Download 6.5.8 nursing student - Rajiv Gandhi University of Health Sciences

SYNOPSIS FOR REGISTRATION OF SUBJECTS
FOR DISSERTATION
SUBMITTED BY:
Ms. HIBU YASE
1ST YEAR M.Sc. (N)
MEDICAL – SURGICAL NURSING
(2012 – 2014 BATCH)
FORTIS INSTITUTE OF NURSING
#20/5, YELACHENAHALLI, KANAKAPURA MAIN ROAD,
BANGALORE-560078
SYNOPSIS FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1.
NAME OF THE CANDIDATE AND
Ms. HIBU YASE
ADDRESS
1ST YEAR M. Sc. NURSING,
FORTIS INSTITUTE Of NURSING,
#20/5, YELACHENAHALLI,
KANAKAPURA MAIN ROAD,
BANGALORE-560078
2.
NAME OF THE INSTITUTION
FORTIS INSTITUTE OF NURSING,
BANGALORE
3.
4.
COURSE OF STUDY AND
1ST YEAR M.Sc. NURSING
SUBJECT
MEDICAL – SURGICAL NURSING
DATE OF ADMISSION TO THE
15th JUNE 2012.
COURSE
5.
“A STUDY TO ASSESS THE
TITLE OF THE TOPIC
EFFECTIVENESS OF REPEATED
STRUCTURED TEACHING
PROGRAMME ON PROGRESSIVE
IMPROVEMENT IN KNOWLEDGE OF
NURSING STUDENTS REGARDING
CARE OF PATIENT ON
MECHANICAL VENTILATOR IN
SELECTED NURSING COLLEGES,
BANGALORE .”
1
6.0 BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“We are what we repeatedly do. Excellence then is not art, but a habit”
– Aristotle.
Cell is the living structural and functional unit of life. Cells in human
body continually use oxygen (O2) for the metabolic reactions that releases
energy from the nutrient molecules and produce adenosine triphosphate
(ATP). These reactions release carbon dioxide (CO2) as a byproduct. The
respiratory system helps in gas exchange- intake of O2 and elimination of
CO2 and cardiovascular system transports blood containing these gases
between the lungs and body cells. Failure of either system disrupts
homeostasis by causing rapid death of cells from oxygen starvation and
builds up waste products. In addition to function of gas exchange, the
respiratory system also helps in regulating pH, contains receptors for the
sense of smell, filters inspired air, produces sounds and rids the body of
some water and heat in exhaled air.1
When the respiratory system fails to function adequately, resulting in
impaired gas exchange, the supportive device like mechanical ventilator is
required. Mechanical ventilator is a positive pressure breathing device by
which air and/or oxygen is forced into the lungs intermittently in a manner
resembling normal breathing. Mechanical ventilation may be required for a
variety of reasons, including the need to control the patient’s respiration
during surgery or during treatment of severe head injury, to oxygenate the
2
blood when the patient’s respiratory efforts are inadequate and to provide
rest to the respiratory muscles. Many patients placed on a ventilator can
breathe spontaneously but the effort needed to do so may be exhausting.2
Galen was the first to describe ventilation of an animal though it was
well over a thousand years later that positive pressure ventilation with a
bellows device became an accepted technique for resuscitation of neardrowning victims. Negative pressure ventilation techniques, including
negative pressure operating rooms were developed in the 19th and early 20th
centuries for clinical use. The first negative pressure device to gain
widespread use, the Drinker-Shaw "iron lung," was developed in 1928.
Later refinements by Emerson during the 1931 polio epidemic resulted in a
simplified and less expensive tank respirator which became the mainstay of
treatment of paralytic poliomyelitis. In the early 1950s, positive pressure
mechanical ventilation emerged following decades of developmental work
in animal laboratories and growing clinical experience with cuffed
endotracheal tubes in operating rooms.
