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A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON MANAGEMENT OF BURNS AMONG NURSING STUDENTS IN SELECTED INSTITUTION OF RAICHUR. PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION. HEPSI NATHA. NAVODAYA COLLEGE OF NURSING RAICHUR. NOVEMBER – 2007. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA. PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION. 1. Name of the candidate and address : HEPSI NATHA M.Sc. Nursing 1st year, Navodaya College of Nursing, P.B.No. 26, Mantralayam Road, Raichur – 584103. 2. Name of the institution : Navodaya college of Nursing. 3. Course of the study and Subject : M.Sc. Nursing 1st year, Medical and Surgical Nursing. 4. Date of Admission to the course : 15/05/2007. 5. Title of the Topic : A study to assess the effectiveness of structured teaching programme on Management of Burns among Nursing Students in selected Institutions of Raichur. 6. Brief Resume Of The Intended Work: 6.1 Need for The Study: Throughout the world, burns remain a huge health issue, atleast in terms of morbidity, especially in the developing countries.1 Injuries that results from direct contact with exposure to any thermal, chemical or radiation source are termed as “Burns”. Burn injuries occur when energy from a heat source is transferred to the tissues of the body. The depth of injury is related to the temperature and duration of exposure or contact.2 Burns continue to be a leading cause of death in developing world.3 Approximately 1.25 million people suffer a burn injury in the U.S. each year. Of this group, 51,000 requires acute hospital admission. About 5,500 people die from burns and related inhalation injuries annually. One million work days are lost each year due to burn injury.4 The current statistical data for the year 2007 is 67 burn cases and is found to the admitted in the civil hospital, Raichur, Karnataka. Among them the mortality rate is 7. Most burn injuries occur in the home, usually in the kitchen while cooking and in the bathroom by means of scalds and by improper use of electrical appliances around water resources. Burn injuries can also occur from work accidents. The National Institute for Burn Medicine which collects statistical data from burn centers throughout the United States noted that most of the clients (75%) are victims of their own actions such as scalds in toddlers, playing with matches, electrical injury in teenage boys and smoking in adults combined with the use of drugs and alcohol.2 A burn may be so severe that it may cause life threatening symptoms. The client may stop breathing or go into shock. In such cases, the first goal of treatment is to save the client’s life not to treat the burns. Clients may require mouth-to-mouth resuscitation or artificial respiration.2 Specialized treatment for severe burn cases may also include installation of a breathing tube if the client’s airway or lungs have been damaged, administration of fluids through an intravenous tube, immunization with tetanus vaccine to prevent infection, covering the burnt area with antibiotic ointment and bandages, debridement or removal of dead tissue. 2 Burns management has yet to be fully understood by everyone in our environment. A retrospective study has been conducted regarding the substances used to treat burns in communities in Nigeria. An analysis of 147 clients in this work shown that 5 per cent of the clients applied one substance or another. Various substances were used including raw eggs, gention violet, cassava, engine oil, kerosene, etc. The risk of infection with most of these substances is obvious.1 The size of burn (percentage of injured skin, excluding first degree burns) is determined by the rule of 9s and an age specific burn diagram or chart. Burn size is expressed as percentage of Total Body Surface Area (TBSA). The basis of the rule is that the body is divided into anatomic sections, each of which represents 9 per cent of the total body surface area. The percentage of burns depends on the degree and severity of the burnt area.2 To prevent burn shock in adults with burn injuries affecting more than 15 per cent total body surface area, intravenous fluid resuscitation is generally required. Fluid resuscitation is used to minimize the deleterious effects of the fluid shifts. The goal of fluid resuscitation is to maintain vital organ perfusion while avoiding the complication of inadequate or excessive fluids. Several formulas are used to calculate fluid requirements. Although each formula is different. The