Download RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALOR
ANNEXURE - II
PERFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1.
NAME OF THE
MR. BHEEMANAGOUDA. D. PADEKANUR
CANDIDATE AND
I YEAR M Sc NURSING
ADDRESS.
BLDEA’S SHRI B. M. PATIL INSTITUTE OF
NURSING SCIENCES BIJAPUR.
2.
NAME OF THE
BLDEA’S SHRI B. M. PATIL INSTITUTE OF
INSTITUTION.
NURSING SCIENCES
BIJAPUR – 586103
3.
4.
COURSE OF THE
STUDY AND
M Sc. NURSING
SUBJECT.
MEDICAL SURGICAL NURSING.
DATE OF
28.07.2011
ADMISSION TO THE
COURSE.
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TITLE OF THE STUDY.
"A
STUDY
TO
EVALUATE
THE
EFFECTIVENESS
OF
SELF
INSTRUCTIONAL MODULE ON KNOWLEDGE REGARDING AUTOLOGOUS
BLOOD TRANSFUSION AMONG STAFF NURSES WORKING IN A SELECTED
HOSPITAL AT BIJAPUR.”
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6.
BRIEF RESUME OF THE INTENDED WORK.
Introduction.
Health is greatest gift, contentment the greatest wealth, faithfulness the best
relationship
-Buddha
Water and blood are the lifeline for the people only their colors differ. Millions of
lives are saved across the world through the timely life saving blood transfusion
procedures1. The first historical attempt of blood transfusion was described in 17th century
before that in the year 1492 Pope innocent VIII sank into coma and blood of three boys
was infused into the dying Pope through the mouth as the concept of circulation and
methods of intravenous access did not exist at that time. However not only the pope died
but three children did also died. And in the year 1667 Dr Jean Batiste transfused the blood
of sheep into a 15 year old boy who survived after transfusion.2
The first successful human blood transfusion was done in 1818
by Dr James
Blundell. From 18th century till today the life saving procedure and its span has enhanced
for thousands of clients. Recently in the year 1980 a new technique was invented by British
scientists that is autologous blood transfusion.3
Blood collected from a patient for re-transfusion at a later time into the same
individual is called autologous blood. The patient who receives his or her own blood gets
the safest possible blood, because no foreign antigens infused, no infectious diseases are
transmitted. Its use has increased with the awareness of infections particularly human
immune deficiency virus transmitted through allogenic transfusion.4
Allogenic blood on the other hand, is collected from someone other than the patient.
Over the last several years an increased awareness of diseases transmitted by allogenic
blood has resulted in a dramatic increase in autologous blood transfusion. Clinical research
and practice in autologous blood use have also grown in recent years, providing new
insights into the issues involved regarding autologous blood transfusion.5
2
Since most planned surgical procedures are associated with autologous blood
transfusion like,
coronary artery bypass, major vascular surgery, primary hip
replacement, total knee replacement, major spine surgery with instrumentation, selected
neurological procedures, hepatic resections, radical prostatectomy, cervical spine fusion,
intervertebral
discectomy,
mastectomy,
hysterectomy,
reduction
cholecystectomy, tonsillectomy, vaginal and cesarean deliveries and
mammoplasty,
transurethral
resection of prostate6.
The benefits of autologous blood transfusion are in contrast with donor blood, the
patient’s type of blood is instantly available and requires no cross matching, no risk of
transfusion reaction due to incomparability, no risk of transmitted disease such as among
others HIV/AIDS, Hepatitis B and C and Syphilis7. The benefits of allogeneic and
autologous RBC transfusions are similar, but the risks of autologous blood are less.
Hence, the risk-benefit ratio supports the more liberal use of autologous blood.8
It is necessary that nurses should have adequate knowledge about autologous
blood transfusion to avoid transfusion adverse effects.
6.1 Need for the study.
Blood is the fragile scarlet tree, we carry within us - Osbert
Blood transfusions are necessary for accident victims, surgical clients, clients
with blood disorders, burns, malaria, severe blood loss as well as altered bone marrow
function related to radiation therapy, chemotherapy and other medications to save their
live. It is done to add more blood to the client’s blood stream. The amount of blood to
be transferred depends on the amount of blood loss and the severity of blood disorder.
