Download 15. Nursing -IJPNSC-Effectiveness of selected nursing

TJPRC: International Journal of Nursing
and Patient Safety & Care (TJPRC: IJNPSC)
Vol. 1, Issue 1, Jun 2015, 89-96
© TJPRC Pvt. Ltd.
EFFECTIVENESS OF SELECTED NURSING INTERVENTION PACKAGE ON
KNOWLEDGE AND SKILL AMONG CLIENTS AT RISK FOR SLEEP APNEA AT
SELECTED HOSPITAL, CHENNAI QUASI EXPERIMENTAL STUDY
BAKYA.M1, GRACE LYDIA2, SUMATHI. M3 & KANCHANA S4
1
2
M.Sc (Nursing), Omayal Achi College of Nursing, Chennai, Tamil Nadu, India
Assistant Professor, Department of Medical Surgical Nursing, Omayal Achi College of Nursing,
Chennai, Tamil Nadu, India
3
Professor & HOD, Department of Medical Surgical Nursing, Omayal Achi College of Nursing
Chennai, Tamil Nadu, India
4
Principal, Omayal Achi College of Nursing, Chennai, Tamil Nadu, India
ABSTRACT
Background
Sleep apnea is commonly seen among all the age groups. In adults it occurs approximately in 15% of men and 5%
of women. In older adults, sleep apnea occurs among 70% of men and 56% of women. Sleep apnea prevalence increases
with aging among both genders. Sleep apnea in older adults contributes to poorer quality of life, nocturia, cardiovascular
diseases, hypertension, heart failure and diabetes mellitus.Globally 100 million people are suspected to have sleep apnea;
of which 80% remain untreated & undiagnosed. Globally around 84% of people with sleep apnea have other co- morbid
illness
Objective
To determine the effectiveness of selected nursing intervention package on knowledge and skill regarding sleep
apnea among clients at risk for sleep apnea.
Design
Quasi experimental equivalent control group design.
Setting
Sir Ivan Stedeford Hospital, Chennai
Population
Client at risk for sleep apnea.
Methods and Materials
Data obtained using non-probability purposive sampling technique. After screening the clients at risk for sleep
apnea using modified STOP BANG questionnaire 60 clients at risk for sleep apnea (30 in experimental group and 30 in
control group) were selected. Knowledge was assessed using structured knowledge questionnaire and skill was assessed
using observational check list. Pre and post test was done. Intervention regarding sleep apnea was done using selected
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Bakya.M, Grace Lydia, Sumathi. M & Kanchana S
nursing interventional package.
Results
The findings revealed that in the experimental group the pre test mean knowledge score was 2.40 with S.D 1.49
and the post test mean score was 17.40 with S.D 1.00. The calculated value t=40.389 was highly significant at p<0.001. In
the control group, the pre test mean score was 2.07 with S.D 0.87 and the post test mean score was 2.33 with S.D 0.88. The
calculated value t=1.975 was not found to be statistically significant. The post test skill score showed a mean of 8.87 with
S.D 0.68 in the experimental group and in the control group the mean score was 2.30 with S.D 0.53. The calculated t value
of t=41.515 was not found to be statistically significant. The correlation of post test knowledge and skill showed a ‘r’ value
of 0.458 which was significant at p<0.001 in the experimental group; whereas in the control group, the correlation ‘r’ value
of 0.999 was not significant.
Conclusion
When compare to control group the post test mean score for knowledge and skill was found high in experimental
group, which indicated that the selected nursing intervention package was a effective intervention to improve the level of
knowledge and skill regarding sleep apnea among clients at risk for sleep apnea.
KEYWORDS: Selected Nursing Intervention Package, Sleep Apnea, Modified STOP BANG Questionnaire
INTRODUCTION
Sleep apnea, a silent disease is the concomitant cause for many cardio vascular problems. Sleep apnea needs
early identification and appropriate treatment. Majority of the clients are not aware of their own risk for sleep apnea. Life
style modification and other alternative treatments may ease sleep apnea; unawareness is a major drawback. Education
programs are generally not in practice. Clients at risk for sleep apnea may develop complications such as cardiac problems,
hypertension and stroke. As people don’t know that they are at risk for sleep apnea, selected nursing intervention package
may be a method to reduce the severity of sleep apnea effectively and skillfully.
Sleep apnea is defined as the reduction of cessation of breathing (airflow) during sleep resulting in inadequate
supply of oxygen. This may last for few seconds to minutes and can occur up to hundred times at night. During sleep, the
airway obstruction results in changes in autonomic nervous system activity resulting in increased systemic and pulmonary
arterial pressure and changes in cerebral blood flow. When sleep apnea is left untreated it may result in certain
complications like arrhythmias and sudden cardiac death.
Sleep apnea is commonly seen among all the age groups. In adults it occurs approximately in 15% of men and 5%
of women. In older adults, sleep apnea occurs among 70% of men and 56% of women. Sleep apnea prevalence increases
with aging among both genders. Sleep apnea in older adults contributes to poorer quality of life, nocturia, cardiovascular
diseases, hypertension, heart failure and diabetes mellitus.