Clustering of patients with
respiratory failure supported on positive pressure ventilators in Copenhagen
in 1950s led the way to the development of modern day Intensive Care Units
(ICUs).3
Today, there are numerous highly sophisticated and refined
mechanical ventilators are available for clinical use.3 But prolonged period
of mechanical ventilation is expensive for both the patient, in terms of the
risk of complications such as Ventilator Associated Pneumonia (VAP) and
to the health service due to the high cost of maintaining a patient in intensive
care.4 Being on a mechanical ventilator is associated with risk of anxiety,
3
post-traumatic stress syndrome, nosocomial pneumonia, and premature
mortality.5
Optimal management of mechanical ventilation and weaning requires
dynamic and collaborative decision making to minimize complications and
avoid delays in the transition to extubation. Effective collaboration requires
open, extensive, and coordinated communication as well as shared team
goals that will result in improved quality of care, patient safety, and
discharge outcomes.6 Both doctors and nurses are responsible for making
decisions about mechanical ventilation and weaning.
4
6.1 NEED FOR THE STUDY
Caring for patients on mechanical ventilation has become an integral
part of the nursing care in critical care or general medical-surgical units,
extended care facilities and at home. The nurses, physicians and the
respiratory therapist must possess good knowledge and understand each
patient’s specific pulmonary need and work together to set realistic goals.3
The movement towards research and evidence-based practice in
health care demands that the best available evidence is applied to practice.
At the same time, the changes to role boundaries mean that nurses are
assuming increased responsibility, especially in relation to decision making.
While there is an increase in responsibility, there has been limited
consideration about the application of best evidence and decision making by
nurses in the context of their clinical work.7
Critical care nurses can identify subtle changes in a patient’s clinical
status and initiate appropriate nursing interventions rapidly and effectively.
The main components of nursing care for mechanically ventilated patients
include the following:
 Performing frequent assessments including level of consciousness and
vital signs.
 Verifying prescribed ventilator settings and appropriate alarm limits.
 Ensuring emergency equipments, such as manual resuscitation bags
and oropharyngeal and nasopharyngeal airways are immediately
available.
 Assessing the adequacy of cardiac output.
5
 Evaluating the adequacy of oxygenation.
 Assessing the adequacy of ventilation.
 Monitoring the patient-ventilator interaction.
 Identify signs of flow dyssynchrony.
 Educating patients and their families (with the patient’s consent).
 Involving patients in the decision making regarding medical treatment
and nursing care.8
A
multi-center,
cross-sectional,
self-administered
survey was
conducted on nurse managers of adult intensive care units (ICUs) in
Denmark, Germany, Greece, Italy, Norway, Switzerland, Netherlands, and
United Kingdom (UK), regarding decisional responsibility for mechanical
ventilation and weaning. Findings indicate, according to nurse managers,
that inter-professional collaboration was the predominant model for
decisions about mechanical ventilation and weaning. The nurses generally
had reasonable influence on decisions made. Inter-professional collaboration
varied according to the type of decision with physicians more likely to select
initial ventilator settings and nurses more involved in the ongoing titration of
ventilation and determination of extubation readiness. ICU nurses maintain a
near continuous presence at the bedside and therefore may be in a best
position to titrate ventilator settings in response to changes in physiologic
parameters.6
A four-year controlled, prospective, quasi-experimental study was
conducted in MICU, surgical ICU (SICU), and coronary care unit (CCU) for
one year before the intervention (period 1), one year after the intervention
(period 2), and two follow-up years (period 3). The SICU and CCU served
6
as control ICUs. The finding shows that, before the intervention, there were
45 episodes of Ventilator associated pneumonia (VAP) (20.6 cases per 1000
ventilator-days) in the MICU, eleven (5.4 cases per 1000 ventilator-days) in
the SICU, and nine (4.4 cases per 1000 ventilator-days) in the CCU. After
the intervention, the rate of VAP in the MICU decreased by 59% (to 8.5
cases per 1000 ventilator-days) and remained stable in the SICU and CCU.
The rate of VAP in the MICU continued to decrease in period 3 (to 4.2 cases
per 1000 ventilator-days), and the rates in the SICU and CCU remained
unchanged. Compared with period 1, the mean duration of hospital stay in
the MICU was reduced by 8.5 days in period 2 and by 8.9 days in period 3.