All over the World millions of lives will be saved every day through blood transfusion. 9
Blood collected from a patient for re-transfusion at a later time into the same
individual is called "autologous blood”.6
Advantages of autologous blood transfusion are preventing wrong blood to
wrong patient and also that of transfusion-transmitted diseases, in this autologous blood
transfusion high quality fully functional red cells reinfused,44.4% postoperative
infection rate with allogenic blood vs 17.4% with autologous blood, shorter hospital stay,
reduced cost of antibiotics and laboratory tests, donating blood promotes blood cell
production by bone marrow.10
3
In this recent decade India is running short with the blood which requires to save
the lives but at the same time a many priceless units of blood is imported from long
distance each year to fill the needies. This estimation was proposed by nonprofit national
blood resource centre. Over the last several years an increased awareness of diseases
transmitted by allogenic blood has resulted in a dramatic increase in autologous blood
transfusion .Approximately 16 million units are donated annually and of those about
6, 43, 000 are autologous .This number of autologous donations is growing each year.
Clinical research and practice in autologous blood use have also grown in recent years,
providing new insights into the issues involved.11
More than three million blood components are transfused every year in the U.K
providing life saving and life is enhancing treatment to thousands of clients. However,
transfusion error, resulting in the client receiving the incorrect blood component, remains
the largest risk related to transfusion in the U.K. By developing accessible blood
transfusion policies, auditable performance standards, training and educational
initiatives, nurses can increase compliance in high risk areas of the transfusion process
and reduce the potential for errors .This review recommended that there is need to create
awareness regarding autologous blood transfusion among the staff nurses.12
Developing a quality autologous blood recovery program is a team effort.
Members of transfusion committees, hospital blood bank personnel, or staff members of
the surgery committee are all possible sources of information. Local blood center also
may have literature or services that could be of assistance knowledge of current
autologous transfusion alternatives will help nurses communicate with patients regarding
transfusion therapy and will make nurses more valuable participants in the crucial
decisions necessary to deliver optimal patient care in perioperative period.13
A study was conducted to assess the knowledge and practice of many hospital
staff, including doctors, nurses, and pharmacists etc. In Japan, which are engaged in
blood transfusion services. The study concluded that there is a great need for special
education in transfusion medicine.14
A survey was conducted to assess the knowledge and to evaluate the practice on
autologous blood transfusion among nurses. First survey revealed poor practice and
knowledge among nurses and a training programme was implemented. After two years
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2nd survey was conducted which consisted of four questions identical to first survey in
order to assess the impact of training strategy. The four questions were on blood samples
identification, patient identification and pre transfusion bed side compatibility test. The
results showed the improvement in knowledge and practice about autologous blood
transfusion between the first and second survey.15
Nurses will play a significant role in identification of transfusion risks such as
transmission of serious blood borne infections and potentially fatal immunologic and
non-immunologic reactions.
So, they need to have a thorough knowledge on
pathophysiology of transfusion reactions, presenting symptoms and treatment necessary
to monitor transfusion safety. Through meticulous nursing assessment, detection and
proper planning of intervention, nurses can prevent and minimize morbidity and
mortality in clients receiving autologous blood transfusion.
The staff nurses will be rendering the services in varied settings. They have to
possess adequate knowledge, skills, and specialized training in transfusion Medicine to
improve the quality of comprehensive nursing care. Hence, the investigator felt the need
to assess the effectiveness of self instructional module on autologous blood transfusion
among staff nurses working in a selected hospital at Bijapur.
6.2 Review of Literature.
A review article on blood management in orthopedic surgery discusses the
different options for blood salvage. States that filtering alone does not markedly reduce
cytokine concentrations in the processed blood. The cost-effectiveness of using washed
blood is questioned since it requires an expensive device and technical expertise to
operate it and may thus be too costly to recommend as a standard procedure.. The use of
unwashed blood, on the other hand, is considered cost-effective in decreasing the need
for allogeneic blood transfusion. Review was recommended that there is a need for
educational intervention regarding autologous blood transfusion.16
A cross sectional study was conducted to assess the awareness and perceptions of
health care providers regarding autologous blood safety and blood donation. Samples
included doctors, trainee doctors, nurses and technicians. A stratified random sampling
technique was used for this study. A pre designed and pre tested semi structured
questionnaire was used to collect data. The results shown that 69.7% of health care
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providers knew correctly, about blood safety and 70.7% were not aware of autologous
blood donation. There is a need of creating awareness regarding autologous blood
transfusion.17
A descriptive study was conducted assessment of knowledge on importance of
autologous blood transfusion. A group of 50 pre university students was selected for the
study by using a purposive sampling method. A descriptive survey approach was used.
