Download “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED

“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING
PROGRAMME ON KNOWLEDGE REGARDING CARDIO
PULMONARY RESUSCITATION AMONG DEGREE
STUDENTS IN SELECTED COLLEGES OF
TUMKUR”
PROFORMA FOR REGISTRATION OF SUBJECT
FOR DISSERTATION
DIVYA LUKOSE
MEDICAL SURGICAL NURSING
ARUNA COLLEGE OF NURSING
RING ROAD, MARALUR, TUMKUR.
2010-2011
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,
KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION.
1. Name of the Candidate
:
MRS. DIVYA LUKOSE
MSc Nursing Ist Year
And Address
Aruna College of Nursing
Ring Road, Maralur
Tumkur.
2. Name of the Institution
:
Aruna College of Nursing
3. Course of Study And
:
M.Sc Nursing Ist Year
Subject
Medical Surgical Nursing
4. Date of Admission
:
10.06.2010
5. Title of the Topic
:
“A Study to assess the effectiveness of
structured teaching programme on
knowledge regarding Cardio Pulmonary
Resuscitation among degree students
in selected colleges of Tumkur”
6.0 BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“Our role is to develop techniques that allow us to provide emergency life saving
procedures to injured patients in an extreme, remote environment without the presence of
a physician”
Chris Hadfield
Cardio means “of the heart” and pulmonary means “of the lungs”. Resuscitation
is a medical word that means “to revive” or bring back to life. Sometimes cardio
pulmonary resuscitation (CPR) can help a person who has stopped breathing, and whose
heart may have stopped beating, to stay alive. People who handle emergencies such as
police officers, firefighters, paramedics, doctors and nurses are all trained to do CPR.
Many other teens and adults like lifeguards, teachers, child care workers, and may be
even your mom or dad know how to do CPR too1.
Sudden cardiac death is a major cause of death in today’s developed countries. In
most cases, defibrillation and other means of advanced life support are not immediately
available. In urban settings it takes an average of nearly ten minutes for professional help
to arrive. During this time victims can only rely upon CPR provided by educated
bystanders. Therefore a substantial burden of responsibility lies on the shoulders of
educators who need to pass on their knowledge and skills of CPR to their trainees in a
way simple enough to be remembered and recalled rapidly in a highly stressful moment.
It has been shown that correctly performed bystander CPR may positively influence short
and long- term survival of cardiac arrest victims2.
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The organizations are primarily responsible for basic cardiac life support
standards in the United States: The American Heart Association and American Red
Cross. These standards are taught to health care providers and general public by certified
instructors across the nation. All nurses should be prepared in CPR. The American Red
Cross offers courses in basic first aid.CPR is taught in most hospitals or community
colleges. Care should be started immediately to prevent complications. The nurse’s
safety should never be jeopardized when administering care3.
Every nurse and physician should be skilled in CPR because cardiac arrest, the
sudden cessation of breathing, and adequate circulation of blood by the heart, may occur
at any time or in any setting. Resuscitation measures are divided into two components,
basic cardiac life support and advanced cardiac life support. The American Heart
Association establishes the standards for CPR and is actively involved in teaching BCLS
and ACLS to health professionals. The American Heart Association recommends that
nurses and physicians working with patients be certified in BCLS and ACLS.
Certification involves attending formal classes and passing cognitive and motor skill
tests. CPR alone is not enough to save lives in most cardiac arrest. It is a vital link in the
chain of survival that supports the victim until more advanced help is available. The
chain of survival is composed of the following sequence: early activation of the EMS
system, early CPR, early defibrillation and early advanced care4.
6.1 NEED FOR THE STUDY
CPR is a rescue procedure to be used when the heart and lungs have stopped
working. There is a wide variation in the reported incidence and outcome for out of
hospital cardiac arrest. These differences are due to in part to differences in definition
and ascertainment of cardiac arrest as well as differences in treatment after its onset.
2
Several authors described the problem of poor performance in CPR, even when
provided by medical professionals. Numerous investigations have reported the problem
of poor skills retention after various CPR courses.
Studies reporting the need for
improvement of resuscitation techniques led to the recent changes in BLS and ALS
algorithms2.