exact amount of fluid is based on the client’s weight and the extent of injury. Fluid resuscitation formulas used in burn care are Evans, Brooke, Modified Brook, Parkland, Hypertonic Saline Solution. Adequacy of fluid resuscitation is based on urine output when hemodynamic monitoring is not used. An indwelling urethral catheter connected to a closed drainage system is placed to measure hourly urine production and to guide intravenous fluid replacement.2 The prognosis for burns depends on many factors, these factors include the degree of the burns, the amount of skin affected by the burns and any additional complications that might have developed.2 As today nursing students are the future care givers throughout the world, the nurses has to play a vital role in rendering the immediate care to the client with burns otherwise it may lead to several other complications. So the Investigator felt the need to assess the knowledge of B.Sc. Nursing students regarding management of burns. Based on their knowledge levels the Investigator is interested to prepare structured teaching programme with the guidance of experts in the field and intervenes the structured teaching programme. Again, after giving a gap of 7 days the Investigator will assess their knowledge to see the effectiveness of structured teaching programme. 6.2 Review Of Literature: A review of literature on the research topic makes the researcher familiar will the existing studies and provides information which helps to focus on a particular problem, lay a foundation upon which to base new knowledge. It creates accurate picture of the information found on the subject. A study has been conducted to assess the impact if advanced burn life support educational programmes (ALBS) on the knowledge among experienced burn nurses in USA. A convenience sampling technique was used to select the sample. The sample size taken was 6 clinical experts with in the 21 bed southeastern burn center who had never taken advanced burn life support educational programme. The tool used for data collection was semi-structured questionnaire. The study results shown that the nurses with high levels of experience had an increase in knowledge and expressed value in continuing education in curriculum. Hence, the study recommended that there is necessity of educational programmes for nurses with significant specialized experience.5 A study has been conducted to understand the cultural meaning which attribute to burn pain among nursing team and burn patients in Portuguese and participant observation were carried out during one year at a burn unit. The sample size taken was four nurses, five auxillaries and twelve clients. The tool used for data collection was semi-structured interview. The study results shown that burn pain was understood by nurses as physical and emotional pain where as for professionals bath and dressing changes were stressful and for patients, burn pain was terrible. 6 An experimental study was conducted to assess the effectiveness of the advanced burn life support course on military physicians and nurses in USA. The study sample taken was 1035 military health care providers. The advanced burn life support and combat burn life support course programmes were given to the study sample. The tool used for data collection was structured questionnaire. The study results shown that the students feed back was largely positive and was being used for further course intended not only for military audience, but also in the casualty situations.7 A descriptive study was conducted to assess the knowledge regarding different aspects of the treatment of burn clients among physicians, nurses and other burn team members in Israel. The study sample taken were 70 health care professionals involved in the treatment of burns. The tool used for data collection was questionnaire comprised of 30 questions. The study results shown that 77 per cent of subjects responded that most local wound care is essential in burns management, where as 23 per cent of subjects responded to dressing changes, Edinborough University Solution of Lime (EUSOL) even though it is unsuitable due to its toxic effects and hydrotherapy which has been proposed as a source of infection and contamination.8 An experimental study was conducted to assess the knowledge and practice regarding care of the clients with burn injuries among home care nurses in USA. The study samples taken were 40 home care nurses. An educational programme was given to them to develop the knowledge and skills to care for the clients