Download 6.2.1 Reviews related to fluid administration in under five

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BENGALURU, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1. NAME
OF
CANDIDATE
ADDRESS
THE MRS. ROSHNI K MATHEW,
AND I YEAR M.Sc. NURSING,
THE OXFORD COLLEGE OF
NURSING,NO 6/9 & 6/11, 1ST CROSS,
BEGUR ROAD, HONGASANDRA,
BENGALURU- 560068.
2. NAME
OF
INSTITUTION
THE THE OXFORD
NURSING
COLLEGE
OF
3. COURSE OF STUDY MASTER OF SCIENCE IN NURSING
AND SUBJECT
CHILD HEALTH NURSING
4. DATE OF ADMISSION 8/7/2011
TO COURSE
5. TITLE OF THE TOPIC A STUDY TO ASSESS THE
EFFECTIVENESS OF STRUCTURED
TEACHING
PROGRAMME
REGARDING KNOWLEDGE ON
FLUID
ADMINISTRATION
IN
UNDER-FIVE CHILDREN AMONG
STAFFNURSES IN A SELECTED
PEDIATRIC
HOSPITAL,
BENGALURU.
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“Let the little children come to me, and do not hinder them, for the kingdom of God
belongs to such as these.”
St. Mark 10:14
Fluids and medications are often administered intravenously to infants and
children1. The goal of fluid and electrolyte management is to replace losses of water and
electrolytes so as tomaintain normal balance of these essential substances during growth
and recovery from disease.A subsidiary aim in the management of fluid and electrolyte
balance is to proceed as per age, weight, and ways the patient is facing the body losses.
The principles of fluid and electrolyte management in the neonatal period are similar to
those established for older children, except for some variations and specific features of
body composition, insensible water loss (IWL), renal function, and neuroendocrine
control of fluid and electrolyte balance2.
Maintenance of fluid balance in the body tissues is essential to health. At birth,
water accounts for approximately 77% of body weight. Normal body losses of fluid occur
through the lungs (breathing) and skin (sweating), and in the urine and feces. Fluid
imbalance may be the result of some pathologic process in the body. Electrolytes are
chemical compounds that break down into ions when placed in water. Important
electrolytes in body fluids are sodium(Na), potassium(K), magnesium (Mg0, calcium
(Ca), chloride (Cl), phosphate(PO) and bicarbonate (HCO). Electrolytes have the
important function of maintaining acid-base balance2.Fluid therapy in children is based
on biochemical and physiologic principles qualitatively and quantitiatively different from
adults. The limitations imposed by body size requires greater precision in calculating
fluid therapy for children1.
Intravenous fluids are administered to provide water, electrolytes, and nutrients
that the child needs. Total parenteral nutrition(TPN), chemotherapy and blood products
also are administered intravenously. TPN, often called hyperalimentation, is the
administration of dextrose, lipids, amino acids, electrolytes, vitamins, minerals and trace
elements in to the circulatory system to meet the nutritional needs of the child whose
needs cannot be met through the gastrointestinal tract2. Intravenous therapy is putting
asterile fluid through a needledirectly into the patient's vein.Intravenous (IV) therapy is
used to give fluids when the patient cannot swallow, is unconscious, is dehydrated or is in
shock, to provide salts needed to maintain abalance of electrolytes, or glucose needed for
metabolism, or to give medication. If the cannula is not sited correctly, or the vein is
particularly fragile and ruptures, the following can occur infection, phlebitis, infiltration,
fluid overload, hypothermia, electrolyte imbalance, embolism3.

Continuous infusion: generally large volumes of drug or solution given at a set
rate over a prolonged period.

Intermittent infusion: drugs such as antibiotics added to a small amount of
solution (up to 500ml) and given over a short period, at a specific time or
frequency.

Bolus or direct injection: direct injection of a drug into the vascular access device
or infusion port, given as a slow bolus or push3.
A macrodrip tube can deliver 10 or 15 drops per 1 ml. Microdrip tubing delivers 60
drops per 1 ml. The number of drops required for 1 ml is called the drop factor. Work out
the number of millilitres of fluid to administer in an hour. Divide the total amount of
solution to be delivered by the number of hours the infusion will last. Then multiply that
figure by the drop factor. To determine how many drops to administer per minute, divide
by 60. Count the number of drops per minute that are being infused. If that is not the
correct flow rate, adjust the drip rate4.
The drop rate (drops /ml) is calculated by the formula:
Drop rate =volume of solution X drop factor
Time4
All nurses are likely to be responsible for the administration and management of
some form of intravenous (IV) therapy.Nurses should always determine the type of drip
chamber that they are using and calculate the IV flow per minute based upon the amount
of fluid that the administration set delivers per drop. The nurse must be careful to doublecheck the medication label before hanging the intravenous fluid bottle to determine that
the medication is correct for the correct patient, that it is being administered at the correct
time2. The nurse should see that it is intact and observed for redness, pain,
induration(hardness), rate of flow, moisture at the site and swelling. Documentation is
done on an intravenous flow sheet on which is recorded the rate of flow, the amount in
the bottle, the amount in the burette, the amount infused and the condition of the site3.
6.1 NEED FOR THE STUDY.
Fluid therapy is of great importance in the care of children because many of the
conditions affecting young children. The nurse accept full accountability and
responsibility for all actions that are taken, this includes the fluid administration.
Hospital-acquired hyponatraemia is associated with excessive volumes of
hypotonic intravenous fluids and can cause death or permanent neurological deficit with
the sample of 17 hospitals on all children receiving intravenous fluids during 1 day of a
specified week in December 2004. The result revealed that 77 of 99 children receiving
intravenous fluids received hypotonic solutions and 38% received >105% of fluid
requirements. 21 of 86 children were hyponatraemic, but the electrolytes of only 79% had
been checked in the preceding 48 h. The study conclude intravenous fluids should be
used with caution as regards the tonicity and volume administered, and with appropriate
monitoring of serum electrolytes5.
A prospective study was conducted to ascertain the prevalence of medication
administration errors for continuous IV infusions and identify the variables that caused
them, with the sample of Six hundred and eighty seven observations were made, with 124
(18.0%) having at least one medication administration error. The result revealed that the
most common error observed was wrong administration rate. The median deviation from
the prescribed rate was −47 ml/h (interquartile range −75 to +33.8 ml/h). Errors were
more likely to occur if an IV infusion control device was not used and as the duration of
the infusion increased. So that study conclude that administration errors involving
continuous IV infusions occur frequently. They could be reduced by more common use
of IV infusion control devices and regular checking of administration rates6.
Nurses must have an understanding of the safe dosage of medications they
administer to children as well as the expected action, possible side effects and signs of
toxicity. It is important that the nurses know to estimate safe dosages and fluid
calculation as well as how these are prepaid in order to prevent drug errors and
complications such as fluid overload, hypovolemia, right ventricular failure, pulmonary
edema and prevent fluid and electrolyte imbalance7.
Each child to whom a medication is administered has five “rights” which, if
adhered to, will prevent most drug errors. The sixth right has been added to the listing
because it also provide a measure of safety when parents give medication to their child.
These rights include the following, the right patient, the right drug, the right dose, the
right route, the right time, and the right of the parents and the child “to know”8.
Although nurses have an important role in the care process surrounding artificial
food or fluid administration in patients with dementia or in terminally ill patients.The
most important arguments explicitly for artificial food and fluid administration in patients
with dementia or in terminally ill patients were sanctity of life, considering artificial food
and fluid administration as basic nursing care, and giving reliable nutrition, hydration or
medication9.
Fluid therapy by the oral route is the accepted method of treatment for smaller
burns in children (less than 10%). Included in the survey was an assessment of the
uniformity of the contents of the fluids, their palatability and acceptance by patients and
any side-effects from this form of treatment. There appears to be no uniformity in
policies regarding fluid therapy in children with this percentage of burns. Treatment
ranged from a formula guided resuscitation therapy (as practiced generally with large
burns) to a 'drink as you like' policy. Fluids used varied from electrolyte to nonelectrolyte containing solutions and fruit juices and were, therefore, markedly different in
content. The electrolyte solutions were reported as being non-palatable unless flavored
with fruit juices. No complication was reported although one unit queried a possible case
of fluid overload10.
The major threat to life is hypovolemic shock due to the loss of intravascular
fluid volume. Intravenous therapy should be initiated in all children with burns greater
than 15% of body surface area, in children less than 2 years of age with burns greater
than 10% of body surface area and in children whose condition is compromised by
trauma or pre-existing illness such as vomiting, dehydration and fever. Many formulae
provide for calculating the amount of fluid needed to replace lost volume .The most
commonly fluid resuscitation formula , the parkland formula, uses ringer’s lactate
solution. Administration of colloid solutions such as plasma, albumin during the first 24
hours after burn injury and after the initial 24-48 hours the fluid requirement is decreased.
The nurses should know about the calculation and administration of fluid replacement
therapy for children with burns9.
The optimize fluid resuscitation in severely burned patients, the amount of fluid
should be just enough to maintain vital organ function without producing iatrogenic
pathological changes. The composition of the resuscitation fluid in the first 24 hours
postburn probably makes very little difference; however, it should be individualized to
the particular patient. The utilization of the advantages of hypertonic, crystalloid, and
colloid solutions at various times post burn will minimize the amount of edema
formation. The rate of administration of resuscitation fluids should be that necessary to
maintain satisfactory organ function, with maintenance of hourly urine outputs of 30 cc to
50 cc in adults and 1-2 cc/kg/% burn in children. When a child reaches 30 kg to 50 kg in
weight, the urine output should be maintained at the adult level. With our current
knowledge of the massive fluid shifts and vascular changes that occur, mortality related
to burn-induced hypovolemia has decreased considerably. The failure rate for adequate
initial volume restoration is less than 5% even for patients with burns of more than 85%
of the total body surface area.
The major disorder of water and electrolyte metabolism in children is dehydrating
diarrhea. The major advance in the treatment of this condition has been the development
of oral rehydration therapy, i.e., the enteral administration of a balanced glucoseelectrolyte solution3. This therapy is effective in patients of all ages, dehydration of all
degrees short of hypovolemic shock, with gastroenteritis of all causes, and electrolyte
disturbances including hypo and hypernatremia. This review highlights current
experimental and clinical studies that have focused on oral rehydration solutions that
have the additional benefit of reducing the severity and duration of diarrheal disease4.
Postoperative total parenteral nutrition (TPN) is indicated for patients already
receiving TPN preoperatively, those severely malnourished prior to major surgery, those
unable to eat satisfactorily for 7 days, or patients presenting with severe complications.
Postoperative TPN should last for at least 7 days. The total energy requirements are
between 30 and 35 kcal/kg/day. About 50% to 70% should be provided in the form of
carbohydrates, and 20% to 30% in the form of lipids. The optimal input rates for glucose
and lipids are 4 to 5 g/kg/day and 80 mg/kg/hr, respectively. The ideal nitrogen
administration is 250 to 300 mg/kg/day, and the optimal calorie/nitrogen ratio is 150 to
200. Some specific amino acids can be added as intravenous dipeptides. An adequate
follow-up must include clinical and biochemical parameters. Several trials evaluated the
impact of TPN in postoperative patients, but further well designed, controlled clinical
trials are still necessary to address a great number of unanswered questions7.
Nurses are the key personnel in administering IV fluid administration.The nurses
should gain adequate knowledge for IV fluid administration. So after searching and
analyzing many studies I found that there is a great need to assess the nurses knowledge
regarding administration.
6.2 REVIEW OF LITERATURE.
Review of literature is a written summary of the state of existing knowledge on a research
problem. The review of literature is defined as a broad, comprehensive, in-depth,
systematic and critical review of scholarly publications, unpublished scholarly print
materials, audiovisual materials and personal communication.
This chapter deals with the literature which is revealed and relevant to the present
study. For this study the review of literature organized under four headings.
6.2.1 Reviews related to fluid administration in under five children.
6.2.2 Reviews related to knowledge of nurses on fluid administration in
under five Children
6.2.3 Reviews related to effectiveness of structured teaching programme.
6.2.1
Reviews related to fluid administration in children.
A comparative study was conducted to investigate the influence of voluven
6% and HAES-steril with sample of 40 children from 3mt to 17yrs of age, which were
divided into two groups according to the type of the administered colloid. The result
revealed that infusion of colloids with 1:3 ratio compared to crystalloids in general
volume of infused liquids dose of 5ml/kg/hr in case of median blood lose of 15% of the
total circulating blood volume during 2hrs long surgery and HAES- steril 10% in the
close of 4ml/kg/hr in case of the blood loss up to 25% of T(BV) allows to effectively
neutralize hemodynamic changes based up on administration of anesthetic agents and
intraoperative fluid loss so the study conclude that administration of voluven 6% is
accompanied by significant, statistically accurate decrease of lower limb impedance,
which indicates the increased amount of water in them, HAES-steril 10% administration
leads to redistribution of water in the body segments with its predominant7.
A prospective study was conducted to evaluate the intraoperative use of a
isotonic-balanced electrolyte solution with 1% glucose with a particular focus on changes
in acid base status electrolyte and glucose concentration with a sample of 101 pediatric
patients aged upto 4yrs with an ASA risk score of I-111 undergoing intraoperative
administration of Bs-G1were enrolled. The result revealed that during the infusion,
hemoglobin, hematocrit, anion gap. Strong ion difference and Ca decreases and Cl ,
glucose increased significantly within the physiologic range. All other measured
parameters including Na, bicarbonate, base excess and lactate remains stable. No adverse
drug reactions were reported, so the study concluded that isotonic, balanced electrolyte
solution with 1% glucose helps to avoid perioperative acid-base imbalance,
hyponatremia, hyperglycemia and ketoacidosis in infants and toddlers and may therefore
enhance patient safety8.
A comparative study was conducted no children with severe malnutrition and
hypervolemia to resuscitation with a standard isotonic solution with a sample of 61
children were enrolled, 41 had shock and severe dehydrating diarrhea and 20 had
presumptive septic shock. The result revealed that by 8hrs response to volume
resuscitation was poor with shock persisting in most children. Oliguria was more
prevalent at 8hrs in the half-strength Darrow/5% (HSD/5D) group compared to RC-3/25
mortality was high HSD/5D/15/26 AND RL 13/29(45%). Neither pulmonary edema nor
cardiogenic failure was detected so the study conducted that the modest volumes used
and rate of infusion were insufficient to promptly correct shock, fluid resuscitation
guideline for severe malnutrition should prompt clinical investigation of isotonic fluids
for resuscitation of compensated shock9.
A meta-analysis study was conducted to examine the relationship between TPN
and complication and mortality rates in critically ill patients, with the sample of 2211
patients comparing the use of TPN with standard care (usual oral diet plus intravenous
dextrose) in surgical and critically ill patients. The result revealed that TPN had no effect
on mortality. So that the study concluded that TPN doesn’t influence the overall mortality
rate of surgical or critically ill patients. It may reduce the complication rate, especially in
malnourished patients, but study results are influenced by patient population, use of
lipids, methodological quality and year of publication10.