Many people may think you need to get a degree to get a healthcare job, but the
truth is many jobs simply require applicants to be CPR and First Aid certified Courses to
receive certification in CPR and First Aid are offered at colleges, technical schools, and
Red Cross facilities across the country. This makes getting certified easy and very
accessible to anyone. People can get both certifications as young as 16 years of age. This
means they can start getting credible work experience at an earlier age, which will only
help them out more down the road. And since the courses are so short, it does not have to
interfere with high school5.
Cardio pulmonary Resuscitation has been used extensively in the hospital setting
since its introduction over 3 decades ago. Saklayen M etal conducted study on in hospital
cardiopulmonary resuscitation. Survival in hospital and they reviewed that CPR records,
44% of the patient initially survived following CPR, and the 1 –year survival rate was 5%
patients with shorter durations of CPR and those administered fewer procedures and
medications during CPR survival longer than patients with prolonged CPR. Knowledge
of the likelihood of survival following CPR for subgroups of the hospital population
based on prearrest and intra arrest factors can help patients, their families, and their
physicians decide with compassion and conviction, in what situations CPR should be
administered6
.
3
Heart disease is the number one killer in the United States. Each year almost
330,000 Americans die from heart disease. Half of these will die suddenly, outside of the
hospital because their heart stops beating he most common cause of death from heart
attack in adult is a disturbance in the electrical rhythm of the heart or ventricular
fibrillation. It can be treated by applying an electrical shock to the chest. One way of
buying time until a defibrillator becomes available is to provide artificial breathing and
circulation by performing CPR7
In India the annual incidence of sudden cardiac death accounts for 0.55 per 1000
population. The survival rate of a sudden cardiac arrest is almost less than 1%. Sudden
cardiac death constitutes 40-45% of cardiovascular deaths and out of this almost 80% are
due to heart arrhythmia disturbances or arrhythmia8.
In April 2008, the American heart association took steps to simplify the process
of helping victims of cardiac arrest by introducing “hands only” CPR. About one third of
people who suffer a cardiac arrest at home or at a public place actually receive help,
bystanders could be afraid to initiate CPR for fear that they will do something wrong or
won’t know what to do. Others may be reluctant to perform mouth to mouth breathing
for fear of contracting an infection. The American heart association proposed the new
guidelines in order to allow bystander who have not been trained in conventional CPR or
who may fear making mistake a way to offer help9.
In the light of above, the investigator found it desirable to assess the knowledge
and skill in CPR technique among the degree students and also to update the knowledge
and improvement in skill. The way to learn CPR is to practice CPR. Educating the
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students and creating awareness in helping them to learn more about CPR and it help to
prevent death occurring due to cardiac arrest. Early initiation of CPR improves the
chance of successful resuscitation and survival.
6.2 REVIEW OF LITERATURE
. Literature review is a critical summary of research on a topic of interest,
often prepared to put a research problem in context10.
A study was conducted regarding awareness and attitudes of Chinese students
towards cardiopulmonary resuscitation in China (2010). Study was conducted among
3500 students from the city of Wuhan in China randomly according to the stratified
cluster sampling technique.
There were 3248 questionnaires answered and 2763
questionnaires were considered valid. Few respondents reported that they had heard
(28%) and studied (27%) of CPR and only 3% of the respondents had attended a CPR
course. The two major sources of information about CPR for Chinese students were
television and books. Most respondents expressed a desire to learn CPR (77%) and were
willing to disseminate CPR (73%). The result of the study was shows that dissemination
of CPR among Chinese students has not been executed satisfactory.
The finding
highlights the importance of CPR dissemination and efforts should be made to provide
more convenient, effective and attractive ways for the Chinese public, especially
students, to learn CPR11.
A study was conducted regarding effectiveness of emergency response planning
for sudden cardiac arrest in United States high schools with automated external
defibrillators in USA (2009). A cohort of US high schools with atleast 1 onsite automated
external defibrillators use in sports. A school representative completed a comprehensive
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survey on emergency planning and provided details of any sudden cardiac arrest incident
occurring within 6 months of survey completion. A case of sudden cardiac arrest victims
included 14 high schools student athletes (mean age 16 years; range, 14 to 17 years) and
22 older nonstudents (mean age 57 years; range is 42 to 71 years) such as employees and
spectators. Of the 36 sudden cardiac arrest cases, 35 (97%) were witnessed, 34 (94%)
received bystander CPR and 30 (83%) received an automated external defibrillator shock.