Globally 100 million people are suspected to have sleep apnea; of which 80% remain untreated & undiagnosed.
Globally around 84% of people with sleep apnea have other co- morbid illness.
More than one quarter of population in United States of America (USA) were not getting adequate sleep. But
sleep is considered vital for good health. Over 40 million people in USA are undiagnosed or not getting treatment for sleep
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Effectiveness of Selected Nursing Intervention Package on Knowledge and Skill among Clients
at Risk for Sleep Apnea at Selected Hospital, Chennai Quasi Experimental Study
91
apnea. National Hospital Discharge Survey, USA estimated the hospital prevalence for sleep apnea as 80%, but only about
6.8% reported and 5.8% people were on home treatment for sleep apnea. National Sleep Foundation (2014) revealed that
poor sleep affects the daily activities among 45% of Americans at least once in seven days. Insufficient sleep is also
associated with a number of chronic diseases such as cardio vascular diseases, obesity, etc. Sleep apnea leads to adverse
effects during hospitalization. In hospitals, screening for sleep apnea is not given much importance. The treatment is given
only when sleep apnea is associated with other co morbid illness or when clients with sleep apnea exhibit other signs and
symptoms.
Aims and Objectives: the main aim of the study to determine the effectiveness of selected nursing intervention
package on knowledge and skill regarding sleep apnea among clients at risk for sleep apnea.
Specific Objectives
•
To assess and compare the pre and post test level of knowledge regarding selected nursing intervention package
among the experimental and control group.
•
To determine the effectiveness of selected nursing intervention package on knowledge and skill regarding sleep
apnea among clients at risk for sleep apnea.
•
To correlate the post test level of knowledge with skill regarding selected nursing intervention package among the
experimental and control group.
•
To associate the selected background variables with mean differed knowledge score and post test level of skill
score among experimental group.
MATERIALS AND METHODS
Design: Quasi experimental equivalent control group design.
Setting and Participants: The study was conducted at Sir Ivan Stedeford Hospital, in Chennai. It is a 220 bedded
multi specialty hospital with 50 beds in both male and female medical ward. On an average, around 90 clients get admitted
per month in these wards. The study comprised of 60 clients, with 30 clients in experimental and 30 clients in control
group clients at risk for sleep apnea who fulfills the inclusive criteria. Non- probability purposive sampling technique was
used to select the samples.
Tools and Techniques: Modified STOP BANG questionnaire was used to screen the clients, the selected samples
were assessed using structured knowledge questionnaire and observational checklist to collect information regarding their
knowledge on sleep apnea, and skill on throat, tongue and ballon exercises. The knowledge questionnaire consists of 20
questions in multiple choice methods and each correct answer carries 1 mark, the level of knowledge score percentage was
classified as >75% adequate knowledge, 50-75% moderately adequate knowledge and <50% inadequate knowledge for
interpretation. The observational check list consists of 10 items, each carries 1 mark, the level of skill score percentage was
classified as >75% adequate skill, 50-75% moderately adequate skill and <50% inadequate skill for interpretation. The
reliability of the tool was established by inter rater method for risk assessment tool, test-retest method for knowledge
questionnaire and inter rater method for observational checklist. The reliability score for risk assessment tool was r’=0.90,
for knowledge questionnaire was ‘r’=0.90 and for observational check list was ‘r’=0.86. Content validity of the tool was
obtained from Medical Expert, Intensivist. General Physician, Nursing experts. The questionnaire was administered to the
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Bakya.M, Grace Lydia, Sumathi. M & Kanchana S
study participants before and after the intervention. Post test was conducted after 7 days of intervention.
Description of Intervention: Lecture cum discussion on sleep apnea- definition, risk factors, signs and
symptoms, management, preventive strategies, complications, and life style modifications using power point presentation
and video show for 15minutes individually to each sample. Video assisted demonstration of throat exercises (chewing
gum, yawning, vowel exercise and swallowing exercises), tongue exercises (palate push, lip route, tongue out, tongue rove
exercises) and balloon exercises were demonstrated for each sample individually for10 minutes. Patients were instructed to
do these exercises thrice a day, for a total of 30 minutes per day. Re demonstration by the patients, Reinforcement using
booklet on selected nursing intervention package.
Ethical Considerations: Informed consent was obtained from the study participants and ethical permission was
obtained from the institutional ethical board of Omayal Achi College of Nursing, Chennai. Privacy and confidentiality was
maintained between the participants.
Statistical Methods: Data collected was analyzed by using both descriptive and inferential statistics. Frequency
and percentage distribution was used to analyze demographic variables, Mean and standard deviation was used to assess
the pre and post test level of knowledge and skill, paired and unpaired t-test was used to assess the comparison of pre and
post test level of knowledge and post test level of skill, Correlation coefficient was used to find the relation between
knowledge and skill, One way ANOVA was used to report the inference.
