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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE, BENGALURU,
KARNATAKA. SYNOPSIS FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1.
NAME OF THE CANDIDATE AND
ADDRESS
TIJY. T.PEEDIKAMALAYIL,
MANIANCHIRA HOUSE,
VELLIEPALLY P.O.
KOTTAYAM (DT),686574
KERALA
2.
NAME OF THE INSTITUTION
M.S RAMAIAH INSTITUTE OF
NURSING EDUCATION AND
RESEARCH, BANGALORE
3.
COURSE OF STUDY AND
SUBJECT
M.SC NURSING
DATE OF ADMISSION
26-11 -2009
5.
MEDICAL SURGICAL NURSING.
TITLE OF THE STUDY:
EFFECTIVENESS
OF
VIDEO
ASSISTED
TEACHING
VS.DEMONSTRATION ON SKILL IN PERFORMING BASIC LIFE
SUPPORT AMONG NURSING STUDENTS.
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6. BRIEF RESUME OF INTENDED WORK
INTRODUCTION:
“Every man’s life is a fairy- tale written by God’s fingers”.
- Hans Christian Andersenlis a
fairy-tale written bf-tale written
by God's fingers
Oxygen is a primary requirement of human body. Humans can live for days
without food and water but only for a few minutes without oxygen. When we inhale
we take in air which contains oxygen, into our lungs. Each time the heart beats, the
oxygen containing blood is sent to all of the cells in the body. Any process that affects
our ability to take air into our lungs or to sent oxygen containing blood to the cells of
the body is an emergency. Without oxygen the cells of the body begin to die.1
Respiratory arrest is the cessation of breathing. When breathing stops, the
oxygen content of the blood decreases and there is not enough oxygen for the cells of
the body to function properly. Within few minutes key organs such as the brain and
heart stop functioning. A person who is in respiratory arrest may have a heart beat
initially, but if breathing is not started again, the heart will stop beating. A person who
has no pulse or is not breathing is said to be clinically dead. Clinical death can
sometimes be reversed with prompt emergency treatment that restarts the heart and
breathing. However, if clinical death is not reversed biological death occurs, which
can never be reversed by humans.1
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Cardio vascular diseases are the number one cause of cardiac arrest. Cardiac
arrest is the abrupt cessation of cardiac pump function which may be reversible but
will lead to death in the absence of prompt intervention. Failure to intervene in a
timely and appropriate manner at the time of an unanticipated cardiac arrest can lead
to sudden cardiac death. Moreover 60% of all cardiac deaths occur due to arrhythmias
leading to sudden cardiac arrest.2
An article reported that Approximately 4280 people out of every 1,00000 die
per year from sudden cardiac arrest in India, 4 Indians die of heart ailment every
minute and by 2010, 60% of the world’s heart patients will be in India.3
Sudden cardiac arrest is the leading cause of death in the United States,
Canada and in developed countries worldwide. More persons die each year from
cardio vascular disease than from AIDS, Breast cancer, Lung cancer and Stroke. The
incidence of sudden cardiac arrest in USA is approximately 3,25,000 deaths annually
or one death every two minutes.4
According to American Heart Association, sudden cardiac death is defined as
the sudden abrupt loss of heart function in a person who may or may not have
diagnosed heart disease. Sudden cardiac arrest is a medical emergency; it can strike
ostensibly healthy persons in their productive years. The event can happen at home,
school, work, shopping malls and other public places. Prompt intervention at the time
of the arrest provides an opportunity to restore a perfusing cardiac rhythm and avoid
the progression from cardiac arrest to death. The measures generally involve
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administration of cardiopulmonary resuscitation, shock treatment to the chest to reset
the heart’s rhythm and advanced life support.5
Attempts to restore life to the lifeless have been reported as far back as biblical
times. Since those early times there have been many methods used to restore breathing
and circulation. The birth of cardiopulmonary resuscitation began in 1960 when
Kouwenhoven and colleagues used closed chest cardiac massage to resuscitate a small
child.4
Cardiopulmonary resuscitation can be used to describe a sequence of
interactions used to reestablish circulation and ventilation in a person who has
suffered cardio pulmonary arrest. The goal of cardio pulmonary resuscitation is to
increase myocardial blood flow by increasing coronary perfusion pressure. Providing
oxygen rich blood to the vital organs without delay is the objective of basic life
support with the ultimate goal being to preserve the individual’s pre arrest
neurological level.4
Basic life support is the initial step that extends the time available for a cardiac