23 sudden cardiac arrest victims (64%) survived to hospital discharge, including 9 of the
14 students and 14 of the 22 older non students. The result of the study shows that school
based automated external defibrillator programs provides a high survival rate. High
schools are strongly encouraged to implement onsite automated external defibrillator
programs as part of a comprehensive emergency response plan to sudden cardiac arrest12.
A study was conducted regarding retention, retention, retention: targeting the
young in CPR skills training in USA (2009).
The prospective investigation was
conducted and set out to determine whether young students have the physical and
cognitive skills to implement CPR. In this investigation, the average time from the last
class of CPR instructions to the evaluation session was 120 days. It is not clear whether
such a large gap in time between initial instruction and skills testing may have affected
testing performance, except that good performance could indicate good retention. As the
investigator demonstrated, students as young as 9 years are able to effectively learn CPR
skills. The students aged 9 to 10 years could compress the chest to the depth recommend
by the guidelines, but 45% of students aged 13 to 14 years old could. Studies also have
found that with retraining, CPR performance can improve in school aged children and
distributing CPR training kits to students aged 12 to 14 years resulted in another 2.5
persons trained per students13.
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A study was conducted regarding community CPR training Greece (2008). There
is a lack of information about the status and characteristics of community CPR training in
Greece. The purpose of the study was to evaluate the knowledge of basic aspects of CPR
practice, characteristics of training an areas in need of improvement to increase CPR
competence in the community. Using a random digit dialing telephone survey, 390
residents of large country were interviewed. Weighting methods were used to estimate
population statistics. Results indicated a low prevalence of current training and lack of
basic CPR knowledge, reflecting the limited extent of and access to training. Results
suggest the need for a standardized, widespread CPR program14.
A study was conducted regarding attitudes toward the performance of bystander
CPR in Japan (2007). Early initiation of bystander CPR improves the chance of
successful resuscitation and survival. A total of 4223 individuals (male 50%) completed
the questionnaire, including high school students, teachers, emergency medical
technicians, medical nurses and medical students.
experienced CPR training more than once.
About 70% of the subjects had
Only 10-30% of high school students,
teachers and health care providers reported willingness to perform chest compression
plus mouth to mouth ventilation, especially on a stranger or trauma victim. The study
result shows that most lay people and health care providers are unlikely to perform chest
compression plus mouth to mouth ventilation, especially on a stranger or trauma victim.
These findings suggest that mouth to mouth ventilation training should be deemphasized
and the awareness of chest compression alone should be emphasized because for
whatever reason, people do not want to perform mouth to mouth ventilation15.
A nationwide survey of CPR training conducted in Sweden about foreign born
and unemployed are not reached by training programmes (2006).
The sample was
selected at random and stratified to correlate to the geographic distribution of the
population. The mean age was 46 (16) years, 54% of the respondents were females and
7
11% were people of foreign origin. 45% had participated in some form of CPR training.
Younger respondents, those living in rural areas, those born in Sweden, employee’s
students and military conscripts were trained more frequently in CPR. The results shows
that held of the non trained population was willing to learn CPR but frequently did not
know that such courses existed or were they were held. Elderly people, people of foreign
origin or those not included in the work force were less likely to have participated in CPR
training16.
A study was conducted regarding teaching basic life support to 12-16 year olds in
Barcelona schools views of head teachers, in 2006(Spain). The aim of the study was to
determine the opinion of head teachers on the educational and logistical characteristics
required for a basic CPR programme for secondary school teenagers to succeed. The
results shows that one hundred out 227 (44%) surveys were sent back.:63% from private
and 37% from public secondary schools with 85% of head teachers being interested in
incorporating a basic CPR in the school curriculum. Interested head teachers did not
differ in age, sex or king of degree compared to their non interested counterparts. Overall
it was considered that the programme could increase the students self esteem (86%) and
be useful for saving lives (72%). It was also felt that both theoretical (77%) and practical
classes (97%) should be given by health care providers. In Barcelona, most secondary
schools surveyed were highly interested in a basic CPR for their teenagers in grades 3 or
4. Teachers would prefer health care providers to give the programme but would be
willing to teach basic CPR theory if trained previously17.