They concluded that a focused education intervention resulted in sustained
reductions in the incidence of VAP, duration of hospital stay, cost of
antibiotic therapy, and cost of hospitalization.9
Although Mechanical ventilator is an essential life saving device
which maintains ventilation and oxygenation, it can cause numerous
complications. A sound knowledge regarding care of a patient on
mechanical ventilator and patients’ clinical status enables clinicians to finetune ventilator settings to maximize the benefits of ventilator support while
minimizing complications. Critical care nurses play a crucial role in
improving the effectiveness of mechanical ventilation, preventing harm, and
optimizing patient outcome.8
In developed countries, mechanical ventilators are no longer limited to
the Intensive care unit but are now a part of long-term and home care
support system.10
7
The researcher during her work experience observed that many nurses
especially the fresh graduates have minimal knowledge about caring for a
patient on mechanical ventilation.
Therefore, in the light of the above facts and the experiences of the
researcher, she felt that if we strengthen the knowledge base of student
nurses regarding care of a patient on mechanical ventilator, by reinforced
teaching and testing during student life, we can create more efficient nurses
for the society.
8
6.2 REVIEW OF LITERATURE
A review of literature on the research topic makes the researcher
familiar with the existing studies and provides information which helps to
focus on a particular problem, lays a foundation upon which to base new
knowledge. It creates accurate picture of the information found on the
subjects.11
A study was conducted to assess the effectiveness of the learning
package, regarding care of a patient on mechanical ventilator on the
knowledge of the staff nurses from the selected hospital, Mangalore. Finding
shows that, the mean post-test knowledge score (x2=30.4) was higher than
the pre-test knowledge score (x1=21.6). The mean post-test score ranged
between 22 and 36 and that of pre-test ranged from 15-20 respectively. The
mean percentage knowledge score of pre-test was maximum (68.8%) in
“area of endotracheal suctioning” and minimum in the area of “working
principle of ventilator” (36.6%) where as the mean percentage knowledge
score of post-test was maximum in the area of “review of anatomy and
physiology of respiratory system” (86.6%) and less in “working principles of
ventilator” (65.0%). The mean difference between the post-test and pre-test
knowledge was significant (t29=12.14) (t29=2.045 at 0.05 level). There is a
significant association between knowledge of staff nurses regarding care of a
patient on mechanical ventilator and working experience in intensive care
unit (x2=5.24; p=0.05 level).12
A study was conducted at tertiary care hospital, in Karachi, Pakistan.
Single group pre-test post-test design was used with a sample size of 40
nurses. The study investigated the impact of teaching module on nurses’
9
knowledge to practice evidence based guidelines for the prevention of VAP.
The knowledge of nurses, were assessed before, immediately after and four
weeks after the intervention. The findings reveals that majority of the
subjects were female (80%, 32/40), having qualified in diploma nursing and
were fresher. Another significant feature of the study group is that 24 nurses
did not have any experience of caring for critically ill patients. The study
further shows that there was a difference in mean and standard deviation
from baseline (7.8±2.9) to post-test:1 (10.8±2.0) and finally in post-test:2
(9.8±2.1). As compared to post-test:1, the scores slightly dropped in posttest:2 conducted at the interval of four week. Though there was a drop, the
mean scores of post-test:2 were significantly higher than the mean scores of
the pre-test.13
A study was conducted in the University of Illinois at Chicago (UIC),
to evaluate the effectiveness of “simulation”, to determine the importance of
adding simulation to the curriculum. The study design was a prospective,
pre-test post-test study without a control group. Seven senior Acute Care
Nurse Practice (ACNP) students participated in a one-time, 2.5 hour
simulation on a patient with pneumonia and septic shock. The finding
suggests that all students completed the pre and post written tests and the
surveys. The mean correct responses on the written test increased after
simulation (7.1±2.4 versus 10.3±1.5). Six of seven students improved their
number of correct responses; one student had the same number of correct
responses. Student’s confidence in their ability to manage a mechanically
ventilated patient, and managing circulatory shock improved after simulation
from generally “somewhat not confident” to “very confident”. Students
10
either “agreed” or “strongly agreed” that simulation enhanced critical
thinking skills and evidence-based practice and should be mandatory part of
ACNP education.14
A survey was designed in Acute Respiratory Distress Syndrome
Network Teaching Hospital in Baltimore, to assess barriers related to
clinicians’ perceived attitudes, knowledge and behaviors related to low tidal
volume ventilation in acute respiratory distress syndrome among physicians,
nurses, and respiratory therapists in intensive care units. There were 291
completed surveys, with a response rate of 84%. Barriers related to
clinicians’ attitude, behavior, and intensive care unit organization were
significantly higher among nurses and respiratory therapists’ v/s physicians.
