Download [Type text] RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1.Name of the candidate and address
ANUJA.M
M.Sc NURSING 1 YEAR
Dr. SYAMALA REDDY COLLEGE OF
NURSING
#111/1 SGR MAIN ROAD,
MUNNEKOLALA,
MARTHAHALLI,
BANGALORE-560037.
2.Name of the Institution
Dr. Syamala reddy college of nursing
3.Course of study and subject
M.Sc nursing 1 year.
4. Date of admission to course
MEDICAL –SURGICAL NURSING
November 2009
5. Title of the study
A study on assessment of level of
knowledge and attitude of
caregivers of clients admitted in
ICU with myocardial infarction
regarding Cardio Pulmonary
Resuscitation at selected hospitals in Bangalore.
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BRIEF RESUME OF THE INTENDED WORK
“SUCCESS IS THE PROGRESSIVE REALIZATION OF A WORTHY
GOAL”
6.0. INTRODUCTION
Birth
and death are the two natural phenomena that all of us have to accept. When a
child is born we are happy because a new person is added to our company whereas when a
person dies, we are in sorrow because he passes away from us .This death occurs at any time
due to any cause. But death can be prevented. For instance death due to cardiac arrest can be
prevented by giving CPR in time.1
We can do without a portion of liver and that of our intestines .We can even do without
a kidney, a lung and, if you are a woman, the uterus. What we cannot do without is the
heart.2The heart is a hollow, muscular organ located in the center of the thorax, where it occupies
space between the lungs and rests on the diaphragm.3 The heart through rhythmic contraction,
provides the pressure necessary to
propel blood through the body .Blood flow is essential to
deliver nutrients to the tissues of the body and to transport metabolic wastes , including heat ,to
removal sites .Functionally , the heart is actually two pumps working simultaneously .The right
atrium and right ventricle generate the pressure to propel the oxygen poor blood through the
pulmonic circulation ;the left atrium and left ventricle
propel oxygen –rich blood to the
remainder of the body through the systemic circulation .At rest, each side of the heart pumps
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approximately 5000ml (5L) of blood per minute (cardiac output).This is accomplished by a
contraction frequency (heart rate ) of 72 beats per minute ,with each contraction ejecting a
volume of 70 ml(stroke volume ) in to the arterial system4.
Of all the cardiovascular diseases
tracked by the American Heart Association, the ischemic
CHD, hypertensive disease, rheumatic fever or rheumatic heart disease and stroke are considered
to be major. Sedentary lifestyle is a major cause of death, disease and disability. Physical
inactivity increases all causes of mortality, doubles the risk of cardiovascular disease, type II
diabetes and obesity. Physical activity in addition to healthy diet and a smoke free lifestyle is an
efficient, cost effective and sustainable way for promoting public health in low and middleincome countries5. Women who smoke up to 15 cigarettes a day and take oral contraceptives,
have 3-5 times higher risk of coronary heart disease .Risk 30% higher in those exposed to
passive smoke .Risk decreases by 50% one year after quitting smoking .Less than 15years after
quitting smoking, the risk is the same as a non-smoker. Women with diabetes have 8 times
greater risk of developing coronary heart diseases6
Myocardial infarction is one of the most important disease in cardiovascular diseases.
Myocardial
infarction is also known as heart attack, coronary occlusion or simply a
“coronary”, which is a life threatening condition characterized by the formation of localized
necrotic areas with in the myocardium. MI usually follows the sudden occlusion of a coronary
artery and the abrupt cessation of blood and oxygen flow to the heart muscle. Because the heart
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muscle must function continuously, blockage of blood in to the muscle and the development of
necrotic areas can be lethal4.
By 2010 CVD is estimated to be the leading cause of death in developing countries.
Ever34seconds a person in the united states
dies from heart diseases .More than 2,500
Americans die from heart diseases each day .Every 20 seconds , a person in the united states
has a heart attack. At least 250,000 people die of heart attack each year before they reach a
hospital. India has the highest number of heart patients in the world .Five crore in 2001 and
expected to grow to 10 crore by 2010.Current projections suggest that by the year 2020. India
will have the largest cardiovascular disease burden in the world. One fifth of the deaths in
India are from coronary heart diseases7 .By the year 2020 , it will account for one third of
all deaths. Sadly, many of these Indians will be dying young. Heart disease in India occurs 10
to15 years earlier than in the west. There are an estimated 45 million patients of coronary artery
disease in India. An increasing number of young Indians are falling prey to coronary artery
disease. With millions hooked to a roller-coaster lifestyle, the future looks even more grim.