Figure 1: Percentage Distribution of Overall Pre and Post Test Level of Knowledge
among Clients at Risk for Sleep Apnea in the Experimental Group
Figure 2: Percentage Distribution of Overall Pre and Post Test Level of Knowledge
among Clients at Risk for Sleep Apnea in the Control Group
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Effectiveness of Selected Nursing Intervention Package on Knowledge and Skill among Clients
at Risk for Sleep Apnea at Selected Hospital, Chennai Quasi Experimental Study
Table 1: Comparison of Pre and Post Test Level of Knowledge
between Experimental and Control Group N=60
Level of
Knowledge
Experimental Group
Mean
S.D
2.40
1.49
Control
Group
Mean S.D
Unpaired
‘T’ Value
t =1.054
Pre test
2.07
0.87
p = 0.297,NS
t = 61.707
17.40
Post test
1.00
2.33
0.88
p = 0.001,S
p<0.001, S – Significant, N.S – Not Significant
Table 2: Comparison of Post Test Skill Scores among Clients at Risk for
Sleep Apnea between the Experimental and Control Group. N = 60(30+30)
Level of Skill
Mean
S.D
Unpaired ‘T’ Test
Experimental Group
8.87
0.68
t = 41.515
Control Group
2.30
0.53
p = 0.000, S
p<0.001, S – Significant,
Table 3: Correlation between Post Test Knowledge and Skill Scores among Clients
at Risk for Sleep Apnea in the Experimental Group and Control Group. N = 30
Variables
Experimental
Group
Mean
S.D
knowledge
17.17
1.29
Control
Group
Mean
S.D
2.33
0.88
‘R’ Value
r = 0.458
p = 0.011, S*
r = 0.000
skill
8.87
0.68
2.30
0.53
p = 1.000,
N.S
p<0.05, S – Significant
RESULTS
Demographic Characteristics
In the experimental group, majority of the clients 16(53.33%) were in the age group of 51 – 60 years, 20(66.67%)
were male, 12(40%) were educated upto high school, 15(50%) had hypertension, 14(46.67%) had blood pressure in the
range of 140/100 – 149/109 mmHg, 10(33.33%) had the habit of both smoking and alcohol, 29(96.67%) had no family
history of obstructive sleep apnea, 29(96.67%) had no history of respiratory illness, 18(60%) had history of daytime sleep,
14(46.67%) had 8 hours of sleep at night.
Whereas in the control group, majority of the clients 19(63.33%) were in the age group of 51 – 60 years,
20(66.67%) were male, 14(46.67%) were educated upto high school, 19(63.33%) had hypertension, 17(56.67%) had blood
pressure in the range of 140/100 – 149/109 mmHg, 10(33.33%) had the habit of both smoking and alcohol, almost all
30(100%) had no family history of obstructive sleep apnea, 30(100%) had no history of respiratory illness, 19(63.33%) had
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Bakya.M, Grace Lydia, Sumathi. M & Kanchana S
history of daytime sleep, 13(43.33%) had 8 hours of sleep at night.
Study Outcome: The mean score of pre test in the experimental group was 2.40 with the standard deviation 1.49
and in the control group it was 2.07 with the standard deviation 0.87. The unpaired t test value of t=1.054 was not found to
be statistical significant at P<0.05 level.(Tab -1) The mean score of post test in the experimental group was 17.40 with the
standard deviation 1.00; whereas in the control group it was 2.33 with the standard deviation 0.88. The unpaired t test with
the value of t=61.707 did not reveal any statistical significance at P<0.05 level. (Tab -1)
The post test mean score of skill in the experimental group was 8.87 with S.D 0.68; whereas in the control group,
the post test mean score of skill was 2.30 with S.D 0.53. The calculated unpaired ‘t’ value of t = 41.515 was found to be
statistically significant at p<0.001 level. (Tab-2)
The post test mean score of knowledge in the experimental group was 17.17 with S.D 1.29 and the post test mean
score of skill was 8.87 with S.D 0.68. The calculated
‘r’ value of r = 0.458 shows a moderately positive correlation and
was found to be statistically significant at p<0.01 level.
DISCUSSIONS
The study revealed that in the pre test 30(100%) clients had inadequate knowledge both in the experimental and
control group. With regard to the post test level of knowledge showed that 26(86.67%) clients had adequate knowledge,
and 4(13.33) had moderately adequate level of knowledge; where as in the control group 30(100%) had inadequate
knowledge. (Fig 1&2)
With regard to post test level of skill among clients at risk for sleep apnea, all 30(100%) had adequate skill in the
experimental group and almost all 30(100%) needs improvement on skill in the control group.
The clients who had history of chronic illness had shown statistically significant association with the mean differed score
of knowledge and post test level of skill at p<0.05 level, and the other demographic variables had not shown any
significance in the experimental group.
CONCLUSIONS
The study findings proved that the selected nursing intervention package improved the knowledge and skill
regarding sleep apnea among clients at risk for sleep apnea.
Source of Support: Nil
Conflict of Interest: Nil
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Effectiveness of Selected Nursing Intervention Package on Knowledge and Skill among Clients
at Risk for Sleep Apnea at Selected Hospital, Chennai Quasi Experimental Study
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