Knowledge related barriers also were significantly higher among nurses’ v/s
physicians and respiratory therapists. Barriers were lower and knowledge
test scores higher among fellows and attending physicians v/s residents.
Similarly, barriers were lower and knowledge test scores higher among
nurses with more than 10years of experience v/s less than 10years of
experience. Important organizational and clinical barriers, including
knowledge deficits, regarding low tidal volume were reported, particularly
among nurses and resident physicians.15
A study was conducted in ICU of Royal Melbourne Hospital,
Victoria, Australia, for three-month period, to describe the role of critical
care nurses in making decisions about mechanical ventilation and weaning
in ICU. A total of 3986 decisions on mechanical ventilation and weaning
were identified, a median of six decisions per patient per day of mechanical
ventilation. Among the 3986 decision episodes, 2790 (70%) occurred during
11
the weaning phase of ventilation. Among the recorded decisions, 2538
(64%) were made exclusively by nurses, 693 (17%) were made exclusively
by medical staff, and 755 (19%) were made by collaboration. In the
collaborative decisions, the patient’s bedside nurse discussed the situation
with a medical colleague and nursing input was considered and used in the
decision making process. Overall, in decisions made exclusively by nurses,
results of arterial blood gas analysis and weaning were the primary
indicators for changes in ventilator settings.16
A study was conducted to examine critical care nurses’ knowledge
about the use of the ventilator bundle to prevent ventilator-associated
pneumonia. A sample of 61 nurses working in coronary care and surgical
intensive care were taken for the study. Changes in the nurses’ knowledge
were evaluated by using a 10-item test, given both before and after the
sessions. The finding reveals that after the education sessions, the nurses
performed better on eight of the ten items tested. The areas of most
significant improvement were elevation of the head of the bed, charting of
the elevation of the head of the bed, oral care, checking of the nasogastric
tube for residual volume, washing of hands before contact with patients, and
limiting the wearing of rings and nail polish. Even after the education
sessions, the nurses’ compliance with hand-washing recommendations
before contact with patients was low, though statistically some improvement
was apparent. Contraindications to elevation of the head of the bed did not
appear to affect the nurses’ practices.17
12
6.3 STATEMENT OF PROBLEM
A STUDY TO ASSESS THE EFFECTIVENESS OF REPEATED
STRUCTURED
IMPROVEMENT
TEACHING
IN
PROGRAM
KNOWLEDGE
OF
ON
PROGRESSIVE
NURSING
STUDENTS
REGARDING CARE OF PATIENT ON MECHANICAL VENTILATOR
IN SELECTED NURSING COLLEGES, BANGALORE.
6.4 OBJECTIVES OF THE STUDY
1. To assess the existing knowledge of student nurses prior to structured
teaching program on care of the patient on mechanical ventilator, by
conducting pre-test.
2. To evaluate the effectiveness of structured teaching program as
measured by progressive improvement in knowledge score on care of
the patient on mechanical ventilator among nursing students by
administering a knowledge questionnaire at four different time points
at a gap of seven days interval.
3. To find an association between knowledge scores of student nurses on
care of the patient on mechanical ventilator with selected
demographic variables.
6.5 OPERATIONAL DEFINITIONS
6.5.1 ASSESS
In this study it refers to, ‘measuring the knowledge of nursing student
regarding care of the patient on mechanical ventilator’.