A study was conducted regarding basic CPR program for high school students
(PROCES). Results from the pilot program in Spanish (2005). They administered 20
question test before and after the program. Students were 14 years old in 38%, 15in 38%
and 16 or more in 24%. Before the resuscitation program, the mean mark (20 points) was
8.5 (2.4). After program, marks improved up to 13.5 (3.2) (p<0.001). Participants who
8
had previously taken a first aid course or were in the 4th course obtained significantly
better marks than the rest. These differences disappeared after program completion.
Students rated the theoretical part as 79 (1.1), the skill part as 8.2(1.2) and emergency
physicians classes as 8.4(1.1). Conclusion of the study was the basic CPR program
useful tool for teaching and improving teenagers knowledge and skills in basic CPR with
no exceptions associated with teenagers characteristics18.
A study was conducted regarding knowledge of CPR among the public in
Hongkong; telephone questionnaire survey in Hongkong (2003). Telephone interview
method was used for this study. Study was conducted among 357 people, approximately
12% had received CPR training. CPR knowledge in Hongkong was poor, even among the
previously trained and especially with regard to circulatory maintenance. The most
common reason for not taking CPR training was lack of time. Intensified educational
efforts and exploration of new approaches to improve this first stage in the chain of
survival are warranted19.
A study was conducted regarding CPR training in Washington state public high
schools in USA (2003). Conducted a state wide survey of all 310 public high schools in
Washington state. The response rate was 89% (276) schools from a combination of mail
and telephone surveys; 35% (n=97) reported that they did not provide any CPR student
training. Of the 132 schools that provided CPR student training. 23% trainees less than
90% of their students 70% did not have any teacher trained to teach CPR or had only one
teacher with such training. Schools perceived the greatest benefit of CPR training as
providing students with the skill to save a life (43%). The most frequently identified
barriers were logical: limited time to teach the curriculum (24%) , lack of funds (16%)
and instructor scheduling difficulties (17%) . Less than 5% of respondents voiced any
opposition to CPR training and that opposition was for logistical reasons. To increase
9
CPR training, the single best strategies suggested were: increase funding, provide time in
the curriculum have more certified instructors and make a CPR students training with
requirements20.
A study was conducted regarding community competence in cardio pulmonary
resuscitation in Australia (2002).The aim of this study was to determine community
application of CPR skills in an emergency, and thus assess the value of training
programmes in raising community competence. A cross sectional telephone survey of the
Western Australian population was chosen randomly (n=803). An urban sub-sample
(n=100) performed a practical demonstration of CPR skills using a simulated collapse
scenario using a recording manikin as the victim. Performance was assessed by two
observers using pre-determined criteria. Of all respondents, 64% had been trained in
CPR. This study provides a comprehensive data base of CPR training and performance,
and highlights future directions to ensure appropriate and cost-effective training .Specific
factors to be addressed include increasing frequency of teaching, and emphasizing early
activation of the emergency medical system21.
A study was conducted a survey on emergency, cardiac arrest! I can we teach the
skills? In Avon and Gloucestershire college of health, Glenside Centre, England (1997).
Students were able to improve knowledge levels, but did not uniformly improve practical
skills. Following this the college formed a resuscitation team whose members coordinate
CPR training in the curriculum, using uniform teaching packs which follow the ERC
guidelines and resuscitation equipment purchased by the college as the result by the
research findings. In addition to maintaining uniform content, sessions are compulsory
and students CPR skills are tested, with a 70% competency level set as pass. Student
results and attendance are stored on a college data base, along with tutor information
10
regarding updating CPR skills. To achieve these developments, the college had to
consider time allocation within the curriculum, training of tutors, funding of resources of
compulsory training programme, which supports a ratio of one tutor to six students22.