A semi-structured questionnaire was used to assess the knowledge level of trained nurses
regarding body mechanics. The study reveals that, among 50 students, 21 (42%) students
have adequate knowledge; 12 (24%) have moderate knowledge and 17 (34%) have
inadequate knowledge regarding importance of autologous blood transfusion. There is a
need of further research studies to educate needy group18
A survey was conducted among physicians and nurses to determine their overall
knowledge about autologous blood transfusions. The physician questionnaire was a 12question survey. The questions focused on informed consent and transfusion-related
risks that the committee felt every physician would know. A similar test, 14 questions
developed by the Nursing Education Department, was administered to nursing staff and
focused on basic transfusion techniques and practices. Both groups scored significantly
lower (in the 50%–80% range) than anticipated (in the 85%–100% range). Following an
educational process, a repeat survey demonstrated significant improvement in all areas.
This indicated that the importance of providing a constant source of information and
feedback to all staff involved in transfusion services. There is a need of educational
intervention regarding autologous blood transfusion.19
A study was conducted to evaluate the significance of autologous blood
transfusion (AT) in reducing homologous blood transfusion (HT) in surgery for
hepatocellular carcinoma (HCC) and also investigated the impact of AT and HT on longterm postoperative outcome after curative surgery for HCC. Result was the proportion of
patients with HT was significantly lower in period B than period A (18.9% vs 60.2%, P
< 0.0001). Multivariate logistic regression analysis identified AT administration as a
significant independent predictor of the need for HT (P < 0.0001). Disease-free survival
in patients with AT was comparable to that without any transfusion. Multivariate
analysis identified HT administration as an independent significant factor for poorer
disease-free survival (P = 0.0380). The study concluded that AT administration
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significantly decreased the need for HT. Considering the postoperative survival
disadvantage of HT, AT administration could improve the long-term outcome of HCC
patients.20
The retrospective study was under took to determine the effect of autologous
blood transfusion on the incidence of adverse postoperative events in patients
undergoing major amputation. The demographic variables, need for autologous blood
transfusion, and clinical outcomes were recorded. The impact of autologous blood
transfusion on clinical outcome was analyzed. Of the 300 patients undergoing major
amputation, 191 (64%) had one or more blood transfusions. Patients undergoing blood
transfusion were 2.5 times more likely to suffer from a postoperative cardiac arrhythmia,
12.8 times more likely to develop acute renal failure, 5.7 times more likely to have
pneumonia, and 2.2 times more likely to have a urinary tract infection.21
A study was conducted on the perception of risk associated with autologous
blood donation and transfusion including the use of so-called blood substitutes. A
questionnaire survey was conducted involving 88 general practitioners, 143 anesthetists’,
20 journalists, and 250 nursing students. Respondents were asked through free response
questions to identify the risks they most associated with blood transfusion and the
infections associated with autologous
blood transfusion and donation. They were also
asked to indicate their preference for their own blood, compared to donor blood or a
blood substitute. The percentage of respondents who preferred to receive their own
blood, compared to donor blood or a suitable substitute, was 73–94%. When required to
choose between donor blood or
a blood substitute, there were significant (P < 0.05)
differences between sample groups: anesthetists and GPs preferred to receive a blood
substitute (52–59%), whereas nursing students and journalists preferred donated blood
(74–93%). These findings have clear implications for the future development and
implementation of modern transfusion options, including the use and acceptability of
blood substitutes as alternatives to donor blood.22
The study was conducted to evaluate the effectiveness of a self-instructional
module in increasing nurses' knowledge of genetics. Pretest/post-test study design was
used. 262 registered nurses involved in screening egg donors at 177 reproductive health
centers. Sixty-five registered nurses were working at reproductive health centers. 100 of
262 eligible nurses completed the pretest (38% return rate) and 65 of these 100 nurses
also completed the post-test (65% retention rate). Results revealed that there was a
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significant increase in mean knowledge score of 20.8% on the post-test (89.0% mean,
SD=8%, range=67-100%) as compared to the pretest (69.0% mean, SD=12%, range=4292%), based on paired t test analysis (t=11.74, SE=0.426, p< .0001). Thus more in depth
independent study programs in genetics for nurses are recommended.23
A study was conducted on need based preparation and evaluation of self
instructional module for staff nurses on care of a child receiving oxygen therapy. The
study aimed at finding association between learning needs and selected variables and
determining validity of self instructional module, on “care of a child receiving oxygen
therapy” and evaluating the effectiveness of the self instructional module. A survey
approach was used for phase one and one group pretest posttest design was adopted for
phase two. The total sample of the study was 30 staff nurses, of 6 months experience in
pediatric ward. The study concludes that self instructional module was effective in terms
of gain in knowledge score as well as acceptability and utility scores of staff nurses.24