13
6.5.2 EFFECTIVENESS
In this study it refers to, ‘significant gain in knowledge of the student
nurses as determined by per-test and multiple post-test knowledge on care of
a patient on mechanical ventilator’.
6.5.3 STRUCTURED TEACHING PROGRAM
In this study it refers to, ‘the systematically developed and organized
instructions, which is administered to the nursing students includes lecture
and discussion, designed to provide information regarding care of a patient
on mechanical ventilator’.
6.5.4 PROGRESSIVE IMPROVEMENT
In this study it refers to, ‘continuous improvement in knowledge due
to continuous and repeated reinforcement by using a structured teaching
programme.
6.5.5 KNOWLEDGE
In this study it refers to, ‘the correct level of response from nursing
students regarding care of a patient on mechanical ventilator, which will be
elicited through structured questionnaire’.
6.5.6 CARE OF PATIENT
In this study it refers to, ‘nursing care of a patient receiving
mechanical ventilation’.
6.5.7 MECHANICAL VENTILATOR
In this study it refers to, ‘a life saving device that can support the
ventilatory function of the respiratory system and improves oxygenation
through application of high oxygen content gas and positive pressure’.
14
6.5.8 NURSING STUDENT
In this study it refers to, ‘student who is studying in 3rd year B.Sc.
nursing in selected college of nursing in Bangalore’.
6.6 ASSUMPTIONS
1. Students may have inadequate knowledge on care of a patient on
mechanical ventilation.
2. Structured teaching program on care of a patient on mechanical
ventilator may help in improving their knowledge and thereby
reduce complications.
6.7 HYPOTHESIS
H0.1: There is no significant difference between the pre-test knowledge
scores and post-test knowledge scores of nursing students exposed to
repeated Structured Teaching Program.
H1.1: There is significant difference between the pre-test knowledge scores
and post-test knowledge scores of nursing students exposed to
repeated Structured Teaching Program.
H0.2: There is no significant association between the multiple teaching and
progressive improvement in knowledge score of nursing students
exposed to repeated Structured Teaching Program.
H1.2: There is a significant association between the multiple teaching and
progressive improvement in knowledge score of nursing students
exposed to repeated Structured Teaching Program.
15
H0.3: There is no significant association between the levels of knowledge
scores of nursing students and selected demographic variable.
H1.3: There is a significant association between the levels of knowledge
scores of nursing students and selected demographic variable.
6.8 VARIABLES IN STUDY
Independent variables: In the present study, independent variable is
the structured teaching program on care of patient on mechanical
ventilator.
Dependent variables: In the present study, dependent variable is the
progressive improvement in the knowledge score of the nursing
students regarding care of patient on mechanical ventilator.
Demographic variables: In the present study, demographic variables
are age, gender, religion, family income, type of family, place of living
and source of information.
7.0 MATERIALS AND METHODS
7.1.1 Source of data
: Nursing students of selected college
of nursing, Bangalore.
7.1.2 Research approach
7.1.3 Research design
:
An evaluative research approach.
:
A quasi-experimental time series
design with one group pre-test &
multiple post-test without control
group.
16
7.1.4 Research setting
:
The study will be conducted in
selected
college
of
nursing,
Bangalore.
7.1.5 Target Population
:
Population of the study is the
nursing students studying in
selected college of nursing,
Bangalore.
7.1.6 Sample
Students studying in 3rd year B.Sc.
:
nursing in selected college of
nursing, Bangalore.
7.1.7 Sampling technique
:
Non probability purposive sampling
technique will be adopted to select
the subject.
7.1.8 Sample size
:
60 nursing students in selected
college of nursing, Bangalore who
fulfills the inclusion criteria.
7.1.9 Sampling criteria
Inclusion criteria
:
Third year B.Sc. nursing students
who are willing to participate in
the study.
Exclusion criteria
:
Third year B.Sc. nursing students
who are absent during the period
of data collection.
:
Nursing students who have already
participated in study related to
knowledge on ventilator.
17
7.2.1 TOOL FOR DATA COLLECTION
Data will be collected using structured questionnaire. Data collection
tool contain items on the following aspects:
Part1: Consists of demographic variables such as age, gender, religion,
family income, type of family, place of living and source of
information.
