Download STEP II: Selection of subjects (Nurses).

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA,
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1
2
NAME OF THE
MRS. MANISHA A. BIJAPURKAR
CANDIDATE AND
K.L.E.S’ INSTITUTE OF NURSING SCIENCES,
ADDRESS
NEHRU NAGAR, BELGAUM-10 KARNATAKA
NAME OF THE INSTITUTE
K.L.E.S’ INSTITUTE OF NURSING SCIENCES,
NEHRU NAGAR BELGAUM-10 KARNATAKA
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COURSE OF THE STUDY
AND SUBJECT
M.Sc. NURSING
1st YEAR
OBSTETRIC AND GYNAECOLOGICAL
NURSING
4
DATE OF ADMISSION TO
15th MAY 2007
THE COURSE
5
TITLE OF THE TOPIC
“EFFECTIVENESS
INSTRUCTIONAL
KNOWLEDGE
AMONG
OF
NURSES
OF
A
SELF
MODULE
ON
OBSTETRIC
DRUGS
WORKING
IN
MATERNITY UNIT OF KLES PRABHAKAR
KORE HOSPITAL & MRC, BELGAUM”.
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BRIEF RESUME OF THE INTENDED WORK.
6.1 NEED FOR THE STUDY
The midwife is recognized as a responsible and accountable professional who
works in partnership with pregnant women to give the necessary support, care and
advice during pregnancy, labour and the postpartum, period. This care includes
preventive measures, the promotion of normal birth, the detection of complications in
mother and child, accessing of medical or other appropriate assistance and the carrying
out of emergency measures. It is true that midwifes are serving women, their babies and
families, society and God. If it looks no different than the myth-based, damaging
knowledge and practice of obstetrics, then it is not midwifery.1
Midwives who care for pregnant and laboring women are faced with an
increasingly frequent use of pharmaceutical agents that facilitate initiation of labor
(uterotropins), augment labor (uterotonics), or potentially stop labor (tocolytics). The
choice of the drug, administration, side effects, and complications varies. Knowledge
about uterine physiology helps the midwife to understand the action of these agents.
Knowledge of the differences and similarities among oxytoxics, ergots, prostaglandins,
and the various drugs used as tocolytics is essential for safe and effective care of
women and their fetuses who may be exposed to these agents.2
All midwives bear a great responsibility when they administer drugs, as these
may act not only upon the mother but also on the fetus during pregnancy and labour and
on the baby in the early days of life.3
Medication administration is an activity that is prone to errors, in part because of
the proliferation of new devices and new drug products. Medications are administered
through a variety of routes, dosages, dosage forms and dosing regimens, adding
variability. More over medication orders are changed frequently as pharmacists and
medical specialists provide input into patient care based on changes in patient clinical
status and the results of diagnostic tests.4
An article in American Journal of Maternal Child Nursing addresses the
importance of the nursing role in the management of oxytocin during induction
augmentation of labor. It highlights that nurses at the bedside of laboring women have
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to make oxytocin titration decisions must be based on a sound knowledge of the
pharmacologic properties of oxytocin, the physiology of uterine contractions, and the
response of the woman and fetus to contractions. In addition, nurses must be aware of
the standards and guidelines of care that govern their actions during induction /
augmentation.5
A study was done at department of pediatrics, Johns Hopkins University,
Baltimore, USA. The objective of the study was to synthesise peer reviewed knowledge
on children’s medication errors and on recommendations to improve pediatric
medication safety by a systematic literature review. Data were from Pubmed, Embase
and Cinahl from 1st January 2000 to 30th April 2005, and 11 national entities that have
disseminated recommendations to improve medications safety. From 358 articles
identified 31 were included for data extraction. The definition of medication error was
non-uniform across the studies. Dispensing and administering errors were the most
poorly and non uniformly evaluated. Over all the distributional epidemiological
estimates of the relative percentages of pediatric error types were: prescribing 3- 37%,
dispensing 5 – 58%, administering, 72 – 75% and documentation 17 – 21%. 26 unique
recommendations for strategies to reduce medication error were identified.6
According to the U.S. Supreme Court, the Fourth Amendment rights of 10
women were violated by a hospital that provided them prenatal care. The incidence of
prenatal drug testing for criminal prosecution with or without a woman’s knowledge is
increasing. Concurrently, funding and availability of drug treatment programs for
pregnant women are declining. Nurses and physicians who act as advocates for the state
rather than the patient damage the patient provider relationship and breach their ethical
responsibility to the patient.7
Medication administration is one of the most time consuming aspects of nursing
practice. Expertise in medication calculation and administration is essential to the
treatment of all patients. However many nurses experience difficulty when calculating
medications. In one study the result was 56.4% of nurses could not calculate
medications correctly in 90% of the problems, suggesting the need for regular self
testing of medication calculation skills. Continuing education programmes implemented
for identified medication calculation errors influences nursing practice and patient
outcome.8
3
During her experience of working in maternity ward, the investigator observed
that though nurses have an important role in administering drugs they do not utilize
their knowledge and just follow doctor’s orders. Thereby affecting their quality nursing
care and giving opportunity for the occurrence of easily avoidable medication errors.
