Download Self instructional module on cardio version and defibrillation.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF
SUBJECTS FOR DISSERTATION
SHAKIR PK
IST YEAR M.SC NURSING
MEDICAL AND SURGICAL NURSING
YEAR 2013 - 2015
CAUVERY COLLEGE OF NURSING
TERESIAN COLLEGE CIRCLE
SIDDARTHA NAGAR
MYSORE
1
1
NAME OF THE
SHAKIR PK
CANDIDATE
IST YEAR M.SC NURSING
2
3
4
AND ADDRESS
CAUVERY COLLEGE OF NURSING, MYSORE
NAME OF THE
CAUVERY COLLEGE OF NURSING,
INSTITUTION
MYSORE - 570007
COURSE OF STUDY
MASTER OF NURSING – MEDICAL AND
AND SUBJECT
SURGICAL NURSING
DATE OF ADMISSION
TO COURSE
13/07/2013
EVALUATE
5.1
TITLE OF THE STUDY
THE
EFFECTIVENESS
OF
SELF
INSTRUCTIONAL MODULE ON KNOWLEDGE
REGARDING
CARDIO
VERSION
AND
DEFIBRILLATION AMONG GNM INTERNSHIP
STUDENTS WORKING IN SELECTED HOSPITALS
MYSORE
A STUDY TO EVALUATE THE EFFECTIVENESS
5.2
STATEMENT OF THE
OF
PROBLEM
KNOWLEDGE
AND
SELF
INSTRUCTIONAL
REGARDING
DEFIBRILLATION
MODULE
ON
CARDIOVERSION
AMONG
GNM
INTERNSHIP STUDENTS WORKING IN SELECTED
HOSPITALS MYSORE
2
6. BRIEF RESUME OF THE INTENDED STUDY
6.1 INTRODUCTION
The wrinkles of the heart are more indelible than those of the brow
Madame Deluzy
The heart, muscular pump of the circulatory system, is powered by an electrical
impulse that signals the heart’s four chambers to contract, each at the proper time. The heart
works in an endless contract- relax/ contract – relax cycle. An average heart beats 1,00,000
times a day, pumping some 2000 gallons of blood through its chambers and then back to the
heart. Over a 70-year life span, that adds up to more than 2.5 billion heartbeats1.
But many forms of heart disease can interrupt the normal contract – relax cycle and
cause abnormally fast or unusually slow heart rates, called cardiac arrhythmias. These
conditions make the heart pump less effectively, so that not enough blood reached the brain
and other vital organs. When the body’s blood flow is inadequate, the person can faint or
suffer chest pain. Even sudden death can occur (Zypes) 1.
A defibrillator is a device that delivers an electric shock to the heart muscle through
the chest wall in order to restore a normal heart rate. There are different types of defibrillators
are in use, those are manual external defibrillator monitor. In which health care provider will
decide what charge (in joules) to use, based on guidelines and experience, and will deliver the
shock through paddles or pads on the patient's chest. Automated external defibrillator are
the simple-to-use units are based on computer technology which is designed to analyze the
heart rhythm itself, and then advise the user whether a shock is required and implantable
cardioverter-defibrillator
also known as automatic internal cardiac defibrillation. These
devices are implants, similar to pacemakers. They constantly monitor the patient's heart
rhythm, and automatically administer shocks for various life threatening arrhythmias,
according to the device's programming2.