Approximately
1.5
million
cases of myocardial infarction occur
each
year
Approximately500,000 – 700,000 deaths related to the coronary artery disease occur each
year , in the United States.8
CPR doubles a person's chance of survival from sudden cardiac arrest. . CPR was
invented in 1960.About 75 percent to 80 percent of all sudden cardiac arrests happen at home, so
being trained to perform cardiopulmonary resuscitation (CPR) can mean the difference between
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life and death for a loved one. The typical victim of cardiac arrest is a man in his early 60's and a
woman in her late 60's. Cardiac arrest occurs twice as frequently in men compared to women.
Effective bystander CPR, provided immediately after sudden cardiac arrest, can double or triple
a victim’s chance of survival. Approximately 94 percent of sudden cardiac arrest victims die
before reaching the hospital. On average, only 27.4 percent of out-of-hospital sudden cardiac
arrest victims receive bystander CPR. Death from sudden cardiac arrest is not inevitable. If more
people
knew CPR, more lives could be saved. Brain death starts to occur four to six minutes
after someone experiences sudden cardiac arrest if no CPR or defibrillation occurs during that
time. If bystander CPR is not provided, a sudden cardiac arrest victim’s chances of survival fall 7
percent to 10 percent for every minute of delay until defibrillation.9
Many
deaths can be prevented by
prompt recognition of the problem
and
notification of the emergency medical system , followed by early Cardio Pulmonary
Resuscitation, defibrillation and advanced cardiac life support measures . Cardio Pulmonary
Resuscitation is a technique used in cardiac arrest to re-establish heart and lung function until
more advanced life support is available.9
Kouwenhoven
and his colleagues set a new
land mark for effective external
cardiac compression, coupled with mouth to mouth breathing in the resuscitation of victims
who had total circulatory stand still . As a result, the combination of closed -chest cardiac
massage and mouth to mouth rescue breathing , coupled with the introduction of external
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defibrillation , created contemporary CPR as it
known today .Thus the foundation of
modern CPR was laid in 1960.10
In 1960 Kouwenhoven reported that “closed chest cardiac massage propelled blood by
compressing the
heart
trapped between the sternum
intraventricular pressure during sternal compression
and the vertebral column”. So
rose higher than
the
the
pressure else
where in the chest .With each sternal compression , the semi lunar valve should open while
the AV valves should close .Release of the sternum would allow ventricular pressure to
fall and the AV valves to open11.
Resuscitation of the apparently dead has fascinated mankind throughout the whole period
of recorded history. Looking at Paleolithic evidence, we know that this fascination went back
even earlier to pre-recorded times
, 25 to 30 thousand years ago. The first documented
resuscitation is a remarkable account of an apparently dead shunammite child by the prophet
Elija. The old testament reads ; “ And he went up , and lay up on the child, and put his mouth
up on his mouth , and eyes up on his eyes, and hands up on his hands and stretched himself
up on the child and the flesh of the child waxed warm……. and the child sneezed seven times
and opened his eyes”.10
Montgomery W H . states that American Heart Association‘s
successful in stimulating lay public , health care professionals
result of the national campaign may
CPR training was
and paraprofessionals .The
result in as many as 100,000 to 200,000 lives
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saved per year and successful resuscitation rates from out of the hospital sudden death
via the chain of survival concept reaching 30 % in the United States.12
In April, 2008, the American Heart Association (AHA) took steps to simplify the process
of helping victims of cardiac arrest by introducing "hands-only" CPR. Since only about 1/3 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'll 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. 13
Sadly, BLS skills such as CPR are not widely used by the layperson for numerous
reasons. Fear and lack of training is most definitely the number one key issue and with the
increased public awareness of disease transmission, the average bystander doesn’t wish to take
on the burden of responsibility for another person’s life nor risk their own. However, consider
this, the risk of doing nothing is far greater than the risk of doing something. Seventy-four
percent of cardiac arrests take place in the home setting and early intervention by a family
member, particularly if there are known cardiac related patients in the home, might make the
difference between life and death for a loved one.14
CPR helps to save thousands of lives.
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6.1. NEED FOR THE STUDY
Cardiovascular disease is the world's leading killer, accounting for 16.7 million or 29.2
per cent of total global deaths in 2003. With modernization, a large proportion of Asians are
trading healthy traditional diets for fatty foods, physical jobs for deskbound sloth, the relative
calm of the countryside for the stressful city. Heart-attack victims are just the first wave of a
swelling population of Asians with heart problems. While deaths from heart attacks have
declined more than 50 per cent since the 1960s in many industrialize countries, 80 per cent of
global cardiovascular diseases related deaths now occur in low and middle-income nations,
which cover most countries in Asia.15
The World Health Organization (WHO) estimates that 60 per cent of the world's cardiac
patients will be Indian by 2010. Dr Timothy Gill, an Asia-Pacific specialist with the International
Obesity Task Force, a medical NGO that coordinates with the WHO on obesity issues feels that
of all Asians, South Asians have by far the worst problems when it comes to heart disease.
Nearly 50 per cent of CVD-related deaths in India occur below the age of 70, compared with just
22 per cent in the West. This trend is particularly alarming because of its potential impact on one
of Asia's fastest-growing economies. In 2000, for example, India lost more than five times as
many years of economically productive life to cardiovascular disease than did the U.S., where
most of those killed by heart disease are above retirement age.15
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Half of these will die suddenly, outside of the hospital, because their heart stops beating.
The most common cause of death from a heart attack in adults is a disturbance in the electrical
rhythm of the heart called ventricular fibrillation. .Ventricular fibrillation can be treated, but it
requires applying an electrical shock to the chest called defibrillation. If a defibrillator is not
readily available, brain death will occur in less than 10 minutes. One way of buying time until a
defibrillator becomes available is to provide artificial breathing and circulation by performing
cardiopulmonary resuscitation, or CPR. Various studies
suggest that in out-of-home cardiac
arrest, bystanders, lay persons or family member’s attempt CPR in between 14% and 45% of the
time, with a median of 32%. This indicates that around 1/3 of out-of-home arrests have a CPR
attempt made on them. However, the effectiveness of this CPR is variable, and the studies
suggest only around half of bystander CPR is performed correctly16.
There are no reliable national statistics on CPR because no single agency collects
information about how many people get CPR, how many don't get it who need it, how many
people are trained, etc. Many studies have examined CPR in specific communities. While they
show varying rates of success, all are consistent in showing benefits from early CPR. Early CPR
and defibrillation within the first 3–5 minutes after collapse, plus early advanced care can result
in high (greater than 50 percent) long-term survival rates for witnessed ventricular
fibrillation. The value of early CPR by bystanders is that it can "buy time" by maintaining some
blood flow to the heart and brain during cardiac arrest.17
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K .Dracup, D. K .Moser, S E Taylor, and P. M .Guzy
conducted a study on the effect
of Cardio Pulmonary Resuscitation training on psychological variables of cardiac rehabilitation
patients among Patient-family pairs (n = 337) .Patient –family pairs were randomized into one of
four groups: control, CPR only, CPR with cardiac risk factor education, and CPR with a social
support intervention. Only family members received CPR training. Data on emotional state and
psychosocial adjustment to illness were collected at baseline, 2 weeks, and 3 and 6 months
following CPR training. The results showed that there were no significant differences in the
emotional states of family members across the four groups. However, significant differences in
psychosocial adjustment and emotional states occurred in patients across treatment groups
following CPR training. Patients whose family members learned CPR with the social support
intervention reported better psychosocial adjustment and less anxiety and hostility than patients
in the other groups. Control patients reported better psychosocial adjustment and less emotional
distress than patients in the CPR-only and CPR-education groups.18
It is estimated that each year, around 310,000 Americans die of cardiac arrest that occurs
at home or in a public place. The AHA proposed the new guidelines in order to allow bystanders
who have not been trained in conventional CPR or who may fear making a mistake a way to
offer help. In short, the procedure for "hands-only" CPR is simple. An untrained bystander who
sees an adult suddenly collapse (after verifying that the person is unresponsive and is not
breathing) should do CPR.19
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The importance of bystander-initiated cardiopulmonary resuscitation (CPR) has been
clearly demonstrated. Bystander CPR followed by advanced cardiac life support has been shown
to be effective in the treatment of out-of-hospital sudden cardiac death both in terms of
improving the long term survival of such patients and their neurological outcome. Since the
majority of cardiac arrests occur in an out-of hospital setting and often in the presence of family
members, friends or co-workers, strong impetus has been provided for the widespread training of
citizens in community-based CPR programs. Indeed, since the landmark conference on the
setting of standards and guidelines for CPR and emergency cardiac care in 1974, it has been
estimated that over 12million Americans have been trained in CPR and more than five times this
number are planning to be trained. It seems unlikely that all Americans could be trained in CPR.
A more appropriate strategy would be to focus on training the family members of patients at
increased risk of sudden cardiac death, particularly those patients with a recent acute myocardial
infarction or cardiac arrest survivors. In a recent study, we have demonstrated a relatively low
rate of CPR training as well as overall emergency preparedness among the family members of
such high-risk patients as compared to other hospital and neighborhood control groups.20
A study on Public perceptions and experiences of myocardial infarction, cardiac arrest
and CPR in London. A quantitative interview survey was conducted with 1011 Greater London
residents. Eight focus groups were also conducted to explore a range of issues in greater depth
and validate trends that emerged in the initial survey .The study revealed that Chest pain was the
most commonly recognized symptom of “heart attack”. Around half of the respondents were
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aware that a myocardial infarction differs from a cardiac arrest, although their ability to explain
this difference was limited. The majority overestimated that at least a quarter of cardiac arrest
patients in London survive to hospital discharge. Few participants had received CPR training,
and most were hesitant about performing the procedure on a stranger .Awareness and knowledge
of CPR, and reactions to cardiac emergencies, reflect relatively low levels of CPR training in
London. Publicizing cardiac arrest survival figures may be instrumental in prompting members
of the public to train in CPR and motivating those who have been trained to intervene in a
cardiac emergency.21
On television, CPR is often depicted as the ultimate life-saving technique. However,
television does not show this process quite accurately—in real life the process is more brutal.