Hence, the investigator decided to use self instructional module on obstetric drugs to
increase nurses knowledge thereby improving quality nursing care and prevent
occurrence of medication error, the outcome being a healthy mother and healthy baby.
6.2 REVIEW OF LITERATURE
A diagnostic study was done in school of nursing, Sweden to assess the
mathematical knowledge and skills in calculation and administration of drug dosage
among Nurses, student Nurses and physicians. The main purpose of this study was to
investigate if student nurses and registered nurses have adequate knowledge and skills
in drug dosage calculation. The sample considered for the study was 545 experienced
nurses and 197 student nurses. The result of the study showed that Nine out of the
fourteen test items were solved accurately and no differences were found in the average
performance between the two groups.9
An observational study was done in German on the cause of IV drug errors by
nursing staff in hospital. The purpose of the study was to explore the cause of IV drug
errors by nursing staff in hospital. The sample for the study were 22 nurses. The result
showed that a total of 74 IV drugs errors were identified, while observing 161
preparations and 135 administrations. The conclusion of the study focused on training
of nurses and providing guidelines by multidisciplinary team.10
A descriptive correlational study was done in Gold Coast Hospital, Australia to
describe nurses’ assessment skills and knowledge related to the management of a
patient with an epidural infusion and to explore relationships between these variables
and the levels of education / clinical experience of the nurses. A convenience sample of
surgical and obstetric unit registered nurses were involved. Data were collected via
survey and observation, using instruments developed by the research team. The results
of this study indicated that the nurses theoretical knowledge outweighed their clinical
skill performance and clinical decision making. Education for nurses regarding the
management of epidural infusions need to be comprehensive, context specific and have
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the capacity to develop the nurse’s autonomous critical thinking and clinical decision
making-skills. Strategies for this include self-directed learning packages best
supplemented by demonstration of clinical skills and supervised practice.11
A structured program was developed and used by the clinical pharmacists in Abu
Dhabi to identify the nursing knowledge on medication errors and other medication
related safety issues. The sample for the study consisted of 370 in-patient nursing staff.
Findings revealed differences in the knowledge of nurses about the causes and reporting
of medication errors. There were statistically significant differences in responses across
the participants years of experience and the current clinical working area. The
participants responses improved significantly [57.4% ± 8.2, (95% CI: 56.6-58.2) vs.68.9
± 10.3, (95% 67.8-69.9): p<0.05] pre and post questionnaire respectively. It shows that
the clinical pharmacists structured program has improved knowledge of the in-patient12
A randomized control trial was done on the medication administration error rate
among nurses of two hospitals (A and B) in Chicago. The objective of the study was to
find the impact of dedicated medication nurses on the medication administration error
rate. The sample for the study included 10 nurses who received a brief review course on
safe medication use and were called “medicated nurses” and 15 “general nurses” who
did not attended the course. A direct observation technique was used to record drug
errors, process-variation errors and total errors. The result of the study showed that at
both hospitals the combined total error rate was 15.7% for medication nurses and 14.9%
for general nurses (p<0.84). comparing the 2 hospitals the total error rate for medication
nurses at hospital B was significantly higher than it was at hospital A (19.7%vs 11.2%;
p<0.04). At hospital A there was significantly lower error rate for medication nurses
then for general nurses in the surgical units(p<0.01) but no significant differences in
total errors comparing nurse types in the medical units (p<0.77). The study suggests that
use of dedicated medication nurses does not reduce medication error rates.13
A pretest / post test study was done in Baltimore on the effectiveness of a
Genetics Self Instructional Module for nurses involved in Egg donor screening. The
objective of the study was to evaluate in increasing nurses knowledge of genetics. The
sample for the study considered were 262 registered nurses involved in screening egg
donor, but only 65 nurses completed the pretest as well as the post test. 22 page self
instructional booklet on genetic risk assessment was given to the nurses after pretest.