Defibrillation is the definitive treatment for the life-threatening cardiac
arrhythmias, ventricular fibrillation and pulse less ventricular tachycardia. Defibrillation
consists of delivering a therapeutic dose of electrical energy to the affected heart with a
3
device called a defibrillator. This depolarizes a critical mass of the heart muscle, terminates
the arrhythmia, and allows normal sinus rhythm to be reestablished by the body's natural
pacemaker, in the senatorial node of the heart. Defibrillators can be external, transvenous, or
implanted, depending on the type of device used or needed. Some external units, known as
automated external defibrillators (AEDs), automate the diagnosis of treatable rhythms,
meaning that lay responders or bystanders are able to use them successfully with little or in
some cases no training at all.3
Defibrillation was first demonstrated in 1899 by Prevost and Batelli, two
physiologists from University of Geneva, Switzerland. They discovered that small electric
shocks could induce ventricular fibrillation in dogs, and that larger charges would reverse the
condition. The first use on a human was in 1947 by Claude Beck, professor of surgery at
Case Western Reserve University. Beck's theory was that ventricular fibrillation often
occurred in hearts which were fundamentally healthy, in his terms "Hearts are too good to
die", and that there must be a way of saving them.3
Beck first used the technique successfully on a 14 year old boy who was being
operated on for a congenital chest defect. The boy's chest was surgically opened, and manual
cardiac massage was undertaken for 45 minutes until the arrival of the defibrillator. Beck
used internal paddles on either side of the heart, along with procainamide, an anti arrhythmic
drug, and achieved return of normal sinus rhythm .Until the early 1950s, defibrillation of the
heart was possible only when the chest cavity was open during surgery. The technique used
an alternating current from a 300 or greater volt source delivered to the sides of the exposed
heart by 'paddle' electrodes where each electrode was a flat or slightly concave metal plate of
about 40 mm diameter. The closed-chest defibrillator device which applied an alternating
current of greater than 1000 volts, conducted by means of externally applied electrodes
through the chest cage to the heart, was pioneered by Dr V. Eskin with assistance by A.
Klimov in Frunze, USSR (today known as Bishkek, Kyrgyzstan) in mid 1950s. 3
In 1959 Bernard Lawn commenced research into an alternative technique which
involved charging of a bank of capacitors to approximately 1000 volts with an energy content
of 100-200
joules then delivering the charge through an inductance such as to produce a
heavily damped sinusoidal wave of finite duration (~5 milliseconds) to the heart by way of
'paddle' electrodes.4
Cardio version is a medical procedure by which an abnormally fast heart rate or
cardiac arrhythmia is converted to a normal rhythm, using drugs or synchronized electricity.
4
Now a day’s defibrillation and cardio version is very much used in clinical setting as a nurse.
We need current knowledge in cardio version and defibrillation in working period also5.
To perform synchronized electrical cardio version two electrode pads are used (or,
alternatively, the traditional hand-held "paddles"), each comprising a metallic plate which is
faced with a saline based conductive gel. The pads are placed on the chest of the patient, or
one is placed on the chest and one on the back. These are connected by cables to a machine
which has the combined functions of an ECG display screen and the electrical function of a
defibrillator. A synchronizing function (either manually operated or automatic) allows the
cardioverter to deliver a reversion shock by the way of the pads, of a selected amount of
electric current over a predefined number of milliseconds at the optimal moment in the
cardiac cycle which corresponds to the R wave of the QRS complex on the ECG. Timing the
shock to the R wave prevents the delivery of the shock during the vulnerable period (or
relative refractory period) of the cardiac cycle, which could induce ventricular fibrillation. If
the patient is conscious, various drugs are often used to help sedate the patient and make the
procedure more tolerable. However, if the patient is hemodynamic ally unstable or
unconscious, the shock is given immediately upon confirmation of the arrhythmia. When
synchronized electrical cardio version is performed as an elective procedure, the shocks can
be performed in conjunction with drug therapy until sinus rhythm is attained. After the
procedure, the patient is monitored to ensure stability of the sinus rhythm. 5
Synchronized electrical cardio version is used to treat hemodynamic ally
significant supra ventricular (or narrow complex) tachycardia’s, including atrial fibrillation
and aerial flutter. It is also used in the emergent treatment of wide complex tachycardias,
including ventricular tachycardia, when a pulse is present. Pulse less ventricular tachycardia
and ventricular fibrillation are treated with unsynchronized shocks referred to as
defibrillation. Electrical therapy is inappropriate for sinus tachycardia, which should always
be a part of the differential diagnosis. 5
6.2
NEED FOR THE STUDY
The American heart association
estimated that the likelihood of surviving
sudden cardiac arrest due to ventricular fibrillation was only 2-5% if defibrillation was
provided more than 12 min after collapse. On the contrary, Burdick and Cone (2004)
demonstrated positive outcomes to support early defibrillation. Of 330 patients experiencing
an out-of-hospital cardiac arrest, 200 patients received defibrillation from the emergency
personnel in Minnesota. With the early administration of defibrillation and cardio version,
5
there was a high rate of survival to hospital discharge and patients had long-term survival
with a near normal quality of life. Similarly, another study found that patients with out-ofhospital cardiac arrests due to ventricular fibrillation had higher survival rate after receiving
rapid defibrillation, with 40% of patients discharged from the hospital and the overall longterm survival of these patients was favorable Graham-Garcia, & Andrews, . Evidence
indicated that early defibrillation was the critical factor to influencing the survival of persons
suffering from sudden cardiac arrests. This emphasizes the need for student nurses and staff
nurses to extend their role to actively participate in emergency resuscitation care6.