6.3 STATEMENT OF THE PROBLEM
A study to assess the effectiveness of structured teaching programme on
knowledge regarding cardio pulmonary resuscitation among degree students in selected
colleges, Tumkur.
6.4 OBJECTIVES
 To assess the knowledge level regarding cardio pulmonary resucitation among
degree students in selected colleges.
.
 To educate the degree students in selected colleges with structured teaching
programme regarding cardiopulmonary resuscitation.
 To evaluate the effectiveness of structured teaching programme on knowledge
regarding cardio pulmonary resuscitation among degree students in selected
colleges.
 To find out the association between knowledge regarding cardio pulmonary
resuscitation among degree students with selected socio demographic variables.
11
6.5 OPERATIONAL DEFINITION
Assess: It is the organized, systematic and continuous process of collecting data
from the degree students regarding cardio pulmonary resuscitation.
Effectiveness: It refers to the extent to which the structured teaching programme
on cardio pulmonary resuscitation has improved the knowledge of students after
the implementation of the structured teaching programme as evidenced by the
differences in the pretest and post test.
Structured Teaching Programme: It refers to systematically developed
instruction designed to provide information regarding cardio pulmonary
resuscitation to degree students.
Cardio pulmonary resuscitation: it is a simple technique used to restore and
maintain breathing and circulation in cardiac arrest victims.
Knowledge: The sum of what is known regarding cardio pulmonary resuscitation.
Degree students: who are undergoing the degree in selected colleges, Tumkur.
6.6 HYPOTHESIS
H1 There will be significant difference between pretest and post test knowledge
score regarding cardio pulmonary resuscitation.
H2 There will be significant association between the knowledge with selected
demographic variables of the degree students such as age, sex, religion, previous
information regarding cardio pulmonary resuscitation.
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6.7 ASSUMPTION

It is assumed that most of the degree student may have some
knowledge regarding cardio pulmonary resuscitation.

It assumed that there will be enhancement in the knowledge of the
degree students after administration of STP.
6.8 DELIMITATION
 The study was conducted only on degree students
 The study was limited to 60 samples
 The study was limited to selected colleges in Tumkur
7.0 MATERIALS AND METHODS
The purpose of this study is to determine the effectiveness of structured teaching
programme on knowledge regarding cardio pulmonary resuscitation among degree
students in selected colleges at Tumkur.
7.1 SOURCES OF DATA
 Research approach
: Evaluative approach
 Research Design
:
One group pretest and post test
pre-experimental design
 Setting of the study
:
13
Selected colleges of Tumkur
 Population
:
Degree students
 Sample Size
:
60 students
 Sampling Technique
:
Purposive sampling
 Selected Variables
Independent variable
:
Structured Teaching Programme
Dependent variable
:
Knowledge on cardio pulmonary
resucitation
Demographic variable
:
Age, Sex, religion, previous information
regarding CPR
 Sampling criteria
 Inclusion criteria
 Student who are studying degree in selected colleges
 Students who are willing to participate
 Exclusion criteria
 Students who are not willing to participate
 Students who are not available at the time of study.
14
7.2 METHODS OF DATA COLLECTION
7.2.1 Tools for data collection
Tool 1
:
Structured questionnaire
Part A
:
Proforma for collecting demographic data
Part B
:
A Structured questionnaire to assess the
knowledge regarding cardio pulmonary
resuscitation
Tool 2
:
Structured teaching programme on cardio
pulmonary resuscitation
7.2.2 METHODS OF DATA ANALYSIS AND INTERPRETATION
Data will be analyzed according to the objectives of the study using
descriptive and inferential statistics and will be presented in the form of tables,
graphs and diagrams.
7.2.3 Duration of the study
:
6 weeks
15
7.3
Does the study requires any investigation or intervention to be conducted on
the patient or other human being or animals. If so please describe briefly
Yes, in the form of structured teaching programme.
7.4 Has ethical clearance been obtained from your institution in case of the above?
Yes, Ethical clearance has been obtained from the institutions ethical
committee.
16
8.0 LIST OF REFERENCES
1. http://kidshealth.org/kid/watch/er/cpr.html.