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The results showed significant increase of 20.8% in participant’s mean knowledge score
on the post test (M=89.0%, SD=8.1%, RANGE = 67% - 100%) as compared with the
pretest (M=69.0%, SD=12%, range = 42-92%) based on paired t test analysis (t=11.74,
SE-0.426, P <0.001).14
6.3 STATEMENT OF THE PROBLEM
“A study to evaluate the effectiveness of a self instructional module on
knowledge of obstetric drugs among nurses working in Maternity Unit of KLES
Prabhakar Kore Hospital & Medical Research Centre, Belgaum, Karnataka”.
6.4 OBJECTIVES OF THE STUDY
1. To identify the learning needs of nurses in relation to drugs used in maternity
unit.
2. To assess the knowledge of obstetrics drugs among nurses.
3. To prepare and administer a self instructional module on obstetric drugs.
4. To evaluate the effectiveness of a self instructional module on the knowledge of
selected obstetric drugs among nurses.
5. To find an association between knowledge of obstetric drugs among nurses and
selected demographic variables.
6.5 OPERATIONAL DEFINITIONS :1. EVALUATE: Refers to statistical analysis, (descriptive and inferential) of
knowledge of nurses in selected obstetrics drugs.
2. EFFECTIVENESS : Refers the extent to which the information in Self
Instructional Module (SIM) has achieved the desired effect as measured by gain
in post test knowledge scores.
3. SELF INSTRCTIONAL MODULE: Refers to an information booklet on
obstetric drugs prepared by investigator and content validated by experts. It can
be used by a learner without the presence of the teacher. It is designed to
provide study information regarding use of obstetric drugs by nurses with
regard to:
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
Pharmacological name

Mode of action

Dosage calculation

Route of administration

Indications and Contraindications

Side effects

Nurses responsibility

Exercises
4. KNOWLEDGE : Refers to nurse’s appropriate response to items related to
selected obstetric drugs as measure by a structured knowledge questionnaire.
5. NURSES: Refers to registered staff nurses with B.Sc. Nursing or GNM
qualification, working in maternity unit of KLES Prabhakar Kore Hospital and
Medical Research Centre, Belgaum.
6. SELECTED DEMOGRAPHIC VARIABLES: Refers to factors such as age,
professional qualification, total years of experience, experience in maternity
unit and inservice programme attended.
7. MATERNITY UNIT: Refers to the labour ward, antenatal ward, postnatal
ward and where nurses are working to provide obstetric care.
8. SELECTED OBSTETRIC DRUGS: In this study obstetric drugs refers to the
drugs used in labour unit which will be highlighted in the need assessment
format by the nurses.
6.6 HYPOTHESES :
1. H1  The mean post test knowledge scores of subject exposed to Self Instruction
Module will be significantly greater than the mean pre test knowledge scores at 0.05
level of significance.
2. H2  There will be statistically significant association between pretest knowledge
scores and selected demographic variables at 0.05 level of significance.
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6.7 ASSUMPTIONS :
1. Nurses working in maternity unit have some knowledge regarding selected
obstetric drugs.
2. Self Instructional Module will increase knowledge of nurses on selected
obstertric drugs.
6.8 DELIMITATIONS:
This study is delimited to the nurses working in maternity unit of KLES
Prabhakar Kore Hospital and MRC, Belgaum.
6.9 PROJECTED OUTCOME :
The nurses will gain more knowledge about selected obstetric drugs and
prevent medication errors. The study aims to provide Self Instructional Module as a
easy reference to nurses working in maternity unit of KLES Prabhakar Kore Hospital &
MRC, Belgaum, Karnataka.
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MATERIALS AND METHOD
7.1 SOURCES OF DATA
 Primary Source:
Nurses working in maternity unit of KLES Prabhakar
Kore Hospital and MRC, Belgaum.
 Secondary Source :
Review of literature collected from various journals,
magazines, newspapers, books and internet.
 Research Approach: Evaluative
 Research design :
One group pretest and post test design.
 Research setting:
The study will be conducted in maternity unit of KLES
Prabhakar Kore Hospital, Belgaum.
 Population:
Nurses working in maternity unit.
 Sample size:
35 nurses
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 Inclusion criteria:
Nurses
1. Having completed their B.Sc. Nursing or GNM Nursing qualification.
2. Working in maternity unit of KLES Prabhakar Kore Hospital & MRC,
Belgaum.
3. Willing to participate.
Exclusion criteria:
Nurses
1. On managerial post
2. Not present during the time of data collection.
7.2 METHOD OF COLLECTION OF DATA.
Sampling technique: Purposive sampling.
Instrument:
1. Structured knowledge questionnaire to assess the knowledge.
2. The learning need assessment format.
3. Opinionnaire
Section I: Items on selected demographic variables like age, professional
qualification, total years of experience, experience in maternity unit and
inservice education attended.
Section II :
Items on knowledge of nurses regarding selected obstetric drugs.
Section III:
Items on learning needs assessment format consisting of necessary
desirable and not necessary alternatives.
Section IV:
Opinionnaire on acceptability
Data Collection Method
STEP I : The investigator will obtains permission from respective authority to conduct
the study.
STEP II: Selection of subjects (Nurses).
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STEP III: Investigator introduces herself to the subject and explains about her aim,
objectives and steps of the study and takes written consent to conduct the
study.
STEP IV: Conducts need assessment and prepare the Self Instructional Module.
STEP V: Conducts pre test with a tool of structured knowledge questionnaire.
STEP VI: Administer self instructional module regarding knowledge of selected
obstetric drugs among nurses.
STEP VII: Conducts post test by using structured knowledge questionnaire.
STEP VIII: Analysis of collected data and interpretation.
7.3 Does the study require any interventions or investigations to be conducted?
Yes ( Self Instructional Module).
7.4 Has ethical clearance been obtained from your institution?
Yes.
7.5 Permission will be obtained from the authorities of KLES Prabhakar Kore
Hospital and MRC, Belgaum.
8.
LIST OF REFERENCES
1. Midwifery Wikipedia, The free encyclopedia. [online] 2007 Aug. [cited 2007
Nov 13]; Available from: URL:http://www.en.wikipedia.org//wiki//midwifery
2. Payton RG, Mary C. Drugs and uterine motility. Journal of Obstetric,
Gynecology and Neonatal Nursing [online] 1999 Nov [cited 2007 Nov 11];
28(6);[628-37]. Available from:
URL:http://www.blackwellsynergy.com/doi/obs/10.1111/i.15526909.1999.tb02172.x
3. Bennett VR, Brown LK. Myles Textbook for midwives. 12ed. Edenburgeh:
Churchill Livingstone; 1998. p.675.
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4. Nancy LG, Elizabeth F. The Impact of Dedicated Medications Nurses on the
medication Adminsitration Error Rate. Arch Internmed [Online] 2003 Oct 27
[cited 2007 Nov 17]; 163: [2359-67]. Available From:
URL:http://www.ncbi.nlm.gov/sites/entrez?cmd=Retrive&db=pubmed&list_uio
ds=14581257
5. Clayworth, Suellen MN. The Nurses’ RoleDuring Oxytocin Administration.
American Journal of Maternal child Nursing [online] 2000 Mar-Apr [cited 2007
Nov 11]; 25(2): [80-85]. Available From :
URL:http//www.ncbi.nlm.gov/sites/entrez?cmd=Retrive&db=pubmed&list_uids
=10748585&dopt=Abstract Plus
6. Miller MR, Robinson KA. Medication errors in peadiatric care. Quality and
safety in health care [online] 2007 Dec [cited 2007 Nov 12]; 16:[116-26].
Available from: URL:http://qshc.bmj.com/cgi/content/abstract/16/2/116
7. Foley EM. Drug screening and criminal prosecution of pregnant women. Journal
of obstetric, Gynecologic and Neonatal Nursing [online] 2002 Mar [cited 2007
Nov
11];
31(2):
[133-37]
Available
From
:
URL:http://www.blackwell.synergy.com/doi/abs/10.1111/j.15526909.2002.tb00032.x
8. Ashby DA. Medical Calculation skills of the medical-surgical Nurse. Med surg
Nursing [online] 1997 Apr. [cited 2007 Nov 26] Available From :
URL:http://qshc.bmj.com/cgi/content/full/16/2/116v/articlerender.Fegi?artid=10
7840
9. Kapborg. Calculation and Adminsitration of Drug Dosage by Swedish Nurses,
student Nurses and Physicians. International Journal for Quality in Health Care
[online] 1994 Nov [cited 2007 Nov 13]; 6(4): [389-95]. Available From:
URL:http??intqhc.oxfordjournals.org/cgi/content.abtract/6/4/389
10. Taxis K, Barber N. Causes of intravenous medication errors observation of
nurses in a German hospital. Journal of Public Health [online] 2004 Apr [cited
2007 Nov 12]; 12(2): [132-38]. Available From:
URL:http://www.springerlink.com/content/5xyx4p2fp7whd6UF/
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11. Bird A, Wallis M. Nursing Knowledge and assessment skills in the management
of patients receiving analgesia via epidural infusion. Journal of Advanced
Nursing [online] 2002 Dec [cited 2007 20]; 40(5): [522-31]. Available From:
URL:http://www.blackwell.synergy.com/doi/pdf/10.1046/j.13652648.2002.02409
12. Elnour AA, Ellahham NH. Raising the awareness of inpatient nursing staff
about medication errors. Pharmacy world & science [online] 2007 Sept [cited
2007 Nov 20]; Available From:
URL:http://www.springerlink.com/content/b26663547/w31735
13. Nancy LG, Elizabeth F. The Impact of Dedicated Medications Nurses on the
medication Adminsitration Error Rate. Arch Internmed [Online] 2003 Oct 27
[cited 2007 Nov 17]; 163: [2359-67]. Available From:
URL:http://www.ncbi.nlm.gov/sites/entrez?cmd=Retrive&db=pubmed&list_uio
ds=14581262
14. Swank CO, Christianson CA. Effectiveness of a Genetics Self-Instructional
module for Nurses Involved in Egg Donor screening. Journal of Advanced
Nursing [online] 2006 [cited 2007 Nov7]; 54(2): [228-37]. Available From :
URL:http://www.blackwell-synergy.com/doi/pdf/10.1111/;.15526909.2001.tb00008.x
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SIGNATURE OF THE
CANDIDATE
10
REMARKS OF THE GUIDE
11 11.1 NAME AND DESIGNATION OF
GUIDE
THE STUDY IS FEASIBLE AND OF
GENUINE INTEREST OF THE
STUDENT.
Mrs.SUDHA A. RADDI
M.Sc(OBG.N) M.Phil
PROFESSOR & H.O.D
DEPARTMENT OF OBSTETRICS &
GYNAECOLOGICAL NURSING
KLES INSTITUTE OF NURSING
SCIENCES,
NEHRU NAGAR,
BELGAUM.
11.2 SIGNATURE
Mrs. SANGEETA N. KHARDE
MSc(OBG.N)
PROFESSOR
DEPARTMENT OF OBSTETRICS &
GYNAECOLOGICAL NURSING
KLES INSTITUTE OF NURSING
SCIENCES, NEHRU NAGAR BELGAUM
11.3 CO-GUIDE
11.4 SIGNATURE
11.5 HEAD OF THE
DEPARTMENT
PROF. Mrs. SUDHA. A. RADDI
MSc(OBG.N)
H.O.D OBG NSG
KLES INSTITUTE OF NURSING
SCIENCES, NEHRU NAGAR,
BELGAUM.
11.6 SIGNATURE
12 12.1 REMARKS OF THE
CHAIRMAN & PRINCIPAL
THIS TOPIC WAS DISCUSSED WITH
THE MEMBERS OF THE RESEARCH
COMMITTEE AND FINALISED. SHE IS
PERMITTED TO CONDUCT THE
STUDY.
12.2 SIGNATURE
13