Part2: Structured knowledge questionnaire regarding care of a patient on
mechanical ventilator.
7.2.2 METHOD OF DATA COLLECTION
The data required for the study will be collected by using a structured
knowledge questionnaire. A sample size of 60 nursing students will be
selected by non probability purposive sampling technique. Written consent
will be taken from each student and pre-test will be administered, followed
by structured teaching program. First post-test will be administered after
seven days. Total of four structured teaching program will be administered
at the interval of seven days and after each of the teaching program a posttest will be administered.
7.2.3 METHOD OF DATA ANALYSIS
The investigator will analyze the data obtained by using descriptive
and inferential statistics. The plan of data analysis as follows:
Descriptive statistics
Data will be analyzed using Percentage, Mean, Mean %, Median,
Standard deviation and results will be represented using tabular and
graphical method.
18
Inferential statistics
 Repeated measures of Analysis of Variance is used for testing the
difference between Mean pre-test and post-test knowledge scores.
 Chi square [χ²] for measuring association between knowledge level
and selected demographic variables. The result will be statistically
significant whenever P≤0.05 level of significance.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR
INTERVENTION TO BE CONDUCTED ON OTHER HUMAN
OR ANIMAL?
Yes, the knowledge of 3rd year B.Sc. nursing student will be assessed
by using a structured questionnaire.
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM THE
INSTITUTION?
a. The ethical clearance is obtained from the research committee of
Fortis Institute of Nursing.
b. Written permission will be obtained from the concerned authorities of
selected college of nursing.
c. Informed consent will be obtained from the samples who are involved
in the study before collecting the data.
19
8.0 LIST OF REFERENCE:
1. Tortora Gerard J, Derrickson Bryan. Principles of anatomy and
physiology, 11th ed. United State of America (USA): John Wiley
&Sons, Inc. publication, 2006; p.847.
2. Smeltzer Suzanne C, Bare Brenda G. Brunner and Suddarth’s textbook
of medical surgical nursing 10th ed. Philadelphia: Lippincott Williams
and Wilkins; P.613.
3. Ednan k Bajwa. Mechanical Ventilation. American Thoracic Society
2009 Aug [cited 2012 Setp 6]. Available from:
URL:http://www.thoracic.org/clinical/best-of-the-web/pages/criticalcare/mechanical-ventilation.php
4. Taylor Fran. A comparative study examining the decision-making
process of medical and nursing staff in weaning patient from
mechanical ventilation. Intensive Crit Care Nurses 2006 Oct [cited
2012 Nov 5]; 22(5): 253-63. Available from:
URL:http://www.ncbi.nlm.nih.gov/pubmed
5. Eckerbald J, Eriksson H, Karner A, Edell-gustafsson. Nurses' conception
of facilitative strategies of weaning patients from mechanical
ventilation- aphenomenographic study. Intensive Crit Care Nurses
2009 Aug [cited 2012 Oct 10]; 25(5):225-32.
Available from:
URL:http://www.ncbi.nlm.nih.gov/pubmed
6. Rose Louise, Blackwood Bronagh, Egerod Ingrid, S Haugdahl Heges,
Jose Hofhuis, Michael Isfort, et al. Decisional responsibility for
mechanical ventilator and weaning: An international survey. Critical
care 2011 Dec [cited 2012 Sept 4]; 15(6):295.
URL:http://ccforum.com/content/15/6/R295
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Available from:
7. Hancock HC, Easen PR. The decision-making processes of nurses when
extubating patients following cardiac surgery: an ethnographic study.
Int J Nurs Stud 2006 Aug [cited 2012 Oct 20]; 43(6): 693-705.
Available from: URL:http://www.ncbi.nlm.nih.gov/pubmed
8. Jin Xiong Lian. Basics of mechanical ventilation. Men In Nursing 2008
Dec [cited 2012 Oct 22]; 3(6): 10-16.