2. Frkovic, Alan Sustic, Fred Zeidier, Alen Protic, Kritian Desa, “A brief reeducation in
cardio pulmonary resuscitation after six months the benefit from timely repetition”.
Signavitae 2008:
3(2):24-28.
3. Harkness A Gail, Dincher R Judith, “Medical surgical Nursing”, 9th edition, Mosby
publishers, Page no 499-500.
4. Lewis Sharon Mantik, Collier Idolia Cox, Heitkemper Margaret, “Medical surgical
Nursing”, volume-1, 4th edition, Mosby publishers, Page no 991-992.
5. http://www.mlatc.edu
6. SaklayenM, Liss H, Markert R, “In hospital Cardiopulmonary Resucitation.survival in
1 hospital”, Department of medicine 1995 july 74(4):163-75. Available from url:
http://www.pubmed.com
7. http://www.emedicine health.com/cardiopulmonary resuciation-cpr/article-em.htm.
8. Wockhardt hospital guide to wellness, February 8, 2010 available on www.google.com
9. Melissa Conrad,stopper, “Hands only CPR no more mouth to mouth?” Nurse education
in practice volume 10, issue 5, page no 291-297.
10. Denise K Polit & Chery Tatano Beck, “Nursing Research”, 8th edition, London,
Lippincott Williams&wilkins, 2008, pp757
17
11. Zi –qiao chen, Yan etal, “Awareness and attitudes of Chinese students towards
cardiopulmonary
resuscitation”,
emerg.med.j.doi:10,
emerg.med.j
doi:10.
Cardio
pulnonary1136/emj.2009.079558.
12.Drenzner JA, Rao AL, Heistands J, Bloomingdale M.K, Harmon, “Effectiveness of
emergency response planning for sudden cardiac arrest in united states high schools with
automated external defibrillators”, circulation 2009 aug 11:120(6):518-25.
13. Lynn p roppolo and Paul e pepe, “Retention: targeting the young in CPR skills
training”, critical care 2009 volume 13:185 doi: 10.1186/cc 7997.
14. Halzakis KD, Krissotakis EI, “Community cardio pulmonary resuscitation training in
Greece”, res nurs Health 2008 apr;3(2):165-71.
15. Tanguchi T, Omi w, Inaba H, “Attitudes toward the performance of bystander
cardiopulmonary resuscitation in Japan”, Resuscitation 2007 oct;75/1:82-7.
16. Axelsson AB, herlity J, Holmberg S, Thorn AB, “A nation wide survey of CPR
training in Sweden: foreign born and unemployed are not reached by training
programme”, Resuscitation 2006 ul:70(1);90-7.
17. Miro o, Jimenez-fabregaz, Espiqol G, Culla A, Diaz N, Abad J etal, “Teaching basic
life support to 12-16year olds in Barcelona Schools; views of head teachers”,
Resuscitaton 2006 jul:70(1) 107-16.
18.Miro o, Jimenez –fabrega z, Diaz N, Coll-Vinet B, Milla J, Espinosa G,Alvarez
HTetal, “Basic cardiopulmonary resuscitation program from high school students
resuscitation results from the pilot program”, Medchin (bari) 2005 jan 15;124(1).
18
19. Dr. BMY chung, “Knowledge of cardiopulmonary resuscitation among the public in
telephone questionnaire survey”, Hongkong Med J vol.9 no 5 oct 2003.
20. Reder S, Quan L, “Cardio pulmonary resuscitation training in Washington state
public high schools”, Resuscitation 2003 march 56(3):283-8.
21. Celenza T, Gennat HC, O Brein d, Jacobs IG, Lynch DM, Jelinek AK, “Community
competence in cardio pulmonary resuscitation”, 2002, nov 55 (2):157-65.
22. Moule p knight C, “Emergency, Cardiac arrest! Can we teach the skill?” Nurse educ
today 1997 apr 17(2):99-105.
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9. Signature of Candidate
:
10. Remarks of the Guide
:
11. Name & Designation
:
11.1 Guide
:
11.2 Signature
:
11.3 Co-Guide (if any)
:
11.4 Signature
:
12.
11.5 Head of Department
:
11.6 Signature
:
12.1 Remarks of the Principal
:
12.2 Signature
: