account for 15% of administration related medication
errors, nurses must take the time needed to check dosing, they need to continually
refresh their memory.7
Heart disease, stroke and chronic obstructive pulmonary disease are now
adding a double burden on low and middle income countries with epidemics of
diabetes (increase from 246 to 380 million between 2007 and 2025) and cancer
(estimated number of new cases world wide will reach 16.8m with 65% occurring
in developing countries in 2020). Of the 16.7 million deaths from cardiovascular
disease every year (first leading cause of death), 7.2 million are due to ischemic
heart disease, 5.5 million due to coronary artery disease, 3.9 million due to
hypertensive and other heart conditions including artherothrombosis, peripheral
arterial disease, thromboembolism which are predicted to be leading cause of
death world wide by 2020 which comes under the cluster of vascular disease.8
Venous thromboembolism is the 3rd most common cardiovascular illness
after acute myocardial infarction and stroke. Approximately one million cases of
venous thromboembolism in United States each year, many of which represent
recurrent disease which include pulmonary embolism and deep vein thrombosis.
Incidence of venous thromboembolism is reported to be 28% in South Indian
population. Pulmonary Embolism is the 3rd most common cause of hospital related
death.9
Deep vein thrombosis occurs in about 1.79 per 1000 general population in
India per year. It is estimated that approximately 350,000 to 600,000 Americans
each year suffer from Deep Vein Thrombosis and pulmonary embolism and
100,000 deaths may be directly or indirectly related to these disease. Various
methods of treatment of vascular disorders include thrombectomy, embolectomy,
venacava filter placement, thrombolytic therapy, and anticoagulant therapy.
Among these, anticoagulant therapy are widely used and are available in the form
7
of Intravenous infusion of large volume of heparin, intermittent intravenous
injection, unfractioned heparin, low molecular weight heparin or oral
anticoagulant therapy.10
The prevalence of heart attack in Bangalore, which was 2% in 1960, has
increased to 12% in 2008. Unfortunately heart attack and other heart related
ailments are steadily increasing among the people.11Anticoagulants are effective
and useful in the primary, secondary prevention of venous thromboembolism,
prevention of acute myocardial infarction, prevention of systemic arterial
embolism in patients with tissue or mechanical prosthetic heart valves and
prevention of stroke. As the population continues to age and wider and variety of
health problems and illness is treated more and more, people are being maintained
on warfarin. Approximately 1% of the population or two million people in the
United States receive oral anticoagulant therapy.5
Although the use of anticoagulant is effective, there are risks associated
with it. The annual risk estimates range from 2-22% of bleeding and 2-9% for
treatment failure. The cumulative risk of life threatening complication and oral
anticoagulation related death was 1% at 6 month, 5% at 1 year, 7% at 2 and 3
years in an actuarial analysis of long term treatment. The risk of hemorrhagic
complications was higher in elderly patients because of poor compliance or a
relative dietary vitamin k deficiency. Other risk factors of anticoagulant related
hemorrhage are well known such as active peptic ulcer, alcoholism, aspirin
associated factors, coagulopathy, occult bleeding, severe hepatic or renal disease,
severe hypertension, poor patient compliance and excessive anticoagulation.12
A descriptive study was conducted in 2012 on under use of Antithrombotic
therapy which caused high incidence of Ischemic stroke (IS) in patients with
Atrial fibrillation (AF). The incidence of ischemic stroke was 46.2% .The
prescription rate was 53.3% in Antithrombotic therapy, which included 42.5% of
Antiplatelet agents and 10.8% of Warfarin. The findings of the study reveals that
it is important to give Anti thrombotic therapy to newly diagnosed patients with
AF in order to prevent Ischemic stroke (IS). 13
8
An evaluative study was conducted on pharmacological Skills of Nurses
and Nursing students, using the medication calculation and skill test. The
maximum score was 24 points. The mean score for nurses was 18.6 and that for
students was 16.3. Half (50%) of the students attained a score of 67% and 57% of
nurses attained a score of 79%. It reveals that nurses and students had deficiencies
in their pharmacological skills.14
The investigator came across ward, where a post Myocardial Infarction
patient treated with Heparin was developing certain complications, where the
nurses failed to recognize those complications. The above facts and studies
created an insight in the investigator’s mind that by improving the knowledge
regarding anticoagulant therapy among staff nurses who are taking care of clients
on anticoagulants, will reduce the incidence of complications. It may enhance the
changes in health care delivery system.