A study was conducted to assess the knowledge and attitude of nurses on medical
wards regarding defibrillation and cardio version. They questioned 112 newly qualified
nurses and student nurses about their resuscitation experience and knowledge of ECG
interpretation and defibrillator. The responses to this enquiry suggested that nurses on
medical wards are enthusiastic about advanced cardiac life support and already have some
basic practical knowledge. The study concluded that appropriate training (and retraining) of
nursing staff and newly qualified nurses and course completed nursing students should
improve the outcome of resuscitation efforts on medical wards7.
Defibrillation often functions as a supportive measure for patients during an
acute illness. As the numbers of chronically ill and elderly patients have increased, these
clients are highly dependent and need comprehensive holistic care with meticulous
attention to detail. They need health care providers who are not only skill full in
managing machines but also understanding and supportive during stressful situations8.
It is essential that all health care professionals are regularly trained in the
practice of basic life support (BLS). In most cases of cardiac arrest, the chances of a favor
able outcome depend not only on efficient BLS, but also on the early use of defibrillation. In
a hospital environment, the first responders are most likely to be members of the nursing
staff. The potential advantage of these personnel being able to perform early defibrillation, as
well as BLS, is considerable. We describe an initiative in which instruction in the use of
automated external defibrillators (AEDs) was introduced into routine BLS training sessions,
with the aim of developing this capability. Using specifically-acquired training aids, 43
nurses and nine other members of the non-medical staffs were trained in 12 teaching sessions
over a period of 4 months. Refresher training was carried out after 6 months and 37 nurses
were retrained during six sessions using a similar syllabus. The program me was wellreceived by all students, and a higher than expected level of motivation and competence was
achieved. Throughout retraining all nurses appreciated the key importance of early
6
defibrillation. The study concludes that, although the initial workload is high, it is entirely
feasible to augment BLS training for health care professionals with instruction in the use of
AEDs. We recommend that this potentially life-saving tuition program me be widely
adopted.9
Today, the nursing team is efficient in not only giving bedside nursing care, but
also in instilling emotional balance and giving encouragement to the patients. Modern
nursing has developed as a result of good understanding, supportive care and essential
teaching, thus promoting good interpersonal relationships. Nurse is the active member of
health care team the nurse's personality, integrity, initiative and knowledge are significant
factors in enabling her to manage emergency situation. Her ability to think logically, observe
and report correctly as well as acting promptly is personal qualifications upon which the
doctors and patient must depend10.
The investigator felt that there is a need to evaluate the knowledge of staff nurses
regarding cardio version and defibrillation through a self instructional module that helps to
improve their knowledge . Theoretically based education program me should help to improve
their practice on cardio version and defibrillation. So that they can serve better, hence further
complications of cardiac arrest and death of the patients can be prevented. 10
6.3 REVIEW OF LITERATURE
The review of literature in a research report is a summary of current knowledge
about a particular practice problem .A literature review is an organized writer’s presentation
of what has been published on a topic by the scholars. The task of reviewing literature
involves the identification, selection, critical analysis and reporting of existing information on
the topic of interest11.
The literatures found relevant and useful for the present study have been
organized under the following headings
6.3(A).Literature related to knowledge on prevalence of cardio version and
defibrillation.
6.3(B). Literature related to knowledge of GNM internship students on cardio version
and defibrillation.
7
6.3(C). Literature related to knowledge on effectiveness of self instructional module on
cardio version and defibrillation.
6.3(A). Literature related to knowledge on prevalence of cardio version and
defibrillation.
A study was conducted to measure basic life support and defibrillation and cardio
version skills in primary care doctors and student nurses in Spain, to prepare and validate a
tool to measure Basic Life Support (BLS) and semi-automatic defibrillator (SAD) skills
adapted for use by health professionals in Primary Care Teams (PCT). They proposed an
updated version and demonstrated self-sufficiency of the team to use it in a training
evaluation. The result
revealed that Within-evaluator and
between-filming reliability,
excellent/ good in all except 1 item; the test score doubled after the training course. A
version of the test according to BLS-SAD recommendations is proposed. The study
concludes that the immediate application
of the updated version for training evaluation
purposes was in need.12
A study was conducted on
developing and evaluating distance education on
prevalence of Cardio version and Defibrillation for student nurses, using the virtual
environment of Tele duck learning in Brazil. The methodology of education chosen for this
course was the Case-based Learning, exploring the characteristic of the collaborative learning
for which 23intenship nurses were invited, being that 21 had initiated the course and 11 had
concluded it. The course was evaluated by professionals with experience in distance
education an intensive Care Unit, that they had considered the adjusted course, but that, in
general, it needed small reformulations. The study concluded that the evaluation of the course
for the participants were effective, great majority presented favorable opinions. 13
A study was conducted on endorsement of the chain of survival concept and
prevalence of defibrillation and cardio version in hospital setting. The sites selected for this
study were two acute care hospitals in rural Australia (RRMA Classification). Each of these
hospitals was in located 'other rural areas' (RRMA Classification) in separate towns and had
25 and 30 beds. The study sample consisted of 10 females and two males. The result revealed
that the two categories were 'quicker response times' (15 responses) and 'increased success
with resuscitation' (8 responses).
14
8
A Prospective, longitudinal study was conducted on Cardiac catheterization
laboratory
and recovery area of a district general hospital of Cardiology, East Bourne
General Hospital, East Bourne BN21 2UD, U to assess the prevalence of safety and
effectiveness of student nurse led elective cardio version of atria fibrillation under sedation
Prospective Cardiac catheter relation laboratory and recovery area of a district general
hospital.300 patients referred for elective cardio version of persistent aerial fibrillation
Cardio version success rate was 87% at discharge and 48% at six weeks. Mean (SD)
cumulative energy was 497 (282) J and number of shocks 1.6 (0.8). Mean (SD) dose of
sedation was 23 (9) mg intravenous diazepam. The result revealed that no patient required
reversal of sedation, airway support, or medical intervention. Ninety eight percent of patients
had no pain or recall of the procedure. Four patients who were adequately ant coagulated
experienced embolic phenomena. Ninety eight per cent of patients would repeat the
procedure if necessary. 15
6.3(B). Literature related to knowledge and practice of GNM internship student on
cardio version and defibrillation.
A prospective cohort study was conducted in Hon Kong to determine the capability
of newly qualified emergency department (ED) nurses and student nurses to recognize VF or
pulse less VT correctly and their willingness to perform defibrillation immediately in an ED
of a teaching. 51 pre-teaching and 43 post-teaching questionnaires were collected. There were
no statistically significant changes in ECG scores after teaching. For defibrillation scores,
there was an overall improvement in the defibrillation decision (absolute mean difference
0.42, p=0.014). Performance was also improved by the teaching (absolute mean difference
0.465, p=0.046), reflected by the combination of both scores. Two-thirds (67%) of nurses
became more confident in managing patients with shock able rhythms. The study concluded
that
student nurses improve in defibrillation decision-making skills and confidence after
appropriate brief, focused in-house training.
16
A comparative study was conducted to compares the resuscitation skills of two
groups of student nursing, one taught by newly trained ERC nurse-instructors and the other
newly trained nurse instructors. Eighteen doctors and 18 nurses were asked to teach a total of
108 nurses in a (BLS/AED) course. One month after its completion, all 108 nurses were
asked to be re-evaluated, with the use of the objective structured clinical examination. The
result revealed that no statistical significant difference between the two groups was noted in
the written test, in contrast with data collected from the practice skills check-list. Nurses in
9
group A could easily identify the patient in cardiac arrest but had difficulties concerning chest
compressions and handling the AED .Nurses in group B were more focused during the
performances, used AED more accurately and continued cardiopulmonary resuscitation with
no delays.17
A longitudinal quasi-experimental study was conducted at Cardio thoracic
Surgery, Royal Prince Alfred Hospital, Sydney, Australia, to find out if internship students
and newly qualified nurses can perform rapid defibrillation at six months and one year after
they have completed training in this procedure fifteen registered nurses and one enrolled
nurse demonstrated. The result revealed that rapid and safe defibrillation at six months and
one year after training internship student and newly qualified staff posted in ward who has a
range of qualifications and experience can deliver safe and rapid defibrillation.
18
A descriptive study was conducted in U.S.A to assess nursing students' acquired
knowledge about appropriate automated external defibrillator use and counseling points
following training and simulated experience. The Study included a lecture on sudden cardiac
arrest and automated external defibrillator use, nursing students were assessed on their ability
to perform basic life support and deliver a shock at baseline, 3 weeks, and 4 months. Students
completed a questionnaire to evaluate recall of counseling points for lay people/the public
.The study results showed that mean time to shock delivery at baseline was 74 ± 25 seconds,
which improved significantly at 3 weeks (50 ± 17 seconds, p < 0.001) and was maintained at
4 months (47 ± 18 seconds, p < 0.001).19
An experimental study was conducted in the intensive care unit of University of
Alicante to know the intensive care aspects of professional of intensive care unit. The study
included the professional workers who had recently received their degrees and internship
students who worked in the intensive care unit, to determine the techniques or
practice
nursing guide in the critical patients it was designed in paper and electronic form. The study
results showed that the defibrillation, cardio version, cardiac arrhythmias and insertion of
temporary pacemakers a total of 92% of the colleagues would re-choose their practices in the
intensive care unit, 33% liked working as a team most. 20
.
A survey conducted about advanced life support skills undertaken by newly
qualified nurses
in India. Many nurses successfully complete the Resuscitation Council
(UK), European Resuscitation Council, advanced life support (ALS) Provider Course. Nurse
ALS providers in 99% of coronary care units, 89% of intensive care units, and 88% of
10
accident and emergency departments undertook manual defibrillation. Providers were
permitted in 19% of coronary care units and in the wards of 16% of the responding hospitals
by nurse ALS providers working in coronary care units, intensive care units and emergency
departments was permitted by 11% of the responding hospitals. This survey has concluded
that many acute hospitals do not permit nurse ALS providers to use a number of the skills
taught on working in hospitals. 21
6.3(C). Literature related to knowledge on effectiveness of self instructional module on
Cardio version and defibrillation.
An exploratory and qualitative study was conducted in an intensive care unit
(ICU) of an acute regional hospital in Hong Kong. Twelve registered nurses were
purposefully selected for interview although all the participants were trained in basic life
support, only50% were trained in advanced cardiac life support (ACLS), and those trained
ACLS described having limited opportunities to apply their defibrillation and cardio version
knowledge. Whilst participants believed that they were theoretically prepared to influence the
patient's resuscitation outcomes, newly qualified nurses were to be accountable for
defibrillation and cardio version. The results revealed that experienced nurse were more
willing to perform defibrillation or cardio version than others. The study concluded that
defibrillation and cardio version is an approach of delivering prompt care to critically ill
patients.
22
A study was
conducted at School of Public Health, Curtin University of
Technology, Perth, Western Australia about The role of internship students
in
cardiopulmonary resuscitation and defibrillation and cardio version Cardiac arrest outcome
studies have identified early defibrillation(among other variables) as a strong predictor of
survival with the emphasis placed on minimal delay between arrest and 'shock'. Nurses play a
key role in management of in-hospital cardiac arrest. Often they are first on the scene of an
arrest initiating cardiopulmonary resuscitation (CPR) as well as summoning assistance from
the 'advanced life support' arrest' team. Thus it is argued that internship nurses should be
willing and able to perform defibrillation and cardio version when it required .The result
revealed that all course completed nursing students are able to appropriately manage a
collapse situation. However research clearly demonstrates that not all nurses are competent in
CPR. There is obviously a mismatch between community expectations and reality.23
11
A study was conducted at Cardiac Department, St Thomas' Hospital, London on
knowledge and attitude of course completed internship students on medical wards to cardio
version and defibrillation. Questioners were administered for 112 qualified nurses working on
general medical wards about their resuscitation experience and knowledge of ECG
interpretation and defibrillation. Although all but two of them had been formally trained in
basic cardio pulmonary resuscitation (CPR) only 16 had received any training in the last six
months Seventy-five per cent of student nurses were involved in CPR as first responders but
only18% had used a defibrillator during a cardiac arrest. Identification of ECG rhythms and
practical knowledge about defibrillation was encouraging despite the lack of formal training
in this field. The result revealed that almost every one of the newly coming nurses were
willing to receive training in advanced cardiac life support. The responses to this inquiry
suggest that all nurses and internship students on medical wards are enthusiastic about
advanced cardiac life support and already have some basic practical knowledges.24
A cohort study was conducted about the course emphasized hands-on practice of
the basic life support and automated external defibrillator algorithm, each nurses and
internship nursing students was evaluated on the computerized immediately after training
(post test). At 1 to 3, 4 to 6, and 7 to 9 months after the initial training, convenience samples
of the cohort in three different groups were evaluated for retention. Satisfactory performance
was defined as delivery of the first defibrillator shock within 2 minutes of recognition of the
arrest. At the post test after training, 139 of 140 nurses (99%) demonstrated satisfactory
performance. Of 77 nurses evaluated, 31 of 32 at 1 to 3 months, 18 of 18 at 4 to 6 months, and
24 of 27 at 7 to 9 months after initial training (95% overall) performed satisfactorily. The
researcher concluded that nurses and newly trained student nurses outside critical care areas
who are proficient in basic life support can easily learn and retain the knowledge and skills to
use automated external defibrillator.25
6.4 STATEMENT OF THE PROBLEM
“A STUDY TO EVALUATE THE EFFECTIVENESS OF SELF INSTRUCTIONAL
MODULE
ON
DEFIBRILLATION
KNOWLEDGE
REGARDING
AMONG
INTERNSHIP
GNM
SELECTED HOSPITALS MYSORE.’’