arrest victim to receive definitive treatment. When began within four minutes after
collapse cardio pulmonary resuscitation can extend viability until therapeutic
interventions such as defibrillation, medication or pacing can occur. In
cardiopulmonary resuscitation emergency personnel administer chest compressions
and artificial breathing at a rate of 30:2 and use an Automated external defibrillator to
administer an electrical shock if necessary. The skill of the performer is absolutely
necessary for the effective performance of Cardio pulmonary resuscitation.5
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6.1NEED FOR THE STUDY
“The whole of life is but a moment of time. It is our duty, therefore to use it, not to
misuse it.”
- Plutarch
Sudden cardiac arrest is not uncommon. It can strike almost anyone at any age
and is a leading cause of death both in India and worldwide. Sudden cardiac arrest
strike men, women and children of all ages and for many reasons. Indians are at even
higher risk because of the sedentary life style, food habits and growing stress levels
among the urban population.3
During the last two decades, while mortality due to cardiovascular disease has
steadily declined in developed countries, it has increased in the developing world. The
increase in these diseases is expected to continue in most countries of our region. In
fact in developing countries where life expectation is over 60 years, cardiovascular
disease is the leading cause of mortality. As such it is mandatory that we are aware of
this silent epidemic and have a plan ready to counter sudden cardiac arrest if it ever
strikes someone around us.3
Of the more than 300,000 cardiac arrests that occur annually in the United
states, survival rates are typically less than 10% for out-of-hospital events and less
than 20% for in-hospital events. Additionally studies have shown that survival falls by
10-15% of each minute of cardiac arrest without CPR delivery. Bystander CPR
initiated within minutes of the onset of arrest has been shown to improve survival
rates two to three fold.7
5
A prospective study was conducted at Netherlands to investigate the
relationship between Ventricular fibrillation and survival by Basic life support, for a
period of two years in 873 patients. The amplitude of ventricular fibrillation decreased
significantly for patients who received Basic life support, than those who did not.8
Millions of individuals worldwide have already been exposed to various
elements of Basic life support. However the number of trained individuals are
insufficient. So, it is important to train the nursing students Basic life support
measures with the best method to retain their skills and knowledge.4
While Cardio pulmonary resuscitation or Basic life support competency is
considered a fundamental skill for health care workers, the evidence suggests that
retention of CPR/BLS knowledge and skills is generally poor. Studies have also
identified differences in the quality of BLS/CPR performed by various health care
professionals. Often chest compression is performed inadequately with slow rates of
compression.4
An evaluative study conducted in Ireland on sixty nursing students to
investigate the extent to which they acquire and retain cognitive knowledge and
psychomotor skills following CPR training. A quasi experimental time series design
was used. A pre test, CPR training programme, post test and retest were conducted.
The findings showed an acquisition in student’s knowledge and psychomotor skills
following a four hour CPR training programme. The study findings present strong
evidence to support the critical role of CPR training in ensuring that nursing students
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progress to competent and confident responders in the event of a cardiac related
emergency.9
An article states, simulation can be integrated into nursing educational courses
enabling students to practice skills in a safe environment. Simulation has been
suggested as a way to bridge the gap between theory and practice. Simulation may be
presented using computer software, role play, case studies or manikins that represent
reality and actively involve learners in applying the content of the lesson.10
Cardio pulmonary resuscitation and Basic life support is deemed an essential
competency that all students must satisfactorily achieve. In the nursing course
students should get a theoretical basis for CPR/BLS followed by a practical
demonstration and participation in resuscitation scenarios. This training is highly
important to provide competencies, skills and knowledge necessary to respond
effectively and safely in an emergency situation. So it is important to find out the best
method of training, for a better performance and retention of knowledge and skills.