6.2 REVIEW OF LITERATURE
A review of related literature is an essential component of any research
study or research project. Literature review through light on the studies and their
findings reported about the problem under study. It gives understanding and
inspires insight into the problem. The review of literature in a research report is a
summary of current knowledge about a particular practice problem and included
what is known and not known about the problem.15
The literature for the present study is organized and presented under the following
headings:
1. Literature related to incidence of using oral anticoagulation therapy.
2. Literature related to complications of anticoagulant therapy.
3. Literature related to knowledge regarding anticoagulant therapy among staff
nurses.
9
Section 1: Literature related to incidence of using oral anticoagulation
therapy
A study was conducted in USA on Trends in use of Anti Thrombotic agents
(ATA) in patients with Non-ST Segment Elevation Myocardial Infarction [NSTEMI]
managed with an invasive strategy. They analyzed Trends in use of ATA in 64,199
NSTEMI patients [n=100 sites] managed invasively with Cardiac catheterization from
2007-2010. ATA included Un-fractionated Heparin [UFH], Low Molecular Weight
Heparin [LMWH], Glycoprotein IIb/IIIa inhibitors [GPI] and Bivalirudin [Biv]. From
2007-2010 a consistent increase in the use of Biv and decline in use of GPI was observed
despite no change in the proportion of patients treated with Percutaneous Coronary
Interventions(PCI) within 48 hrs of hospital arrival [50.0% VS 51.8% P=0.19]. Excess
dosing of UFH [81.1% VS 58.9% P<0.0001] and GPI [8.4% VS 5.4%, P<0.0001] also
declined significantly over this time period. Although in hospital mortality remained
unchanged [2.2% VS 1.9% P=0.08], there was a significant decline in the rate of major
bleeding [9 .1% VS 6.8%, P<0.0001]. In past 4 years NSTEMI patients managed
invasively receiving less GPI and LMWH and more UFH and Biv, with better dosing
accuracy as well. Mortality rate remained stable, but rates of major bleeding have
improved.16
A study was conducted on global patterns of use of Antithrombotic and
Antiplatelet therapies in patients with Acute coronary syndrome (ACS). Data from
12,665 patients with ACS were analyzed. Baseline characteristics, clinical
presentation and medication use were compared. Regional differences of
Antiplatelet and Antithrombotic therapies were analyzed. Overall Unfractionated
Heparin (UFH) was used in 57% of patients and LMWH in 47% (P<0.0001).
More than 90% of patients received aspirin, but approximately 13% were not
discharged on Aspirin. Overall, 30% of patients received Thienopyridines (with
PCI) in 79%. Of those who did not receive Aspirin, 31% received
Thienopyridines. Intravenous Glycoprotein inhibitors were given to 17% patients.
Among those treated with PCI, only 47% received Glycoprotein inhibitors and
21% of those given GPI inhibitors did not undergo PCI. The results revealed that
significant geographic variation was apparent in the use of Un-fractionated
Heparin, LMWH, Thienopyridines and Glycoprotein inhibitors.17
10
A prospective study conducted with an objective to determine the
incidence of Deep Vein Thrombosis after abdominal, orthopaedic, neurosurgical
procedures among 100 patients in Fr. Muller medical college, Karnataka from
July 2004- June 2006 and the results revealed that 14 patients were having Deep
Vein Thrombosis postoperatively, 7 from general surgery, 4 from neurosurgery, 3
from orthopaedic surgery and the author concluded that the incidence of Deep
Vein Thrombosis in postoperative patients are significant enough to advocate
prophylactic anticoagulant therapy to those who have to undergo major surgical
procedures.18
A study conducted to identify the main indication of oral anticoagulant
therapy and common drug used among 41 patients who are on long term
anticoagulation with acenocumarol in hematology department, Spain over a period
of 3 months and results revealed that indications of oral anticoagulation therapy
were
prosthetic
valve
(36.6%),
Atrial
Fibrillation
(34.15%),
Venous
thromboembolism (21.95%) and others(7.31%) with target of 2-3 International
Normalized Ratio units (63.4%) or 2.5-3.5(36.6%) and the most common drugs
using are acenocumerol and the author concluded that oral anticoagulant therapy
are mostly used by prosthetic valve patients.19
A retrospective study conducted with
an objective to determine the
incidence of Venous Thromboembolism among hospitalized patients and to
increase the awareness of need for Venous Thromboembolism prophylaxis in
medical college, Madhya Pradesh and the data collected from inpatient and
outpatient record during the period of 1996- 2005 and the results revealed that
Venous Thromboembolism was 17.6 per 10000 admissions, 5 per 10000
operations, 40.3% Deep Vein Thrombosis after general surgery, 20.1% after
orthopaedic surgery and the author concluded that general surgery operations are
the most common cause of Deep Vein Thrombosis, which is no longer a rarity in
India, which require prophylaxis with anticoagulant therapy.20
A case report of 42 year old male patient with an old case of deep vein
thrombosis on warfarin and other drugs like duetiapine, aspirin, diclofenac,
sodium, fonofibrate, atrovastatin, propanolol and citalopram for concurrent illness
11
who presented with widespread mucocutaneous bleeding and epidural hematoma,
presented in military hospital, Shilong, detected by MRI of the spine and the case
report concluded that intraspinal hemorrhage is a rare but dangerous complication
of anti coagulant therapy, that must be suspected in any patients in anti coagulant
agents who complains of local or referred spinal pain so immediate intervention
are essential to prevent complication from intraspinal hemorrhage due to drug
interaction with warfarin which is common.21
2) Literature related to complications of anticoagulant therapy.
A study was conducted on predictors and early outcomes of Hemorrhagic
Transformation after Acute ischemic stroke (AIS) in particular in patients treated
with Tissue Plasminogen Activator (tPA). 122 consecutive stroke patients (mean
age 65.5 years, 41% women) who underwent T (2)-MRI within 6-60 hrs after
stroke were included. 25.4% of patients were treated with tPA, the overall
detection rate of Hypertension (HT) on T (2)-MRI was 20.5%. Potential predictors
of HT such as age, sex, blood pressure, and stroke etiology, prior Antithrombotic
medication, neurologic deficits on admission, tPA treatment, and specific MRI
findings were analyzed. The main predictor for Hypertension(HT) was tPA
treatment (48.4vs11.1% and odds ratio 7.50, 95% p<0.001).The results revealed
that HT is a frequent finding on T(2)-MRI in patients with AIS associated with
tPA treatment, territorial infarction and several neurological deficits on
admission.22
A prospective multicenter observational study was conducted to determine
the Incidence and severity of bleeding events in patients with Stroke and
Cardiovascular disease who were taking Oral Antithrombotic agents in Japan. A
sample of 4,009 patients were taken, who were taking Oral Antithrombotic agents
for Cardiovascular Disease (CVD) and Stroke. They were classified into 4 groups,
the single Antiplatelet agents group (47.2%), the dual Antiplatelet group (8.7%),
the Warfarin group (32.4%) and the Warfarin plus Antiplatelet group (11.7%).
During 19 months follow up there were 57 life threatening and 51 major bleeding
events. The annual incidence of primary end point was 1.21% in single platelet
group, 2.00 % in dual platelet group. After adjustment for baseline characteristics,
12
adding a platelet to Warfarin increased the risk of primary end point and adding
another platelet to single platelet agent increased secondary end point bleeding.
The study reveals that dual Antithrombotic therapy was related to increased risk of
bleeding events.23
A study was conducted on the risk of Hemorrhagic complications of patients
in hospital who fall while receiving Antithrombotic therapy. A 4 years old
retrospective review of patients who fell during admissions in 500 bedded
hospital, major hemorrhagic injuries including subdural hematoma, major
bleedings, cuts, patients use of Antithrombotic medications (Warfarin, Aspirin,
Clopidogrel and Heparin) and Anticoagulation status were recorded. A total of
1,861 patients were reviewed. 10% falls caused major hemorrhagic injury
(Warfarin 6%, no therapy 11%. Logistic regression showed in hemorrhagic injury
was with female gender (odds ratio 1.6), use of Aspirin (odds ratio 1.4) and use of
Clopidogrel (odds ratio 2.2). The results revealed that person taking
Antithrombotic therapy had more fall rates than Warfarin taking person. Their
perception may contribute to the care gap between the number of patients who
would theoretically derive over all benefit from Warfarin therapy and those who
actually receive it.24
A population based observational cohort study was done to estimate the
bleeding risks associated with combinations of Aspirin, Thienopyridine
derivatives and Warfarin in elderly patients following Acute Myocardial
Infarction (AMI). A total of 21,443 elderly survivors of AMI were studied.
Patients were divided into five groups according to drug exposure. Hospitalization
for bleeding was observed in 1,428 patients (7%). Compared with rates of patients
receiving Aspirin alone (0.03% / patient year), rates of bleeding were higher
among patients with Antiplatelet combination (0.07 % / patient year),
Anticoagulation combination (0.08% / patient year) and 3 drug combination
(0.09%/patient year). Compared with Aspirin alone, the ratio of bleeding was 1.65
for patients receiving Antiplatelet combination and 1.92 for patients receiving the
Anticoagulant combination. Only 1 of 141 patients in 3 drug combination group
had a bleeding event. The results revealed that in practice, Antiplatelet and
13
Anticoagulation combinations lead to modest increases in bleeding risk in elderly
patients.25
Section III: Literature related to knowledge regarding anticoagulant therapy
among staff nurses.
A cross sectional study was conducted on Medication knowledge,
certainty and risk of errors in health care. A sample of 203 RN’s aged 42.0(9.3)
years with a working experience of 12.4(9.2) years were taken. Knowledge scores
in pharmacology, drug management and drug calculations were 10.3, 7.5 and
11.2, respectively and certainty scores were 1.8, 1.9 and 2.0. 15% of the total
answers showed a high risk of error, with 25% in drug management. Independent
factors associated with high medication knowledge were working in hospitals,
post graduation specialization (p=0.01) and completion of courses in drug
management. The study revealed that Medication knowledge was found to be
unsatisfactory among practicing nurses with significant risk for medication errors
and need to improve nurses basic knowledge, especially in drug management is
essential. 26
A study was conducted on Nurses knowledge of pharmacology behind
drugs they commonly administer. The study included 42 nurses working in
surgical wards of a foundation hospital in the North of England. Data were
collected by structured knowledge interview and questionnaire methods. They
were given a score of 10(100%) to determine their actual pharmacology
knowledge. The sample comprised of 18(42.9%) junior nurses and 24(57.1%)
senior nurses. They had a median experience of 10.87 years post registration. The
results shows that mean knowledge score was six ranging between two and nine.
Only 11(26.1%) nurses scored eight or above and the majority 24(57.2%) scored
below seven, indicating inadequate knowledge. Knowledge of the mechanism of
action and drug interactions was poor. There was a correlation between
knowledge and experience. The study concludes and supports that the need for
supplementary pharmacology education for nurses in clinical settings, focusing on
common drugs they administer is necessary.27
14
A study was conducted on Assessment of healthcare professionals knowledge
about Warfarin-vitamin K drug-nutrient interactions. The study sample included 160
randomly selected healthcare providers (40 in each- Physicians, Pharmacists, Dietitians
and Nurses). A 98 item questionnaire was used in this study. It concluded that the
healthcare professionals appear to have demonstrated some proficiency in their respective
areas of expertise; they exhibited less knowledge in others. Therefore, additional training
and integration of knowledge and expertise about drug-nutrient interactions among
healthcare professionals are essential to provide appropriate patient counseling and
optimal therapeutic outcomes.28
A study conducted to assess the knowledge on anti coagulant therapy
among 120 patients in an outpatient clinic in Brazil over a one month period
(2006), through a questionnaire with 10 questions with closed answers and correct
answers to about 80% of the questions were considered satisfactory and results
revealed that 64% showed satisfactory knowledge, 69.4% of the sample was
beyond therapeutic range and 42.5% had hemorrhage in the last 6 months, so the
author concluded that factors such as educational level, income, hemorrhagic
event, anti coagulant time, gender, did not show satisfactory significant
differences and obvious need for systematic follow up by health care professional
using educational measure to detect the difficulties faced by patient and measuring
optimal International Normalized Ratio.29
An article on the importance of organization of an education program by
nurses for the assessment of patients satisfaction involved six districts of health
authority “ASL 3 Genovese” (Genoe-Italy), where 3764 patients in oral anti
coagulation therapy are followed for monitoring International Normalized Ratio
after administration of a questionnaire to assess patients satisfaction with clarity of
presentation, relevance of the contents, appropriateness of educational method and
usefulness of booklet which was developed with the contribution of hospital
cardiologist, laboratory services, risk managers and general practitioners and the
results revealed that among 1074 patents who attended the 96 health education
sessions, 1039 participants completed
the questionnaires and the rate of
attendance varied greatly in the 6 districts ranging from 26%-68%, mean age was
15
74 and author concluded that educational services with the involvement of all the
professionals that contribute the patents care were very appreciated.30
A study conducted to evaluate patients knowledge regarding oral
anticoagulation among 150 patients attending anticoagulation clinic in Dublin
teaching Hospital, over a 1 month period, 2003, Ireland and revealed the
following as 125(83%) perceived that they had received education about therapy,
concomitant aspirin was avoided by 125(83%) patients but 25(12%) thought it is
safe in combination with warfarin, 33 (22%) believed that alcohol was safe in
combinations with warfarin, 125 (83%) patients identified the 1mg correctly, 105
(70%) identified 3mg tab and 98 (65%) the 5 mg tab correctly . 42 (28%) patients
couldn’t describe their current therapy, potential complication from over and
under dosage with warfarin were unknown 89 (59%) and 90(68%) patients
respectively and the author suggest improving staff nurse knowledge and educate
patients may improve control, reduce complication and therefore reduce burden
on the health science.31
6.2.1 STATEMENT OF THE PROBLEM
“A study to evaluate the effectiveness of self instructional module on
knowledge regarding care of patients on anticoagulant therapy among staff
nurses in a selected hospital, Bangalore.”
6.3 OBJECTIVES OF THE STUDY
1. To assess the knowledge of staff nurses regarding care of patients on selected
anticoagulant drugs by conducting pre test.
2. To evaluate the effectiveness of Self instructional Module regarding care of
patients on selected anticoagulant drugs among staff nurses by comparing
mean pretest and post test knowledge scores.
16
3. To find the association between pretest knowledge scores of the staff nurses
regarding care of patients on selected anticoagulant drugs with selected socio
demographic variables.
6.3.1 OPERATIONAL DEFINITIONS
1. Effectiveness: In this study, it refers to the extent to which the self
instructional module has achieved the desired result in enhancing the level
of knowledge of staff nurses on care of patients on selected anticoagulant
drugs in terms of difference in mean pre test and post test knowledge scores.
2. Self instructional module: In this study, it is a self contained written
material prepared by the researcher to promote self learning of staff nurses
about care of patients on selected anticoagulant drugs.
3. Knowledge: In this study, it refers to the information obtained from the
staff nurses regarding care of patients on selected anticoagulant drugs as
measured by the number of correct responses given to the items in the
structured knowledge questionnaire.