12
CARDIOVERSION
STUDENTS
AND
WORKING
IN
6.5
OBJECTIVES OF THE STUDY
 To assess the pre test level of knowledge regarding cardio version and defibrillation
among GNM internship students.
 To evaluate the effectiveness of knowledge regarding cardio version and defibrillation
after administering self instructional module. .
 To compare pre test and post test score of knowledge regarding cardio version and
defibrillation among GNM internship students.
 To find out the association between pre test knowledge score regarding cardio version
and defibrillation with the selected demographic variables
6.6
RESEARCH HYPOTHESIS
In this study an attempt is made to test the following hypothesis.
 H1- There will be a significant difference between the pre-test and post test
knowledge scores of GNM internship students regarding cardio version and
defibrillation.
 H2- There will be a significant association between the pre-test knowledge of
GNM internship students regarding cardio version and defibrillation with
selected socio-demographic variables..
6.7 OPERATIONAL DEFINITIONS OF TERMS
1.
Evaluate
In this study evaluate refers to the difference in the knowledge of internship
students regarding cardio version and defibrillation before and after administration
of self instructional module.
13
2. Effectiveness
In this study effectiveness refers to the extent to which the self instructional
module has achieved the desired result as measured by the internship student’s gain
the knowledge in cardio version and defibrillation.
3. Knowledge
In this study knowledge refers to the correct responses given by the intenship
students to the items seeking knowledge regarding cardio version and defibrillation.
5. Self instructional module
It refers to systematically planned instruction module designed to
provide information’s which is prepared by researcher.
6. Defibrillation
In this study defibrillation refers to one of the emergency procedure. It is
achieved by delivering a strong electric current to the surface of a patient’s chest
wall in cardiac arrest condition.
7. Cardio version
In the study cardio version refers to the process of restoring the heart's
normal rhythm by applying a controlled electric shock to the heart.
8. GNM Internship students
In this study GNM internship students refer to the student nurses who are
just completed their three years course and working as interns for six months in
clinical at selected hospitals at Mysore.
6.8 DELIMITATIONS
 Selected hospital only.
 Study limited to 60 samples.
 GNM Internship students only.
14
7
MATERIALS AND METHOD OF STUDY
7.1 SIGNIFICANT OF THE STUDY
Research methodology is the way of doing research to solve the problem. This chapter
deals with the methodology which was followed to assess the effectiveness of Self
instructional module on knowledge regarding cardio version and defibrillation among GNM
internship students working in selected hospitals Mysore.
7.2 SOURCE OF DATA
The investigator collected the data from GNM internship students working in selected
hospitals of Mysore.
7.3
RESEARCH APPOACH & DESIGN
Pre experimental one group pre-test and post test design will
be
used to conduct
present study.
7.4
7.4.1
METHODS OF DATA COLLECTION
DATA COLLECTION TOOL
A structured open ended questionnaire on knowledge regarding cardio version and
defibrillation will be used.
It comprises two parts:
Part 1: consists of items related socio demographic characteristics of internship
students.
Part 2: consists of items seeking knowledge regarding cardio version and
defibrillation.
15
7.4.2 DATA COLLECTION METHOD:
Prior permission will be obtained from the concerned authorities. The purpose of the
study will be explained to the participants. A pre-test will be conducted by using structured
open ended questionnaire to assess the existing knowledge regarding cardio version and
defibrillation among internship students then self instructional module will be administered,
after one week post test will be conducted with the same questionnaire
7.5
SAMPLING PROCEDURE
7.5.1 CRITERIA FOR SAMPLE SELECTION
INCLUSION CRITERIA
1)
The GNM internship students who are available at the time of data collection.
2)
The GNM internship students who are willing to participate in the study.
3)
Both male and female GNM internship students.
EXCLUSION CRITERIA
1) The GNM internship students who are not on shift at the time of data collection.
2) The GNM internship students who are not willing to participate in the study.
3) The GNM internship students who are not able to cooperate throughout the period of
study.
7.5.2 POPULATION
The GNM internship students who are working in selected hospitals of Mysore.
7.5.3 SAMPLE
In this present study the sample comprises of the GNM internship students working
in selected hospitals of Mysore.
7.5.4 SAMPLE SIZE
The sample size for the present study is 60 GNM internship students working in
selected hospitals of Mysore
16
7.5.5 SAMPLING TECHNIQUE
Simple random sampling technique will be used to select the subjects.
7.5.6 SETTINGS OF THE STUDY
The present study will be conducted in selected hospitals of Mysore.
7.5.7 PILOT STUDY
Pilot study planned with 10% of population.
7.6
VARIABLES
Dependent variable
Knowledge of GNM internship students regarding cardio version and
defibrillation.
Independent variable
Self instructional module on cardio version and defibrillation.
Socio demographic variable
Age, Sex,, marital status, In-service education and. Previous
Exposure to information.
7.7
PLANS FOR DATA ANALYSIS
Descriptive and Inferential statistics will be used.
1) Descriptive statistics
The data collected from the sample will be summarized and organized with the help of
descriptive statistics like mean, frequency and percentage distribution and standard deviation.
2) Inferential statistics
Significance of difference between pre-test and post test knowledge scores of internship
students will be done by using paired‘t’ test. Association between the internship student’s
knowledge regarding cardio version and defibrillation and selected socio demographic
variables will be found using chi-square test.
17
7.8
PROJECTED OUTCOME
The finding of the study will reveal
1) The level of knowledge of GNM internship students regarding
cardio version and
defibrillation.
2) The importance of self instructional module.
3) The study will motivate the GNM internship students to do educational program me in the
future to manage the critical situations.
7.9
1.
ETHICAL OUTCOMES
Has ethical clearances been obtained from concerned authority?
-Yes.
2.
Whether the ethical committee’s suggestions and opinions
Will be taken into consideration?
-Yes.
3.
Has the researcher been obtained permission to do self instructional module
For the participants?
-Yes.
18
8. LIST OF REFERENCE: [VANCOUVER STYLE FOLLOWED]
1. Zippers D. Production of cardiac arrhythmias. AORNJ. 2003 Oct; 38(4): 572-81.
2. Claude Beck, ‘‘defibrillation and CPR" Case Western Reserve University
3. http://www.case.edu/artsci/dittrick/site2/museum/artifacts/group-c/c-8defrib.htm.
Retrieved 2007-06-15
4. Dorsey BM, Gazette CE, Kenner CV. Critical care nursing: Body-mind-spirit. 3rd ed.
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21
SIGNATURE OF THE
9
CANDIDATE
THIS STUDY WILL HELP THE GNM
10
REMARKS OF THE GUIDE
INTERNSHIP STUDENTS TO
IMPROVE THEIR KNOWLEDGE
REGARDING CARDIO VERSION AND
DEFFIBRILATION
11
NAME AND DESIGNATION
Mr. RAMESHA K H
OFTHE GUIDE (IN BLOCK
HOD MEDICAL SURGICAL NURSING
LETTERS)
CAUVERY COLLEGE OF NURSING
MYSORE
11.1
GUIDE
11.2
SIGNATURE
11.3
CO – GUIDE ( IF ANY)
11.4
SIGNATURE
Mr. RAMESHA K H
Mr. RAMESHA K H
11.5
11.6
12
HEAD OF THE DEPARTMENT
SIGNATURE
REMARKS OF THE
GOOD
CHAIRMAN AND PRINCIPAL
12.1
SIGNATURE
22