A nurse who graduates from the student period is the one who is going to
turn out to be a clinical nurse, working in any setup to handle emergencies. It is a well
known fact that sudden cardiac arrest is the leading cause of death in the world and
and most of them die before reaching the hospital or in the emergency room. During
such situations where time plays a crucial role in the recovery. Nurses are expected
to be mainly responsible for the efficient and effective management of patient care
services. More importantly, it must be ensured that they are adequately trained in
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terms of Basic life support which is a crucial step in a patients survival in cardiac
arrest.1
The personal experience of the student researcher and the above mentioned
factors regarding the importance of practicing Basic life support inspired the
investigator to do this study to find out the best method of training, to retain skills in
performing Basic life support.
6.2 REVIEW OF LITERATURE:
The review of literature is traditionally considered as a systematic critical review
of the most important published scholarly literature on a particular topic.
Literature review for the present study has been collected and is listed down.
A comparative study conducted at Norway to assess the effectiveness of personal
resuscitation manikin and a 24-minute video instruction in improving the basic life
support skills and confidence of hospital employees. A total of 5118 employees were
taken randomly for the study. A pre and post skill assessment done. The number of
correct chest compressions increased significantly from 60 to 119.Study proved that
after distributing a personal resuscitation manikin with video instruction, the median
number of correctly performed chest compressions doubled and self confidence in
BLS skills improved significantly.12
8
A prospective study conducted at UK to compare the pre test and post test class
performance of BLS among 34 health care workers. A convenient sampling was used.
A two hour demonstration class was provided followed by pre test. Results shows that
a significant improvement in the number of persons perform correct chest
compressions, ie. 14/34 to 25/34.13
A study conducted at Japan to evaluate the effectiveness of one hour practical
chest compression –only CPR training with or without a preparatory self learning
video. A randomized control used and 183 health care professionals were selected.
Participants were randomly assigned to either a control group or a video group who
received a self learning video before attending the one hour chest compression only
CPR training programme. In the pre test 92.6% of the video group attempted chest
compression ,while only 64.4% of the control group did so. After one hour practical
training for both groups, the number of chest compressions markedly increased in
both groups.14
A controlled randomized study conducted in Portland to assess the retention of
CPR skills learned in a traditional American Heart Association heart saver course
versus 30 minute video self training among nurses.285 nurses were assigned randomly
to a non-training control group. Post training performance of CPR skills was assessed
in a scenario format. immediately and two months after training. Even though there
was a decline in skill after two months video assisted trained subjects generally
demonstrated CPR skill retention equivalent to that of Heart saver trained subjects.15
9
A comparative study conducted at Denmark to assess the efficiency of a 24minute instruction using a DVD-based self training BLS course combined with a
simple take- home resuscitation manikin to a conventional 6 hour course for teaching
BLS to nurses. A total of 238 nurses were randomly assigned to two groups. After
three months BLS skills were assessed by using a skill reporting system. Assessment
of breathing was performed significantly more often in the 6 hour group (91% vs
72%) and chest compression depth were significantly higher (844ml vs 524ml)in the 6
hour group.16
A prospective study conducted at Atlanta to compare the effectiveness of a 34 minute video self instruction training programme for adult CPR with AHA heart saver
course among 89 medical students. A randomized controlled trail was used
.Assessment done 2-6 months after training.20 of 47 traditional trainees were judged
not competent in their performance of CPR compared with only 8 of 42 video self
instruction trainees. The result shows that a half hour of video self instruction resulted
in superior overall CPR performance compared with that in traditional trainees.17
A comparative study conducted at Turkey to evaluate the effects of traditional,
case based and web based instructional methods on acquisition and retention of CPR
skills among 90 university students who were selected randomly. The students were
tested three times. Pre test, post test and retention test by an observational check list.