A descriptive study was conducted to evaluate IV hypotonic fluid administration
in children with LRTD leads to hyponatremia 1,039 children with LRTD were
selected ( 58 received iv fluids), 35 patients met the inclusion criteria. The result revealed
that 11 children had a ale decrease>or=4mEq/1 none showed clinical manifestation of
hyponatremia for each mEq/l of increase in initial natremia the odds of achieving
decrease in serum Na>or 4mEq/l increases in 40% so that the study concluded decrease
in initial serum Na values increase the odds of a significant decrease11.
A retrospectively collected data on 141 of the children who had received two
serum electrolytes (one upon admission and the other 4-24 h thereafter).Around 124
patients had initial serum sodium (Na) level between 130-150 mEq/l and excluded 17
patients whose admission serum sodium fell outside this range. All patients were treated
with intravenous hypotonic fluids (5% dextrose in 0.2% saline, n = 4; 5% dextrose in
0.3% saline, n = 102; 5% dextrose in 0.45% saline, n = 18 patients) as maintenance fluid
therapy or maintenance fluid plus deficit therapy; 100 of these children had received an
initial saline bolus of 21.05 8.5 ml/kg upon admission. The serum Na level decreased by
1.7-4.3 mEq/l in the whole group. Of the 97 children with isonatremia (Na 139.5-2.7
mEq/l) on admission, 18 (18.5%) developed mild hyponatremia (Na 133.4-0.9 mEq/l,
range 131-134), with a decrease in serum Na of 5.7 3.1 mEq/l, and 79 remained
isonatremic (Na 138.3-2.7 mEq/l), with a decrease in serum Na of 1.8-3.4 mEq/l (p <
0.0005). There was no significant difference in type, rate, or amount of intravenous fluid
or saline bolus (26.1 10.4 vs. 20.2 8.6 ml/kg, respectively) administered in these two
groups. Children who became hyponatremic were older (5.8 2.7 years) than those who
remained isonatremic (2.8 3.1 years) (p < 0.0005), but there was no statistical difference
in gender, degree of dehydration, and severity of metabolic acidosis between the two
groups. Although serum Na increased by 3.9 2.5 mEq/l in 19 patients with mild
hyponatremia upon admission (Na 132.8 1.3 to 136.7 2.6 mEq/l) and 73% of these
became isonatremic, hypotonic saline solutions have the potential to cause hyponatremia
in children with gastroenteritis and isonatremic dehydration11.
6.2.2 Reviews related to knowledge of nurses on fluid administration in children
Monitoring and manipulating body fluid and electrolytes form a crucial
aspect of nursing care. For the average male, only about 18% of the body weight is
protein with 15% fat and 7% minerals; 60% is water. For health, body water and
electrolytes must be maintained with a limited range of tolerances. Homeostatic
mechanisms regulate parameters such as body fluid volume, acid-base balance (pH) and
electrolyte concentrations, maintaining a delicate, dynamic balance which can be
established during illness. In extreme cases, the fluid or electrolyte deficit can lead to
death. Consequently, nurses must have a clear understanding of fluid and electrolyte
homeostasis so that they can assess fluid and electrolyte status, anticipate/recognize
deterioration and implement corrective interventions. However, without a knowledgeable
appreciated of the physiology and patho-physiology of fluid and electrolyte balance there
is a real risk that these tasks will be performed in a somewhat mechanistic fashion,
without sufficient thought or understanding. The normal mechanisms which regulate
body fluid and outlines some of the basic adaptive responses to stress. The regulation of
acid-base balance is also considered, along with basic principles in the management of
fluid and electrolyte disorders12.
A prospective study conducted to determine to assess the availability of
central line IVs, percutaneous endoscopic gastrostomy (PEG) tubes and hypodermoclysis
for hydration in this setting tubes or hypodermoclysis for hydration. With sample of 100
nursing facilities. A total of 79 nursing facilities had active IV programs (79%) and 54 of
those (68%) also managed central lines. The result revealed that the 19 nursing facilities
with IV programs available only in subacuteor equivalent units, only 26% (N = 5) did not
allow direct transfer of residents from other wards into these units. Of the 79 nursing
facilities having IV capability, a total of 91% (N = 72) have also used PEG tubes for
hydration and nutritional needs although only 6% (N = 5) have ever used
hypodermoclysis for hydration. So that study concluded that the majority of nursing
facilities in the Boston area provide IV programs for their residents, although in limited
numbers on a monthly basis13.
A study were to examine the amount of daily fluid intake among nursing
home residents and to explore the caregiver's perceived barriers to elderly's fluid intake,
With the sample of from 111 nursing home residents and 64 caregiver's in 4 nursing
homes. The result revealed that average amount of daily fluid intake was 1,035(SD=359)
ml with the range of 210 ml to 2,050 ml. About 52% (n=58) of the subjects had a less
than adequate fluid intake. The amount of daily fluid intake was significantly associated
with age, mental status, physical functioning, and the number of oral medications
ordered. The most frequently mentioned caregiver's perceived barrier was elderly's
concern about incontinence with increased fluid intake. So that study conclude that
inadequate fluid intake among nursing home residents is prevalent. To enhance adequate
hydration of nursing home residents, an institution wide nursing intervention is
necessary14.
The article explores issues related to children's nurses learning about
preparation and administration of IV drugs, considering professional and organizational
issues. The competencies required for safe practice are discussed, and the question of
who is in the best position to teach and assess students in this skill is considered.
Organizations need to ensure that clear guidelines exist for student nurses' involvement in
IV therapy.
6.2.3 Reviews related to effectiveness of structured teaching programme.
An experimental study was conducted to find out the effectiveness of
structured teaching programme in improving knowledge and attitude of school going
adolescents on reproductive health, with the sample of 200 adolescent school students.
The result revealed that the post-test score of knowledge of the groups on responsible
sexual behavior and their attitude towards reproductive health were better in the
experimental group than in the control group (p<0.001). So the study concluded that the
knowledge of adolescent school students on reproductive health is inadequate15.
The study involved interviews of 80 patients with epilepsy attending a
comprehensive rural health services project, and was conducted according to a structured
questionnaire. The majority of the patients were well informed regarding the cause of
epilepsy, but more than half had tried alternative treatment methods. Many patients had
misconceptions regarding the goal of the treatment and the consequences of missing a
prescribed drug dose. Surprisingly few patients avoided taking medicines on days of
religious fast. It was also noted that most patients depended on free medical supplies
from the clinic dispensary, and a small number of patients would stop the medicines if
these were not given free of cost. We stress the need to understand patients' concepts
about the cause and the treatment of epilepsy, the need to educate them and their families
regarding principles of modern medical treatment of epilepsy and most importantly, the
need to maintain a regular, uninterrupted supply of free medicines, to improve the
effectiveness of similar epilepsy management programmes in the setting of rural India
and other developing countries16.
A study to evaluate the effectiveness of structured teaching programme
on knowledge of staff nurses regarding care of patients with head injury was conducted
at selected hospital. A quasi experimental , one group pre-test and post test was adopted
for the study, through purposive sampling technique. 50 samples were selected in which
most of the subjects 36 (90%) were found to be female and 4 (10%) were found to be
male. Structured knowledge questionnaire was developed and administered to collect the
data. Collected data were analyzed and interpreted based on descriptive and inferential
statistics. The results revealed that the overall pre test knowledge scores obtained by
staff nurses were 56.5% with the SD of 2.72. After the administration of structured
teaching programme over all post test mean knowledge score was increased to 87.1%
with the SD of 2.77 with obtained t value of 23.76. This supports that increase in the
knowledge level of staff nurse indicates that the developed structured teaching
programme was effective in increasing the knowledge of staff nurses17.
A study to evaluate the effectiveness of structured teaching program on knowledge of
staff nurses regarding management of patients with fluid and electrolyte imbalance was
conducted at Wockhardt hospital. A quasi experimental, one group pre-test and post-test
design was adopted for the study, with purposive sampling technique. 40 samples were
selected in which most of the subjects 36 (90%) were found to be female and 4(10%)
were found to be male. Structured knowledge questionnaire was developed and
administered to collect the data. Collected data were analyzed and interpreted based on
descriptive and inferential statistics. The study results revealed that the pre-test
knowledge score obtained by staff nurse was 18.25. After the administration of structured
teaching programme post test mean knowledge score was increased to 28% with value of
24.60. This supports that increase in the knowledge level of staff nurses is not by chance
but by the developed structured teaching program18.
STATEMENT OF THE PROBLEM
A STUDY TO ASSESS THE EFFECTIVENESS OF STRUTURED TEACHING
PROGRAMME REGARDING KNOWLEDGE ON IV FLUID ADMINISTRATION IN
UNDER-FIVE CHILDREN AMONG STAFF NURSES IN A SELECTED PEDIATRIC
HOSPITAL, BENGALURU.
6.3 OBJECTIVES OF THE STUDY.
6.3.1 To assess the knowledge of staff nurses regarding IV fluid administration by pre
test.
6.3.2 To evaluate the effectiveness of structured teaching programme regarding IV fluid
administration by comparing pre and post test knowledge scores.
6.3.3 To find the association between pre-test knowledge scores with selected
demographic variables.
6.4 HYPOTHESIS
H1-
There will be significant difference between the pre-test and post-test knowledge
scores of the staff nurses regarding IV fluid administration in children.
H2 -
There will be significant association between pre-test knowledge scores with
selected demographic variables.
6.5 RESEARCH VARIABLES.
DEPENDENT VARIABLES
Knowledge of staff nurse on IV fluid administration in under five children.
INDEPENDENT VARIABLE
Structured teaching programme regarding administration of IV fluids in under five
children.
EXTRANEOUS VARIABLES
Demographic variables like age, sex, professional qualification, marital status, total years
of experience in nursing, years of experience in pediatric setting and previous source of
information on assessment of IV fluid administration among under five children.
6.6 OPERATIONAL DEFINITIONS
6.6.1 Assess: It refers to the way the level of knowledge as expressed by the staff nurses
regarding IV fluid administration of under five children as measured by pre-test scores.
6.6.2 Effectiveness: It refers the extent to which the structured teaching programme
improves the knowledge of staff nurses working in Indira Gandhi Institute of Child
Health, Bengaluru.
6.6.3 Structured teaching programme: It refers to systematically developed
instructions designed for a group of staff nurses to provide information regarding IV fluid
administration in children.
6.6.4 Knowledge: The level of understanding of staff nurses working in Indira Gandhi
Institute of Child Health regarding IV fluid administration in children.
6.6.5 Fluid administration: Refers to the administration of intravenous fluid to under
five children.
6.6.6 Under five children: Children from birth to five years of age.
6.6.7 Staff Nurses: Refers to the trained nursing personnel , who have completed their
GNM, B.Sc. (Basic) or PC. B.Sc. Nursing and working at Indira Gandhi Institute of Child
Health, Bengaluru.
6.7 ASSUMPTIONS.
6.7.1 Staff nurses may have some knowledge regarding IV fluid administration in
children.
6.7.2 Staff nurses may have some interest to know about IV fluid administration in
children.
7. MATERIALS AND METHODS.
7.1 SOURCEOF DATA.
Data will be collected from staff nurses in a selected pediatric hospital in Bengaluru.
7.2 METHOD OF DATA COLLECTION
Structured knowledge questionnaire will be used to collect the data from staff nurses.
7.2.1 RESEARCH DESIGN
The research design for the study will be pre-experimental design, with one group
test – post test design.
pre
GROUP
PRE-TEST
TREATMENT
POSTTEST
1
O1
X
O2
O1: Knowledge on IV fluid administration in under five children among staff nurses by
pre test.
X: Administration of structured teaching programme on IV fluid administration.
O2: Knowledge on IV fluid administration of STP by post test.
7.2.2 RESEARCH APPROACH
Evaluative approach
7.2.3 RESEARCH SETTING
Study will be conducted at a selected Indira Gandhi institute of child Health, Bengaluru,
which is 250 bedded pediatric hospital.
7.2.4 POPULATION
The population of the study will be staff nurses who are working in pediatric hospital
7.2.5 SAMPLE SIZE
Total sample of the study will consists of 50 nurses working at Indira Gandhi Institute of
Child Health, Bengaluru.
7.2.6 SAMPLE TECHNIQUE.
Simple random sampling technique will be adopted
7.2.7 SAMPLING CRITERIA
Inclusion Criteria:
 Staff nurses who are working in selected pediatric hospital in Bengaluru.
 Staff nurses who are willing to participate in the study.
 Staff nurses who are available at the time of data collection.
Exclusion Criteria:
 Staff nurses who are not willing to participate in the study.
 Staff nurses who are not available at the time of data collection.
7.2.8 TOOL FOR DATA COLLECTION
Data collection will be done through structured knowledge questionnaire method. It
consists of two parts:
Part 1: Deals with socio demographic information.
Part 2: Knowledge Questionnaire to assess the knowledge of staff nurses regarding IV
fluid administration in children.
7.2.9 DATA ANALYSIS METHOD.
Data analysis method will be through descriptive and inferential statistics.
Descriptive statistics:
Frequency, mean, median, mode and standard deviation will be used to analyze the
demographic profile.
Inferential statistics:
Parametric: Paired “t” test will be used to compare the pre and post test knowledge scores
of staff nurses.
Non Parametric: Chi-square (x2) test will be used to find out the association between pre
test knowledge scores with selected demographic variables.
7.3 DOES THE STUDY REQUIRE ANY INTERVENTION TO BE CONDUCTED
ON PATIENTS OR OTHER HUMANS OR ANIMALS?
Yes, the study will be conducted among staff nurses in a pediatric hospital .
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM THE ETHICAL
COMMITTEE OF THE OXFORD COLLEGE OF NURSING?
-Ethical clearance will be obtained from the Ethical Committee of The Oxford College of
Nursing.
-Permission will be obtained from the concerned authority of the selected padiatric
hospital in Bengaluru.
-Informed consent will be obtained from the staff nurses who are participating in the
study.
8. LIST OF REFERENCES
1. Gobbi M, Cowen M, Ugboma D. Fluid and electrolyte balance. Nursing Mirror and
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9.0 SIGNATURE OF THE STUDENT
:
10.0 REMARK OF THE GUIDE
: The topic which is selected by the candidate
is relevant and appropriate as it attempts to
increase knowledge and responsibilities
among staff nurses in fluid administration.
11.0 NAME AND DESIGNATION
11.1 GUIDE’S NAME AND
ADDRESS
: Dr. G. Kasthuri
Prof. and Head of the Department
Child Health Nursing
The Oxford College of Nursing
Bengaluru-560078
11.2 SIGNATURE OF THE GUIDE
:
11.3 HEAD OF DEPARTMENT
NAME
: Dr. G. Kasthuri
ADDRESS
: Head of the Department
Child Health Nursing
The Oxford College of Nursing
Bengaluru-560078
11.4 SIGNATURE OF HOD
:
12. REMARKS OF PRINCIPAL
: The topic selected is relevant as it
empowers the knowledge and
responsibilities of staff nurses in fluid
administration in pediatric clients.
12.1 SIGNATURE OF PRINCIPAL
:
Dr. G. Kasthuri
Principal
The Oxford College of Nursing
No.6/9 & 6/11,1st cross
Begur road, Hongasandra
Bengaluru-560068
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