4. Anti coagulant therapy: In this study, it refers to the drugs which reduce
chance of clot formation like Heparin,Warfarin, ,Danaparoid,Urokinase etc.
5. Staff nurses: It refers to a Registered nurse who holds Diploma, Bachelor’s
degree or Masters Degree in nursing and those who are working in a
selected hospital, Bangalore.
6.3.2 ASSUMPTIONS
1.
Staff nurses may have inadequate knowledge regarding care of patients on
selected anticoagulant drugs.
2.
Self Instructional Module may improve the level of knowledge of staff
nurses regarding care of patients on selected anticoagulant drugs.
17
6.3.3. HYPOTHESIS:H1: There will be significant improvement in the post test knowledge scores
among staff nurses regarding care of patients on selected anticoagulant drugs.
H2: There will be significant association between the pretest knowledge scores
among staff nurses regarding care of patients on selected anticoagulant drugs with
selected socio demographic variables.
6.3.4 SAMPLING CRITERIA
A. INCLUSION CRITERIA:
The study includes staff nurses who are:1. available at the time of data collection.
2. working in ICU, Medical and surgical wards.
B. EXCLUSION CRITERIA:
The study excludes staff nurses who are:
1. not willing to participate and not available during data collection.
6.3.5 DELIMITATIONS
1. The study is limited to selected staff nurses in a selected Hospital, Bangalore.
2. The study is limited to 50 staff nurses.
3. The duration of data collection is limited to 4 weeks.
7. MATERIALS AND METHODS
7.1 SOURCES OF DATA
Staff nurses in a selected Hospital, Bangalore.
18
7.2 METHOD OF DATA COLLECTION
i. Research approach
: Evaluative approach.
ii. Research design
: Quasi-experimental, pretest-post test design.
iii. Setting of the study
: Selected Hospital, Bangalore.
iv. Population
: All staff nurses in a selected hospital, Bangalore.
v. Sample
: Staff nurses in a selected hospitals who fulfill the
inclusion criteria, Bangalore.
vi. Sample size
vii. Sampling technique
: 50 staff nurses.
: Non-probability, Convenient sampling technique.
viii. Method of data collection: Self administered Questionnaire.
ix. Tool for data collection
: Structured knowledge Questionnaire.
x.Method of data analysis : The researcher will use appropriate statistical
technique for data analysis and will present in the form of tables and diagrams.
1. Demographic variables will be analyzed by frequency, percentage distribution.
2. Knowledge will be analyzed by Mean, Median, Standard Deviation.
3. Effectiveness of self instructional module will be analyzed by paired T-test
4. Association between pre test level of knowledge regarding care of patients
with anticoagulant therapy and selected demographic variables will be
analyzed by chi-square test.
xi. Duration of study
: 4 weeks
xii. Variables
Independent variable
In this study the independent variable refers to SIM on care of patients on
selected anticoagulant drugs.
Dependent variable
In this study the dependent variable is knowledge of staff nurses regarding
on care of patients on selected anticoagulant drugs.
Demographic variables
Demographic variables such as age, gender, marital status, occupation,
educational qualification, types of family, previous information.
19
xiii. Projected Outcome: The study may be beneficial in improving the level of
knowledge among staff nurses regarding the care of patients on
anticoagulant therapy and help them to take precautionary measures to
prevent further complications.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR
INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR
OTHER HUMANS OR ANIMALS?
Yes
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM
INSTITUTIONS?
Yes. Ethical clearance report is here with enclosed.
20
8.0 REFERENCE
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23
28. Couris RR, Tataronis GR, Dallal GE, Blumbers JB, Dwyer JT. Assessment
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24
9.
SIGNATURE OF THE
CANDIDATE
10.
REMARKS OF THE GUIDE
11.
NAME AND
DESIGNATION
11.1 GUIDE
11.2 SIGNATURE
11.3 CO-GUIDE
11.4 SIGNATURE
11.5 HEAD OF THE
DEPARTMENT
11.6 SIGNATURE
12.
12.1 REMARK OF THE
PRINCIPAL
12.2 SIGNATURE
25
26