with burn injuries at home. The tool used for data collection was semi-structured questionnaire. The study results shown that there was marked improvement of knowledge and practice and the client outcome was improved by application of all nursing measures at home. Hence, the study concluded that this educational programme improved the knowledge of home care nurses and it also helped the home care nurses to give a well integrated continuity of care to the clients.9 An experimental study was conducted to assess the impact of a Burn Wound Education Programme and implementations of a clinical pathway on client outcomes among home care nurses in USA. The sample size taken was 60 home care nurses. The tool used for data collection was semi-structured interview. The data were collected from 54 clients’ records from the first two periods and the entire samples of 12 records from the third period were reviewed. The study results shown the positive impact of education in combination with the use of a burn home care clinical pathway.10 6.3 Statement of the problem A study to assess the effectiveness of structured teaching programme on Management of Burns among Nursing Students in selected Institution of Raichur 6.4 Objectives of the study To assess the knowledge of nursing students regarding management of burns. To evaluate the effectiveness of structured teaching programme in management of burns. To find out the relationship between knowledge of the nursing student regarding management of burns with selected socio-demographic variables. 6.5 Hypothesis There will be a significant relationship between the knowledge of the nursing students on management of burns with the selected socio demographic variables. There will be a significant relationship between pre test and post test knowledge scores. 6.6 Operational Definition Effectiveness : It is the extent to which the knowledge of nursing students improved with regard to management of burns after the implementation of structured teaching programme as evidenced by the differences in the pretest and post test scores. Structured teaching programme: It refers to systematically developed instrument designed for a group of nursing students to provide information regarding management of burns. Nursing students: Students who are studying in II year B.Sc.Nursing at Navodaya College of Nursing, Raichur. Management: It is the art of securing maximum results by planning, organizing and implementing the comprehensive nursing care by the nursing students for managing the burns client. Burns: Injuries that result from direct contact with any thermal or chemical or radiation or inhalation source. 7 Materials and Methods: 7.1 Sources of Data: Design: The research approach adapted is one group pre and post test experimental study. Setting of the study: Study will be conducted in a selected nursing institution at Raichur. In Raichur 3 nursing institutions are functioning. Among them Navodaya College of Nursing has been selected for the present study. Navodaya Institution emerged in 1992. It was affiliated to Gulbarga university from 1992-1995. In 1996 it got affiliated to Rajiv Gandhi University of Health Sciences, Bangalore. The institution initiated nursing education with diploma in general nursing and midwifery and added basic B.Sc. Nursing in 1993, post Basic Nursing in 2003 and M.Sc.Nursing course in 2001. Navodaya Institution is having total strength of five hundred and eighty five GNM students, thirteen post basic B.Sc. Nursing students, three hundred and eleven B.Sc. Nursing students and twenty five M.Sc.Nursing students. Population: The population included in the study are those who are studying in II year B.Sc. Nursing in Navodaya College of Nursing, Raichur. There are 28 boys and 64 girls comprising a total of 92 students in B.Sc. Nursing IInd year, 2007-08 batch. Sample size: Simple size for the study consists of 92 B.Sc. Nursing II year, 2007-08 students studying at Navodaya College of Nursing, Raichur. Sampling technique: Purposive sampling technique will be used to select the nursing institution and simple random technique will be used to select the sample by using lottery method. Inclusion Criteria: The study includes nursing students who are studying in B.Sc. nursing II year at Navodaya College Of Nursing, Raichur. willing to participate in the study. available at the time of data collection. Exclusion Criteria: The study excludes the nursing students, who are not studying in B.Sc. Nursing II year at Navodaya College Of Nursing, Raichur. willing to participate