Available from:
URL:http://www.nursingcenter.com/prodev/ce article.asp?tid=830701
9. Apisarnthanark A, Uavporn P, KanokPorn T, Chanart Y, David K,
Jeanne E, et al. Effective of an educational program to reduce
ventilator-associated pneumonia in a tertiary care centre in Thailand:
A 4-year study. Oxford Journal of Nursing 2007 May [2012 Aug 29];
45(6): 704-11. Available from:
URL:http://cid.oxfordjournals.org/content/45/6/704.full
10. Lewis Sharon L, Heitkemper Margaret Melean, Dirksen Shannon Ruff,
O’Brien Patricia Graber, Bucher Linda, Mani Mrinaline. Lewis’s
medical-surgical nursing assessment and management of clinical
problems. 1st ed. Delhi: Reed Elsevier India (Pvt) Ltd; 2011. P.1717.
11. Polit Denise F, Beck Cheryl Tatano. Nursing research generating and
assessing evidence for nursing practice. 8th ed. New Delhi: Wolters
Kulwar (India) Pvt Ltd; 2008. P.105.
12. Shubhashini s. Effectiveness of learning package regarding care of a
patient on mechanical ventilator to the staff nurses of selected of
hospital
in
Mangalore.
Available
from:
URL:http://119.82.96.198:8080/jspui/bitstream/12345789/4268/1/shu
bhasini%20s.pdf
21
13. Salima Moez Meherali, Yasmin Parpio, Tazeen S Ali, Fawad Javed.
Nurses’ knowledge of evidence-based guidelines for prevention of
ventilator- associated pneumonia in critical care areas: A pre and Posttest design. J Ayub Med Coll. 2011 [cited 2012 Oct 23] 23(1).
Available
from:
URL:http://www.ayubmed.edu.pk/JAMC/23-
1/Salima.pdf
14. Thomas C Corbridge, Susan J. Corbridge, Rich Mc Laughlin, Rozanna
Templin, Jenny Tiffin, Leonard Wade. Acute Care adviser: Using
simulation to enhance knowledge and confidence. Available from:
The Nurse Practitioner: The American Journal of Primary Health care:
2008 June; 33(6):12,13.
15. Dennison CR, Mendez-Tellez PA, Wang W, Pronoyost PJ, Needham
DM. Barriers to low tidal volume ventilation in acute respiratory
distress syndrome: Survey development, validation and results. Crit
Care Med 2007 Dec [cited 2012 Oct 23]; 35(12): 2747-54. Available
from: URL:http://www.ncbi.nlm.nih.gov/pubmed
16. Louise Rose, S B Lawrence. Decisions made by critical care nurses
during mechanical ventilation and weaning in an Australian intensive
care unit. Critical Care Management 2006 Feb [cited 2012Aug 28]:
445,446. Available from:
URL:http://www.aacn.org/WD/CETests/Media/A071605.pdf
17. Tolentino-delos Reyes AF, Ruppert SD, Shiao SY. Evidence-based
practice: use of the ventilator-associated pneumonia. Am J Crit Care
2007 Jan [cited 2012 Sept7]; 16(1): 20-7. Available from:
URL:http://www.ncbi.nlm.nih.gov/pubmed
22
9.0
Ms. Hibu Yase
SIGNATURE OF THE
CANDIDATE
10.0 REMARKS OF THE GUIDE
Study is feasible. Sample size,
sample technique, method of data
collection
and
analysis
is
appropriate for study design.
11.0 NAME AND DESIGNATION OF Prof. Shridhar K.V.
11.1 THE GUIDE
Principal
11.2 SIGNATURE
Prof. Shridhar K.V.
11.3 CO-GUIDE
Mr. Prabhuswamy A.C.
Associate Professor
11.4 SIGNATURE
Mr. Prabhuswamy A.C.
11.5 HEAD OF THE
DEPARTMENT
Prof. Shridhar K.V.
11.6 SIGNATURE
Prof. Shridhar K.V.
Principal
Study design is strong. The
outcome of the study contributes to
the knowledge base of nursing.
12.0 12.1 REMARKS OF THE
PRINCIPAL
Prof. Shridhar K.V.
12.2 SIGNATURE
23