Based on the CPR performance measurements by the skill reporter manikin, the web
based instruction group performed poorer than the traditional and case based
instruction groups.18
10
A quasi experimental study conducted at Atlanta, to determine video selfinstruction in CPR in comparable or better performance than traditional CPR training.
A randomized controlled trial was conducted among congregational volunteers in an
African American church,Atlanta.Subjects were randomly assigned to receive either
34 minutes of video self-instruction or the 4-hour American Heart Association heart
saver CPR course.VSI trainees and traditional trainees achieved comparable scores on
tests of CPR related knowledge and skills. Study proved that 34-minutes of VSI can
produce CPR of comparable quality to that achieved by traditional training methods.19
6.3 STATEMENT OF THE PROBLEM
An experimental study to assess the effectiveness of video assisted teaching vs.
demonstration on skill in performing Basic Life Support among final year BSc
nursing students at selected nursing colleges, Bangalore.
6.4 THE OBJECTIVES OF THE STUDY
1. To assess the pre test level of skill in performing Basic life support among nursing
students in experimental and control group.
2.
To determine the effectiveness of video assisted teaching and demonstration
method on skill in performing Basic life support among nursing students.
3. To find the association between the post test level of skill and selected socio
demographic variables.
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6.5 HYPOTHESES
H01 - There is no significant difference in the pre test scores and post test scores of
nursing students in the experimental and control groups in performing Basic life
support
H02 - There is no significant association between posttest level of skill exhibited by
nursing students in experimental and control groups and their selected socio
demographic variables.
6.6 OPERATIONAL DEFINITONS
1. Effectiveness – Refers to the ability of video assisted teaching and demonstration
to enhance the skill of nursing students in performing Basic Life Support as
determined by significant improvement in the post test scores measured by using a
structured observational check list.
2. Video assisted teaching-Refers to the teaching given by the investigator using a
Compaq disc which contains the visual and auditory information about the sequential
steps of performing Basic life support.
3. Demonstration– Refers to the exhibition and explanation of the sequential steps
that should be carried out in Basic life support, performed by the investigator to the
nursing students in the laboratory using a manikin.
4. Skill –Refers to the proficiency shown by the nursing students in performing
Basic life support as measured by observational checklist.
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5. Basic life support-Refers to the provision of treatment designed to maintain
adequate circulation and ventilation to a patient in cardiac arrest, which includes
recognition of signs of sudden cardiac arrest, heart attack, stroke and foreign body
airway obstruction, Cardiopulmonary resuscitation and defibrillation with an
automated external defibrillator.
6. Nursing students-Refers to individuals who successfully completed III year BSc
nursing and studying in IV year BSc nursing at selected nursing colleges, Bangalore.
6.7 ASSUMPTIONS
1. Nursing students have basic knowledge on Basic life support.
2. Demonstration and video assisted teaching are accepted methods of teaching
strategies which enhances teaching learning activities.
3. Nursing students may improve skill in performing basic life support by video
assisted teaching and demonstration method.
6.8
DELIMITATIONS
The study is delimited to:
1. 1V year Basic BSc
nursing students studying at selected nursing colleges,
Bangalore.
2. Four weeks period of data collection.
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7. MATERIALS AND METHODS
7.1 SOURCE OF DATA:
IV year Basic BSc Nursing students studying at selected nursing colleges, Bangalore.
7.2METHOD OF DATA COLLECTION:
7.2.1TYPE OF STUDY/RESEARCH APPROACH:
Comparative evaluative study
7.2.2 RESEARCH DESIGN:
True experimental pre test post test control group design
7.2.3VARIABLES:
Independent variable – Video assisted and Demonstration method of teaching on
Basic life support.
Dependent variable – Skill of nursing students in performing Basic life support
Attribute variables - Age, gender, witness/performance of basic life support, class
obtained in III year examination..
7.2.4 SAMPLING TECHNIQUE
Simple random sampling technique
7.2.5 SAMPLE AND SAMPLE SIZE:
45 IV year Basic BSc nursing students.
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15 students in demonstration method of teaching.
15 students in video assisted method of teaching.
15 students in control group.
7.2.5 SELECTION CRITERIA:
Inclusion criteria
Nursing students who are willing to participate.
Exclusion criteria
Nursing students who are not available during the period of data collection.
7.2.6
FOLLOW-UP:
A posttest skill assessment will be done for experimental and control groups 7 days
after pre test.
7.2.7
COMPARISON PARAMETER:
The pre test and post test scores of final year BSc nursing students will be
compared between the experimental and control groups.
7.2.8
DURATION OF STUDY
One month of data collection
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7.2.9
TOOL OR INSTRUMENTS:
Section A: Socio-demographic profile –age, gender, witness/performance of Basic
life support, class obtained in III year examination.
Section B: Structured observational check list on Basic life support.
7.2.10 DATA COLLECTION PROCEDURE:
After obtaining formal permission from the concerned authorities of three
different nursing colleges, by using a lottery method the colleges will be assigned to
any one of the experimental group or control group. Samples for each group will be
selected by simple random sampling technique. Written consent will be taken from
the participants after explaining the purpose of the study. Pretest will be conducted by
using structured observational check list to assess the skill of nursing students
regarding Basic life support, followed by teaching will be provided to students in
experimental group. A post test will be conducted for both experimental and control
group 7 days after the pre test by using the same observational check list.
7.2.12. PLAN FOR STATISTICAL ANALYSIS:
The data obtained will be tabulated and analyzed in terms of the objectives of
the study by using descriptive and inferential statistics. The plan of data analysis is as
follows:
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Descriptive statistics:
a. Frequency and percentage distribution will be used to analyze the sociodemographic variables and skill of nursing students in performing Basic life support.
b. Mean; mean percentage and standard deviation will be used to assess the pre test
and post test level of skill in performing Basic life support.
Inferential statistics:
a. Repeated measures of ANOVA will be used to compare the pre test and post test
scores of experimental and control groups.
b. “Chi-square” test will be used to determine the association between posttest level
of skill and selected socio-demographic variables.
7.3
Does the study require any investigation or intervention on patient or
human/animal? If so, describe briefly
Yes. Video assisted teaching programme /demonstration regarding Basic
life support will be performed to students in the experimental groups and the skill will
be assessd in both experimental and control group by using a structured observational
check list.
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7.4
Has ethical clearance been obtained?
Yes.Ethical clearance will be obtained from concerned authorities and a written
consent will be taken from the subjects. Confidentiality and anonymity of the subjects
will be maintained.
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8. LIST OF REFERENCES
1. Pamela JC.Lippincott text book for nursing. 2nded. Philadelphia: Lippincott; 2007.
p.223-24.
2. Rodrigues C. Medtronic presents results of first Indian pan arrhythmia and heart
failure registery. Medtronic Today.[serial online]2007[cited on 2008 Jun 12].
Available from URL http://www.medtronic.com.
3. Singh B. Cardiac arrest claiming about 4,280 lives from every 1 lakh of population
annually. WHO census statistics mortatility due to cardiac causes.[serial online]
2009 [cited on 2010 Jan 12]; Available from URL http://www.businessstandard.com
4. Moser DK, Reigel B. Cardiac nursing a comparison to braunwald’s heart disease.
Missouri: Elsevier publishers; 2008. p.858-74.
5. Marguerite KK, Sandra BD, Jonn BB, Nancy M, Jan MV. AACN Clinical
reference for critical care nursing. 4th ed. Missouri: Mosby; 1998. p. 199-209.
6. Erik S, Mary FH, Louis G, Lindy ON. BLS for health care providers-student
manual. American Heart Association: 2006. p. 1-5.
7.
Butler M. Sudden cardiac death. [serial online] 2008 [cited on 2009 May2];
Available from URL http://www.Right Health.com.
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8. Waalecoiin RA, Nijpels MA, Tiesen JG, Koster RW. Prevention of deterioration of
ventricular fibrillation by Basic life support during out of hospital cardiac arrest.
Resucitation-Jornal of Europian Resucitation council. 2002 Jul;54(1):31-6.
9. Catherene Madden.Under graduate nursing students acquisition and retension of
CPR knowledge and skills.Nurse education today. 2006 Apr; 26(3):218-27.
10. Carol AR.Simulation as a teaching strategy for nursing education.Critical care
nurse. 2004 ;24:46-51.
11. Devi Elsa S, ShreemathiMayya S, Bairy KL, Mohn M, Anjali A et al. Knowledge
of cardiac emergency and its application in clinicsamong undergraduate students
of a college of nursing in Karnataka. Scandinavian journal of trauma,resuscitation
and emergency medicine. 2008 Sep 22;16(11).
12. Biorshol CA,Linder TW, Soreide E, Moen L,Sunde K. Effectiveness of personal
resuscitation manikin and a 24-minute video instruction in improving the basic
life support skills and confidence of hospital employees. Resucitation-Journal of
European resuscitation council. 2009 Aug;80(8):898-902.
13. Ric Mellor, Malcolm W. Skill acquisition by health care workers in the
resuscitation council. Journal of international emergency medicine. 2010
Apr;18(2):61-6.
14. Chika N, Taku I, Takashi K, Masahiko A, Kentaro K et al. Effectiveness of
simplified chest compression-only CPR training programme with or without
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preparatory self training video. Resucitation-Journal of European resuscitation
council. 2009 Oct ;80(10):1164-68.
15. Einspruch EL, Lynch B, Aufderheide TP, NicholG, Becker L. Retension of CPR
skills learned in a traditional AHA heart saver course versus 30-minute video self
training. Resucitation-Journal of Europian resuscitation council. 2007Sep
;74(3):476-86.
16. Isbye DL, Rasmussen LS, Lippert FK, Rudolph SF, Ringested CV. Efficiency of a
24 minute instruction using a DVD-based self training BLS course combined with
a simple take- home resuscitation manikin to a conventional 6 hour course for
teaching BLS. Resucitation-Journal of European resuscitation council.2006 Jan;
69(3):435-42.
17. Knox HT, Allan B, Robert TB, Douglas WL, Robert JC, et al. Effectiveness of a
34-minute video self instruction training programme for adult CPR with AHA
heart server course. Annals of emergency medicine. 2002 Mar; 31(3):364-9.
18. Leyla S, Ahmet O. The effect of different instructional methods on student’s
acquisition and retention of CPR skills. Resucitation-Journal of European
resuscitation council. 2010 May ;81(5):555-61.
19. Todd KH, Heron SL, Thompson M, Dennis R, Cannor J, Kellermann AL. Video
self instruction in CPR in comparable or better performance than traditional CPR
training. Annals of emergency medicine. 2000 Jul;36(1):79-80.
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9.
SIGNATURE
CANDIDATE
OF
THE
10.
REMARKS OF THE GUIDE
11.
NAME AND DESIGNATION
(in block letters)
11.1.
GUIDE
11.2.
SIGNATURE
11.3.
CO- GUIDE (IF ANY)
11.4.
SIGNATURE
11.5.
HEAD
OF
DEPARTMENT
THE
11.6.
SIGNATURE
12.1.
REMARKS
CHAIRMAN
PRINCIPAL
12.2
SIGNATURE
OF
THE
AND
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