in the study. available at the time of data collection. Selected Variables: Dependent Variables: Knowledge of the nursing students regarding management of burns. Independent Variables: Structured teaching programme regarding management of burns. Extraneous Variables: 1. Age: Age of the sample is categorized as. 19-21 years 22-24 years 25 years and above 2. Gender: Gender of the sample is categorized as Male Female 3. Religion: Religion of the sample is categorized as Hindu Muslim Christian 4. Educational Background: It refers to previous education of the subjects. It is categorized as Intermediate Intermediate with vocational nursing General graduation or above 5. Clinical Exposure: It refers to experience of the sample in burn care unit. It is categorized as 3 week. 4 weeks. 5 weeks. 6 weeks. 7.2 Methods of collecting data: Data collection instrument: A structured questionnaire will be developed and used for collecting the data. It consists of 2 parts namely part I and part II. Part I deals with sociodemographic data and Part II represents the knowledge related items on management of burns. Data collection method: After obtaining the prior permission from the significant authorities and consent from the subjects the Investigator will assess the knowledge of nursing students regarding management of burns by using a structured questionnaire and then intervenes structured teaching programme. Again the Investigator will assess the effectiveness of structured teaching programme by post test after a gap of 7 days depending on time convenience of the sample. Plan for data analysis: Numerical data obtained from the sample will be organized and summarized with the help of descriptive statistics. Testing the level of significance of hypothesis will be done with the help of inferential statistics like chi-square tests and coefficient correlation to identity the relationship between knowledge to nursing students regarding management of burns with selected demographic variables. Projected Outcomes: The result of the study throws light on effectiveness of structured teaching programme on management of burns among nursing students. There by helps the future researchers to adopt modified strategies to enhance the knowledge of nursing students. 7.3 Does the study require any investigation or intervention to be conducted on patients or other human or animals? If so please describe briefly. Since, it is one group pretest and post test experimental design, the study requires intervention. The Investigator will assess the knowledge of nursing students on management of burns and administers structured teaching programme and again tests the knowledge of nursing students to assess the effectiveness of structured teaching programme. 7.4Has ethical clearance been obtained from your institution in case of 7.3? Permission will be obtained from institutional ethical committee, Navodaya College of Nursing, Raichur. Consent will be obtained from all the participants. 8. LIST OF REFERENCES: 1. Olaitin P.B, Lyidobi E.C. ANNALS OF BURNS AND FIRE DISASTERS. Volume XVII – 2004 June. 2. Joyce. M.Black. MEDICAL AND SURGICAL NURSING. 7th edition, Volume – 2; 1433, 1442-1446. 3. Aoron J. PERIOPERATIVE MANAGEMENT OF BURN PATIENTS. 1999 June; 69(6): 1211-22. 4. Brunner and Suddarth. TEXT BOOK OF MEDICAL- SURGICAL NURSING. Philadelphia. Lippincot Company. 8th edition; 1223-30. 5. Wolak E, Klish K. EDUCATIONAL OPPORTUNITIES FOR EXPERIENCED STAFF. 2006 Jul-Aug; 22(4): 181-6. 6. Rossi LA, Casagrande LD. THE NURSING PROCESS AT A BURNS UNIT. Lat Am Enfermagem. 2001 Sep-Oct; 9(5) :39-46. 7. Barillo DJ, Cancio LC. COMBAT BURN LIFE SUPPORT: A MILITARY BURN-EDUCATION PROGRAM. J Burn Care Rehabil. 2005 Mar-Apr; 26 (2): 162-5. 8. Haik J, Ashkenazy O. BURN CARE STANDARDS IN ISRAIL. Burns. 2005 Nov; 31(7): 845-9. Epub 2005 Jun 20. 9. Dattolo J, Trout S. HOME HEALTH CARE AND BURN CARE: AN EDUCATIONAL AND ECONOMICAL PROGRAM. J Burn Care Rehabil. 1996 Mar-Apr; 17(2): 180-7. 10. Momolem NL, Brenner PS. THE IMPACT OF A BURN WOUND EDUCATION PROGRAM AND IMPLEMENTATION OF A CLINICAL PATHWAY ON PATIENT OUTCOMES. J Burn Care Rehabil. 2000 Sep-Oct; 21(5): 440-5. 9. Signature of the Candidate : 10. Remarks of the Guide : 11. Name & the Designation of : 11.1 Guide : Miss Annapoorna. S Asst. Professor, DEPT. OF MEDICAL SURGICAL NURSING 11.2 Signature : 11.3 Co-guide : 11.4 Signature : 11.5 Head of the department : Miss Annapoorna. S Asst. Professor, DEPT. OF MEDICAL SURGICAL NURSING 11.6 Signature : 12.1 Remark of the Chairman & Principal 12.2 Signature :