Pushing the center of the chest down about one and one-half inches, 100 times a minute for
several minutes, causes pain, and may even break ribs, damage the liver, or create other
significant problems. CPR produces a barely adequate heartbeat, and doing it more gently is not
sufficient to circulate enough blood. Electric shocks and a tube in the throat are also harsh
treatments, but may be essential to resuscitate someone.22
Whereas most people believe that learning to perform CPR is very important, the
key problem appears to be the inevitable hurdle of getting them trained . Many communities that
have experienced a relatively high frequency of bystander CPR and accompanying high survival
rates for out-of-hospital ventricular fibrillation have been communities where healthcare is a
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major industry or where CPR training is provided for all students in the school system.
Therefore, wide spread CPR training often requires a focus on captured audiences who are
required or compelled to learn CPR. In turn, a promising strategy could be to require or facilitate
CPR training in the average workplace .Many employers, when surveyed, agree that it creates a
safer workplace and also that it is a good thing to do because the employees’ families would also
benefit. Simultaneously, efforts to increase CPR education should still target the generally
untrained households of retirees and their spouses, recognizing that most cardiac arrests occur in
the home in this population.23
Chew K.S , Mohd Idzwan Z et al conducted a study on “ How frequent is bystander
Cardio Pulmonary Resuscitation performed in the community of Kota Bharu, Malaysia at the
emergency department ,Hospital university Sains Malaysia ,in between march 2005 to march
2006. The study revealed that out of a total of 23 out of hospital cardiac arrest patients that
had CPR performed on arrival at the emergency department ,only two cases (8.7%) had
bystander CPR
performed . None of these two cases achieved return of spontaneous
circulation.24
CPR frequently can save a person's life, particularly in the case of some kinds of heart
attacks and accidents an otherwise healthy person may experience. CPR is also most successful
when the failure of heartbeat and breathing occurs in the hospital, in the Cardiac Care Unit
(CCU). Nurses in the unit will instantly recognize the problem and begin sophisticated care.25
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Emergency Medical Services and the hospital are not the life savers; the life savers
are the people willing to step up and start helping somebody right away , so adequate
knowledge and positive attitude towards CPR help to save lots of precious life. Hence the
investigator fascinated to identify the knowledge and attitude of care givers of patients
with Myocardial infarction regarding Cardiopulmonary Resuscitation.22
6.2.REVIEW OF LITERATURE
Bystander cardiopulmonary resuscitation (CPR) is defined as CPR performed by any
person who is not responding as part of an organized emergency response system approach to a
cardiac arrest. Early bystander CPR improves the chance of survival of out-of-hospital (OHA)
cardiac arrest victims. It serves as a vital link, by temporarily perfusing the heart and brain with
oxygen in order to preserve these vital organs while awaiting the arrival of the emergency
medical services. In fact, according to the recent 2005 American Heart Association Guidelines
for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care,(4) two interventions
are considered to be of utmost importance in improving the chances of survival of an OHA
victim, namely :early bystander CPR and early defibrillation26.
The review of literature is presented in the following order:-
1.
Studies
related
to
Myocardial
infarction.
2.
Studies related to knowledge of
care givers of clients with myocardial infarction regarding CPR.
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3.
Studies related to attitude of
caregivers of clients with myocardial infarction regarding CPR.
Studies related to Myocardial infarction
A study was conducted
on magnitude of coronary artery diseases among Asian
Indians revealed that Indian’s have the highest rate of coronary artery diseases ( CAD) ,
irrespective of the region , religion ,gender and education. About 50% of all heart attacks were
under the age of 55 and 25% under the age of 40 , out of which 10 % belongs to New Delhi
and 11% belongs to Chennai. The prevalence of CAD is 13 % in urban area and 7 % in rural
areas and excess risk is in women than men.27
A study was conducted among relatives of 368 CCU patients on the effects of a training
session for relatives of myocardial infarction patients in Basing stroke and Alton cardiac
rehabilitation centre, U.K in 1999. The result revealed that 36.5% of relatives attended a ‘Heart
learn’ session following there was
a significant increase in levels of confidence for
understanding the nature of a heart attack, for knowledge of causes of a heart attack and for
feeling confident as a carer.28
A descriptive study was conducted on
coping, social support and quality of life over
time after myocardial infarction in U.K among 74 women and 97 men in 2001 . The results
revealed that
no statistically significant changes over time in coping assessments emerged in
the study group, except for fatalistic coping, which diminished over time in men. The perceived
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efficiency in coping with physical aspects of the heart disease increased. Health-related quality
of life increased in women and men in physical functioning, role-physical, vitality, social
functioning, and role-emotional scales. Moreover, an improvement in the mental health scale
was evident in women and a reduction in pain in men. No statistically significant gender
differences were found for quality of life at any point in time.29
A study was conducted on incidence of cardiac arrest and requirement for the use of
Automated External Defibrillators (AED) in German hospitals. It revealed that sudden cardiac
arrest is one of the most frequent causes of death in Germany with an incidence of 130,000 per
year .Each day 350 patients dies from cardiac arrest .At present, survival of sudden cardiac death
is reported to be in the range of 5-8% .30
A study was conducted on incidence of cardiac arrest. The result revealed that cardiac
arrest is one of the leading causes of mortality in industrialized countries and is mainly due to
ischemic heart diseases. Each minute that passes the probability that the patient survival rate
decreases by 10%. For this reason, the first ten minutes are considered to be priceless for an
efficacious first Aid .The possibility of survival depends on the presence of witnesses, on the
heart rhythm and on the resolutions made immediately to correct the arrhythmias.31
Studies related to knowledge of care givers of clients with MI regarding CPR
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A study was conducted on family member presence during Cardio Pulmonary
Resuscitation in San Francisco,
26, 2000.The result
among
health-care professionals in between October 23 to
revealed that, fewer physicians (20%) than nurses and allied health-care
workers combined (39%) would allow family member presence during adult CPR. Fourteen
percent of physicians and 17% of nurses would allow a family presence during pediatric CPR.32
A study was conducted to identify the current extent, nature and factors Influencing
Cardiopulmonary resuscitation training among family members of patients on cardiac
rehabilitation programmes in Scotland in 1999 .The result revealed that only 37% of programmes
provided information to families about attending a CPR course and 37% actually provided CPR
training .The numbers trained by these programmes were very small and the hospital
programmes were significantly more likely than community programmes to provide CPR
training.33
A study was conducted on practical skills and theoretical knowledge in life saving first
aid among health care and rescue workers outside hospital .Forty
five police officers , forty six fire man , fifty seven nurses and forty two general practitioners
participated. Only 1 % was able to perform satisfactory basic CPR of a cardiac arrest according
to guidelines, and only 17 % ventilated and compressed efficiently with rhythm of 2: 15 or 1:5.
50% believed they were efficient in life saving first aid measures. Those who had taken a course
in first aid during the previous year achieved significantly better results than the rest, but they
suggested that situation can be improved by more regular training.34
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A study was conducted
in 2001 on
the understanding of living wills regarding CPR
among Patient, Physician, and Family Member of 4800 patients. The results revealed that 206
having living wills, Of 140 admitted to the general hospital wards, 17 (12%) wanted their living
wills to preclude intubation/mechanical ventilation and 12 (8.6%) did not want resuscitation
under any circumstances. Seven of 120 (6%) physicians and 4 of 108 family members would not
perform CPR even if there was a chance of recovery. Of 88 patients with complete data
(including physicians and family members), 29 (33%) wanted their living wills to block CPR
only if they were deemed terminal and 46 (52%) wanted the living will to block CPR even if
there was a 10% chance of recovery. 35
A study was conducted
on understanding Cardio Pulmonary Resuscitation decision
making: perspectives of seriously ill hospitalized patients and family members .The result
revealed that a total of 440 of 569 patients (78%) and 160 of 176 available caregivers (91%)
agreed to participate. Most patients (61%) had thought about what treatment they wanted if their
heart stopped, few patients (11.3%) could describe more than two components of CPR, and only
2.7% of patients thought that the success rate of CPR was < 10%. A minority of patients (34%)
had discussed CPR with their physician; 37% did not want to discuss their preferences with their
doctor.36
Studies related to attitude of care givers of clients with MI regarding CPR
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A study was conducted
on attitudes and factors associated with successful
Cardiopulmonary resuscitation (CPR) knowledge transfer in an older population most likely to
witness cardiac arrest among men and women 55 years of age and old in 2008.The results
revealed that overall survival rates for out-of-hospital cardiac arrest rarely exceed 5%. While
bystander cardiopulmonary resuscitation (CPR) can increase survival for cardiac arrest victims
by up to four times, bystander CPR rates. Most cardiac arrest victims are men in their sixties,
they usually collapse in their own home (85%) and the event is witnessed 50% of the time. 37
A study was conducted on Physicians' attitudes and Practices toward CPR training in
family Members of Patients with Coronary Heart Disease in central and western Massachusetts
among 482 physicians. The study revealed that Seventy-nine per cent of physicians felt that CPR
training was important for the family members of patients with CHD yet only 6 per cent actually
provided information about CPR to families.38
A study on the attitude of cardiac care patients towards CPR and CPR education among
401 patients admitted to a coronary care unit. The study revealed that most participants had heard
about the concept of CPR and 64% were aware of its content. In the event of an emergency, 96%
were willing to undergo CPR. Age, previous myocardial infarction and heart failure were
significantly associated with the willingness or lack of willingness to undergo CPR. Forty
percent of the participants had attended one or more courses but only a few within
the last two years.39
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A study was conducted
on attitudes toward and beliefs about family presence during
resuscitation in the emergency department, neonatal intensive care unit (NICU), and medical,
surgical, neurosurgical, and burn/trauma intensive care units (adult ICUs) at the University of
Colorado hospital among 202 clinicians, 72 family members, and 62 patients in 2003 . The
study revealed that Clinicians had positive attitudes toward family presence but had concerns
about safety, the emotional responses of the family members, and performance anxiety. Nurses
had more favorable attitudes toward family presence than physicians did. Patients and their
families had positive attitudes toward family presence.40
A study was conducted
on assessing CPR training: The willingness of teaching
credential candidates to provide CPR in a school setting at California public university in
U.S.
among
582 teacher credential candidates , in between 2002
to 2004 . The study
revealed that ,an association was found between the willingness to perform CPR and the
presence of any one concern regarding training , with 68.6 % of those expressing concerns
willing to perform CPR compared to 81.9% of those expressing no concerns .Males were
more likely to express willingness to perform CPR than females .41
A study was conducted on attitudes and factors associated with successful
Cardio Pulmonary resuscitation (CPR) knowledge transfer in an older population most likely to
witness cardiac arrest in Canada
among
men and women 55 years of age and older in
2008.The results revealed that Overall survival rates for out-of-hospital cardiac arrest rarely
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exceeds 5%. While bystander cardiopulmonary resuscitation (CPR) can increase survival for
cardiac arrest victims by up to four times, bystander CPR rates remain low in Canada (15%).
Most cardiac arrest victims are men in their sixties, they usually collapse in their own home
(85%) and the event is witnessed 50% of the time.42
6.3. STATEMENT OF THE PROBLEM
A study on assessment of level of knowledge and attitude of care givers of clients admitted in
ICU with myocardial infarction regarding Cardio Pulmonary Resuscitation at selected hospitals
in Bangalore.
6.4. OBJECTIVES
1. To assess the level of knowledge of caregivers of clients with myocardial Infarction
regarding Cardio Pulmonary Resuscitation.
2. To determine the attitude of caregivers of clients with myocardial infarction regarding
Cardio Pulmonary Resuscitation.
3. To determine the correlation between the level of knowledge and attitude of care -givers
of clients with myocardial infarction regarding Cardio Pulmonary Resuscitation.
4. To identify the association between the level of knowledge and attitude of care -givers
of clients with myocardial infarction with selected demographic variables.
6.5. HYPOTHESIS
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H0 1 : There is no significant relationship between the level of knowledge and attitude of
Care givers of clients with myocardial infarction regarding Cardio Pulmonary Resuscitation.
H0 2 : There is no significant relationship between the level of knowledge and attitude of
care givers of
clients with myocardial infarction regarding Cardio Pulmonary Resuscitation
with the selected demographic variables.
6.6. OPERATIONAL DEFINITIONS
ASSESSMENT:
It is the process of measuring the level of knowledge and attitude among care givers of
clients admitted in ICU with myocardial infarction regarding Cardio -Pulmonary Resuscitation
using structured questionnaire .
KNOWLEDGE
It is an understanding of care givers of clients with myocardial infarction regarding
Cardio Pulmonary Resuscitation
using structured questionnaire .
ATTITUDE
It is a feeling of care givers of clients with myocardial infarction regarding CPR .
CARE GIVER
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Care givers are individuals in the age group of 20-60 years, residing and providing care to the
clients who are diagnosed as myocardial infarction.
CLIENT WITH MYOCARDIAL INFARCTION
Clients those who have admitted in ICU with diagnosis of myocardial infarction.
ICU
ICU is a life saving unit and provide constant attention and care for critically admitted
MI clients .
CPR
CPR is the artificial life saving process that support the circulation and respiration of a
person.
6.7. ASSUMPTIONS
1. Care givers of clients with myocardial infarction with adequate knowledge on Cardio
Pulmonary Resuscitation save the life of patient
2. Care givers of clients with myocardial infarction feel the need to learn CPR
3. Socio-demographic factors influence the knowledge and attitude of care givers of clients
with myocardial infarction on Cardio Pulmonary Resuscitation.
4. Mass media influences the level of knowledge and attitude of care givers of clients with
myocardial infarction regarding Cardio Pulmonary Resuscitation.
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7.0. MATERIALS AND METHODS
7.1. SOURCES OF DATA ; The care givers of clients admitted in ICU with myocardial
infarction at selected hospitals, Bangalore.
7.2. METHOD OF DATA COLLECTION PROCEDURE
 RESEARCH APPROACH
Non experimental approach
 RESEARCH DESIGN
It is cross sectional descriptive design using questionnaire to determine the level of
knowledge and attitude among care givers of clients with myocardial infarction.
 SAMPLING TECHNIQUE
The sample of 60 care givers of clients with MI at selected hospitals will be
selected using non probability convenient sampling technique .Data will be collected
by using structured questionnaire method .The verbal consent will be taken from the
samples prior to the study.
 SAMPLE AND SAMPLE SIZE
The sample of 60 care givers of clients with myocardial infarction at selected
hospitals will be selected for the study.
 SETTING OF THE STUDY
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A descriptive cross sectional study will be conducted in ICU of selected
hospitals in Bangalore
7.2.1. CRITERIA FOR SAMPLE SELECTION
1. Male and female care givers of clients admitted in ICU with myocardial infarction
2. Care givers, 20-60 years of age group
3. Care givers, who are willing to participate
4. Care givers of clients with myocardial infarction, who knows English and Malayalam.
5. Care givers, who are mentally /psychologically sound
7.2.2. DATA COLLECTION TOOL
Structured questionnaire will be prepared to assess the knowledge and attitude of
care givers of clients with myocardial infarction
regarding CPR in ICUs at selected hospitals,
Bangalore.
Questionnaire will consist of 3 sections
Section A : Items on socio –demographic variables such as age , occupation , income etc.
Section B : Items on assessment of level of knowledge among care givers of clients with
myocardial infarction regarding CPR.
Section C: Items on assessment of attitude among care givers of clients with myocardial
infarction regarding CPR.
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VALIDITY: The validity of the tool will be ascertained in consultation with guide and other
expert from various fields like nursing, cardiologist and biostatistician. Reliability of tool will be
established by split half method.
7.2.3. DATA ANALYSIS METHODS;
Data analysis can be done by descriptive and inferential statistics .
7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO
BE CONDUCTED ON PATIENTS OR OTHER HUMAN OR ANIMALS?
No, only a structured questionnaire will be used for data collection .No other invasive
physical or laboratory procedures will be conducted on the samples.
7.4.. HAS ETHICAL CLEARENCE BEEN OBTAINED?
Yes. Confidentiality and anonymity of the subjects will be maintained. Prior to the
study consent will be taken from the caregivers of patients with myocardial infarction
regarding their willingness to participate in the study.
8.0. REFERENCES
1. Sandra M .Nettina.
The
Lippincott
manual of Nursing practice. 7th edition
Philadelphia: Lippincott Wilians and Wilkins, 2001.
2. S. Chandrashekar .The Times of India. April 28, 2010
26
[Type text]
3. Brunner and Suddarth ,“Medical-Surgical Nursing “ ; 10th
Edition ,2004,Lippincot
Williams and Wilkins , page 647
4. Joyce M .Black, Jane Hokanson Hawks “ Medical Surgical Nursing “ 7th edition,
Elsevier’s publication, volume 2, page no.1548
5. V. Radhika,
'Heart disease and the young' ,December 1999; information available at
www.diabetes-india.co
6. http://www.wrongdiagnosis.com/c/coronary_heart_disease/stats.htm
7. http.//www.who.int/cardiovascular-diseases /prioritieslen:8. http://www.mamashealth.com/Heart stat.asp
9. http://www.americanheart.org/presenter.jhtml?identifier=3035653
10. John A. Parasko s. Cardio Pulmonary Resuscitation in : David L Brown .Cardiac
Intensive care. Philadelphia: W.B. Sunders company, 1999.
11. Resuscitation (Ms .Word ) Version 2.2 Texas (US),2003
12. Montgomery W.H ,The development of standards and guidelines for Cardio
Pulmonary Resuscitation and emergency Cardiac care in the United States ,.Ann Acad
Med Singapore ,2003 july; 21 (1) : 92-96
13. http://www.emedicinehealth.com/cardiopulmonary_resuscitation_cpr/article_em.htm.
14. http://firstaid.suite 101.com/article.cfm/basic-life-support-bls
15. http://www.expresshealthcaremgmt.com/20041215/criticare06.shtml
27
[Type text]
16. Kramer-Johansen, J., et al., Quality of out-of-hospital cardiopulmonary resuscitation
with real time automated feedback: a prospective interventional study. Resuscitation,
2006. 71(3): p. 283-92. October 27, 2006.
17. http://www.americanheart.org/presenter.jhtml?identifier=4483.
18. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1380966/
19. .http://www.emedicinehealth.com/cardiopulmonary_resuscitation_cpr/article_em.htm.
20. http://ajph.aphapublications.org/cgi/reprint/77/6/671.pdf
21. R. Donohoe, K. Haefeli, F. Moore Official journal of the
European Resuscitation
Council, Resuscitation, Volume 71, Issue 1, Pages 70-79
22. Moss, Alvin, “Discussing Resuscitation Status with Patients and Families,” The Journal
of Clinical Ethics, Summer, 1999, Vol. 4, No. 2, pgs. 180-182
23. http://www.laerdaltraining.com/cpr/pdf/Layperson-training-for-CPR.pdf ,
24. Singapore
Med
J,
layperson
role
in
cpr
2008;
49(8)
:
696http://smj.sma.org.sg/4908/4908a7.pdf
25. . (Darcy L Haris, “Family members open ion regarding Resuscitation ,” The Journal of
Clinical Ethics, 2006, Vol. 4, No. 2, pgs. 180-182).
26. Singapore Med J 2008; 49(8) : 636
Available from : URL : http://smj.sma.org.sg/4908/4908a7.pdf
27. Enas. A . Enas . Magnitude
of CAD among Asian Indians Ital Heart J Suppl , 2004
Aug;(285-289). Available from URL:http://www.medscape .com.
28
[Type text]
28. Westmacott, J. Evans, S. Turner, S. Todd et al , effects of a training session for relatives
of myocardial infarction patients, Coronary Health Care Volume 3, Issue 4, November
2002, Pages 199-204
29. Marja-Le et al ,Official journal of the European Resuscitation Council ,Resuscitation,
Volume 71, Issue 1, Pages 70-79
30. Bickenbach J , Fries M, Beckers , Rossaint R ,Kublen R. Requirements for the use of
automated external defibrillators in German Hospitals ,2004.
Available from UR : http://www.pubmed.com
31. Chiarella F . et al .Heart arrest.It al Heart J suppl.,2001 .
Available from URL: http://www.pubmed.com
32. CPT Bruce M. McClenathan, et al , Family Member Presence During Cardiopulmonary
Resuscitation,2000
Available from URL: http://chestjournal.chestpubs.org/content/
33. M.Richardson, Cardiopulmonary resuscitation training for family members of patients
on
cardiac rehabilitation programmes, 2004
Available from URL; http://linkinghub.elsevier.com/retrieve/pii/S0300957298001476
34. Bjorshol C A CPR Skils .A survey on practical skills and theoretical knowledge in
life saving first aid among health care and rescue workers outside hospital.2003,
Available from URL: http://www.pubmed.com.
29
[Type text]
35. Anupama Upadya et al .American Journal of Respiratory and Critical Care Medicine.
Patient, Physician, and Family Member Understandingof Living Wills regarding
endotracheal intubation and cardiopulmonary resuscitation (CPR) . 2002 Vol 166. pp.
1430-1435,
36. Heyland DK, Frank C, Groll D, Pichora D, Dodek P, Rocker G, Gafni A Chest.
Understanding cardiopulmonary resuscitation decision making: perspectives of seriously
ill hospitalized patients and family members 2006 Aug;130(2):419-28
37. Vaillancourt, et al , BMC Emerg Med., attitudes and factors associated with successful
cardiopulmonary resuscitation (CPR) knowledge transfer in an older population , 2008;
volume 8,13
Available from URL :
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2585573/
38. Robert J. Goldberg et al , Am J Public Health, Physicians' Attitudes and Practices
toward CPR Training in Family Members of Patients with Coronary Heart Disease
among 482 physicians practicing 1999; 75:82
Available from URL:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1646170/pdf/amjph00279-0075.pdf
39. Patrick Plaisance,The attitude of cardiac care patients towards CPR and CPR education
Resuscitation ,2005 http://linkinghub.elsevier.com/retrieve/pii/S0300957204000127
30
[Type text]
40. Christine R.Duran et al, American Journal of Critical Care. “Attitudes Toward and
Beliefs
About
Family
Presence
during
resuscitation,2007;16:
270-279
Available from URL: http://ajcc.aacnjournals.org/cgi/content/full/16/3/270
41. J L Winkelman , R Fischbach , EF spinello , Education for health,
Assessing CPR
training : The willingness of teaching credential candidates to provide ,volume 22 ,
issue 3 , 2009 Available from URL: http://www.education for health . net /published
articles /article –print-81.pdf
42. Christian Vaillancourt, et al, , A survey of attitudes and factors associated with successful
cardiopulmonary resuscitation (CPR) knowledge transfer in an older population most
likely to witness cardiac arrest ,2008
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9.
Signature of Candidate
10.
Remarks of the Guide
11.
Name and Designation
12
11.1
Guide
11.2
Signature
11.3
Co-guide
11.4
Signature
11.5
Head of the
Department
11.6
Signature
12.1
Remarks of the
Chairman and
Principal
12.2
Signature
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