6.3 Problem statement.
A study to evaluate the effectiveness of self instructional module on knowledge
regarding autologous blood transfusion among staff nurses working in a selected hospital
at Bijapur.
6.4 Objectives.
1. To assess the level of knowledge regarding autologous blood transfusion among
staff nurses as measured by structured knowledge questionnaire.
2. To find out the effectiveness of self instructional module regarding autologous
blood transfusion among staff nurses.
3. To find the association between the pre-test knowledge
regarding autologous
blood transfusion with selected socio demographic variables.
6.5 Operational definitions.
1. Effectiveness: It refers to determine the extent to which the self instructional
module programme achieved the desired effect in improving the knowledge of
staff nurses regarding autologous blood transfusion.
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2. Self instructional module: It refers to a written material prepared by the
investigator includes, introduction, definition, types, and its advantages,
procedure of autologous blood transfusion.
3. Knowledge: In this study knowledge refers to awareness of staff nurses
regarding meaning and concept, indications, incidence, methods, management
and complications of autologous blood transfusion.
4. Autologous blood transfusion: In this study autologous blood transfusion refers
to collection and reinfusion of the patients own blood or blood components.
5. Staff nurses : In this study staff nurses refer to the registered nurses working in
a selected hospital at Bijapur.
6.6 Assumptions.
1. Staff nurses may have inadequate knowledge regarding autologous blood
transfusion.
2. Administration of self instructional module will help to enhance the knowledge
of staff nurses regarding autologous blood transfusion.
6.7 Hypothesis.
The following hypotheses will be tested at 0.05 level of significance.
H1- There is a significant difference between pre test and post test knowledge.
H2- There is a significant association between pretest knowledge score with
selected demographic variables.
6.8 Delimitation.
1. This study is limited to staff nurses working in selected hospitals at Bijapur.
2. This study is delimited to 60 staff nurses.
3. The study is limited to only knowledge about autologous blood transfusion.
4. The study is limited to only selected hospital at Bijapur.
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7.
MATERIALS AND METHODS
7.1 Source of data collection.
Staff nurses working in a selected hospital at Bijapur.
7.1.1 Research Design.
In this study research design is pre-experimental research design. (one group pre
test post test experimental design)
7.1.2 Research Approach.
Evaluative research approach.
7.1.3 Setting
The study will be conducted in a selected hospital at Bijapur.
7.1.4 Population.
Registered staff nurses who are working in selected hospital at Bijapur.
7.1.5 Variables.
1. Independent variable.
Self instructional module
2. Dependant variable
Knowledge of staff nurses regarding autologous blood transfusion.
7.2 Method of data collection
7.2.1 Sampling.
The sampling procedure will be purposive sampling technique.
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7.2.2 Sample size.
In this study sample size will be 60 registered staff nurses from selected hospital at
Bijapur.
7.2.3 Inclusion criteria for sampling.
1. Staff nurses from selected hospitals.
2. Staff nurses who are available during time of study.
3. Staff nurses who are willing to participate in study.
7.2.4 Exclusion criteria for sampling.
1. Staff nurses who are not registered in state nursing council.
2. Staff nurses who are undergone training of transfusion medicine.
7.2.5 Instruments to be used.
1. Section A – Includes selected socio demographic variables.
2. Section B- Structured knowledge questionnaire.
7.2.5 Data collection method.
1. Permission will be obtained from the concerned authority.
2. Purpose of conducting the study will be explained to the subjects.
3. Informed consent will be obtained from the subjects.
4. Data will be collected using structured knowledge questionnaire.
7.2.7 Data analysis plan.
7.2.8
Data will be analyzed according to the objectives and hypotheses of the study,
using descriptive statistics like mean, median, frequency, and percentage. Inferential
statistics like chi square test, paired T test, standard deviation, cumulative percentage and
Data will be presented in the form of tables, graphs and diagrams.
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7.2.8 Duration of the study :
4 - 6 weeks
7.3 Does the study require any investigation to be conducted on
patients or other human or animals (if so please describe briefly)
NO.
7.4 Has ethical clearance been obtained from your institution in case of
7.3?
Not applicable.
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LIST OF REFERENCES.
1) Biradar V. Autologous blood transfusion Nightingales nursing times 2010;
6(2):57-62.
2) Blood and Blood Transfusion Available from:URL:http://www.blood transfusion
Wikipedia
3) Autologous blood transfusion Available from: URL:http://www.edurite.com.htm:
4) Available from: URL:http://www.wisegeek.com.
5) Benjamin Lichtiger, MD, Yango Huch MD, Current issues in transfusion
medicine 1992, October-December.
6) Autologous blood transfusion Available from :URL:http//www.blood index.com
7) Henry DA et al Pre-operative autologous donation for minimizing perioperative
allogenic blood transfusion Cochrane review issue 2003 January.
8) Vanderlinde, Elizabeth S. Joanna M Heal, and Neil Blunberg Autologous blood
transfusion, British medical Journal 2002 march, 324:722-5.
9) Available from : URL:http//www.Blood transfusion.com
10) The
serious
Hazards
of
Transfusion
annual
report
2007
Ref:
http//www.shotuk.org/home.htm.
11) Available from: http//www.globalbloodstatistics.com.
12) Based on WHO Global Database on blood safety and blood safety indicators.
Available from: http//www.globalbloodbank.com.
13) Johnson GM, Bowman RJ American Red cross. Autologous blood transfusion.
Current trends, nursing implications. American Red cross AORN J 1992 Aug,
56(2):282-92.
14) Dr. Mohd. Samiullah khan .Paramedical and nursing Times Hyderabad Magnum
Graphics.2005.
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15) Available from: http//[email protected].
16) Keating EM, 1998: Current options and approaches for blood management in
orthopedic surgery J Bone joint surg 80-A: 5,750-62.
17) Available from: http//www.bloodBook.com.
18) Available from: http//www.globalbloodstatistics.com.
19) Available from: http//www.tralispain.com.
20) Yoshito
tomimaru, Hidetoshi. Eguchi, Shigeru et al department of surgery
Graduate school of medicine Osaka university2-2 Yamadaoka, Suita 565-0871,
Osaka Japan Advantage of autologous blood transfusion in surgery for
hepatocellular carcinoma.
21) Sail our Glens son F, Tricaud S, mathoulin-Peliser S, Bouchon B, Galperine I,
Failon P. Factors associated with nurse’s poor knowledge and practice of
Transfusion Safety procedure. Int J Quail Health care. 2009:14(1) .25-32.
22) Umar AS, Abdulkareem “A Cross sectional study was conducted to assess the
awareness and perceptions of health care providers regarding blood safety and
blood transfusion” 2007.
23) Swank, Colleen O'Donnell; effectiveness of a genetics self-instructional module
for nurses involved in egg donor screening; 2001 Nov-Dec; 30(6); Pg-617-25.
24) Machado A, Bhaduri A, George A; oxygen therapy for children; need based
preparation and evaluation of self instructional module for staff nurses on care of
a child receiving oxygen therapy; 1998 Jun; 89(6); Pg- 125-27.
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