EXECUTIVE SUMMARY. 1. Introduction

Transcription

1 EXECUTIVE SUMMARY 1. Introduction As the staff nurses are the frontline workers at all areas in the hospital, a need was felt to see the effectiveness of American Heart Association (AHA) certified Basic Life Support (BLS) Provider Course on the knowledge and skill set of nurses. The staff nurses in the hospitals are trained in preventive, curative and rehabilitative aspects of patient care for the hospitals, and this becomes an expected behavior pattern while they are employed. AHA certified BLS Provider Course is internationally accredited module drawn for the benefit of trainees undergoing this certificate course. It requires skilled professionals who can apply these skills in emergency and prevent catastrophic disaster for a patient. It is important to train the staff nurses to protect and take care of patients in hospitals. AHA certified BLS Provider Course is a very popular, well designed course that would be helpful to protect the patients from going into disaster. 2. Statement of the problem A study to assess the Effectiveness of American Heart Association (AHA) certified Basic Life Support training on knowledge and skill set of Nurses working in selected Hospitals of Pune city. iv

2 3. Objectives 1. To assess the existing knowledge and skill set pertaining to Basic Life Support among Nurses working in the selected hospitals of Pune city. 2. To assess the effectiveness of AHA certified BLS Provider course of two days duration, among the nurses, working in the selected hospitals of Pune city immediately after the training(post test I) and after a gap of six months (Post test II). 3. To correlate the knowledge and skill set of AHA certified BLS Provider Course of two day s duration among nurses working in the selected hospitals of Pune city. 4. To associate the knowledge and skill set of nurses pertaining to AHA certified BLS Provider Course of two day s duration with selected demographic variables. 4. Hypothesis H0 - There will not be any significant improvement in the Knowledge among Nurses working in the selected Hospitals of Pune City regarding BLS after undergoing AHA certified BLS Provider Course of two days duration. H0.1- There will not be any significant improvement in the Skill set among Nurses working in the selected Hospitals of Pune City regarding BLS after undergoing AHA certified BLS Provider Course of two days duration. H1 - There will be significant improvement in the Knowledge among Nurses working in the selected Hospitals of Pune City regarding BLS after undergoing AHA certified BLS Provider Course of two days duration. H1.1- There will be significant improvement in the skill set among Nurses working in the selected Hospitals of Pune City regarding BLS after undergoing AHA certified BLS Provider Course of two days duration. v

3 H0.2 - There will not be any significant correlation between the Knowledge and Skill set regarding AHA certified BLS Provider Course of two days duration variables among Nurses working in selected Hospitals of Pune city. H1.2 - There will be significant correlation between the Knowledge and Skill set regarding AHA certified BLS Provider Course of two days duration among Nurses working in selected Hospitals of Pune city. H0.3- There will not be significant association between the Knowledge and Skill set regarding AHA certified BLS Provider Course of two days duration and the demographic variables among Nurses working in selected Hospitals of Pune city. H1.3- There will be significant association between the Knowledge and Skill set regarding AHA certified BLS Provider Course of two days duration and the demographic variables among Nurses working in selected Hospitals of Pune city. 5. Methodology A quasi experimental time-series design was selected by the researcher. In this design researcher used randomization of treatment to test units. The researcher has the advantage of multiple observations in time series design. The effect of maturation, main testing effect, Instrumentation and statistical regression can be ruled out. The study was conducted in three phases. Cognitive Knowledge questionnaire was administered (Pre Test) after obtaining the willingness of respondents. Observational checklist for skill set was completed as the respondents attempted Cardiopulmonary Resuscitation (CPR) on Resusci Anne skill-meter manikin (Pre Test). Cognitive Knowledge questionnaire had 40 items. Grading of the knowledge score was done as Poor (score 0-13), Average (score 14-27) and Good (score 28-40) vi

4 Observational checklist for skill set was observed and completed by the Trained Data recorder. The instrument had 20 items. AHA certified BLS Provider Course was imparted to these subjects by the AHA certified Intensivists for two days. Cognitive knowledge questionnaire was administered to respondents (Post Test I). Observational checklist for skill set was completed as the respondents attempted CPR on Resusci Anne skill-meter manikin (Post Test I). After six months of AHA certified BLS Provider course cognitive knowledge questionnaire was administered on the same respondents in their respective area of work (Post Test II). Observational checklist for skill set was completed by observing study respondents perform on Resusci Anne skill-meter manikin in their respective area of work (Post Test II). Descriptive and inferential statistics were applied for assessing the result and to test the hypothesis. Initial sample size was 250. The sample size declined to 229 for Post test I and it further declined to 210 for Post test-ii, this was due to screening at various levels and respondents inability/unwillingness to participate in the study. Thus, a sample size of 210 was considered adequate to draw credible conclusion. In this research study 210 nurses from various cadres were selected from four Hospitals in Pune city i.e. Multispecialty Corporate Hospital, Multispecialty Private Hospital, Teaching Hospital and Non-Governmental Hospital. A non-probability convenient sampling was used. A structured questionnaire was administered to assess the cognitive knowledge scores and the observation checklist was used for observing the skill set of respondents. Validity & Reliability A structured cognitive knowledge questionnaire comprising of 40 statements of sub-sections of AHA certified BLS Provider Course module was administered to assess the cognitive knowledge. Observational checklist for BLS technique was used for observing the skills of respondents. The content validity and reliability of the tool was obtained from experts in the field (Annexure 3) and a pilot study was conducted at the selected hospitals on 20 respondents from Nov 2010 to April Reliability of questionnaire, when pilot tested on 20 subjects, was 0.80 (Cronbach s alpha) coefficient which proved that the instrument was highly reliable. These vii

5 subjects were not included in the main study. The entire data collection was carried out between July 2011 to April Findings of the study Analysis of data is organized and presented under five different sections Section I: Description of respondents in terms of demographic Variables The frequency and percentage of staff nurses were analyzed for the following demographic variables viz. age, gender, educational qualification, type of institution, duration of clinical experience, current deployment, exposure to previous CPR training. In institution wise distribution of nurses, 83 (39.52%) staff nurses were from Multispecialty Corporate Hospital, 64 (30.48%) staff nurses were from Non-Governmental Hospital, and 52 (24.76%) staff nurses were from Multispecialty Private Hospital and very few i.e. 11 (5.24%) staff nurses were from Teaching Hospital, who participated in the study. Thus, in this study, maximum participation of staff nurses was from Multispecialty Corporate Hospital. In age and gender wise distribution of nurses, majority of the nurses belonged to age group of years 182 (86.7%), followed by years 20 (9.5%). The study reveals that staff nurses above the age of 40 were very few i.e. only 8 (3.8%). Out of the selectedsample147 (70%) were females and 63 (30%) were male nurses. Thus, maximum participation was witnessed from the age group of years, which predominantly comprised of female gender. In regard to professional qualification wise distribution of nurses, majority of the staff nurses i.e 126 (60%) were B.Sc Nurses, G.N.M Nurses were 79 (37.62%) followed by P.B.B.Sc Nurses 5 (2.38%). Thus it was observed that maximum number of nurses who participated in this study were graduates. In regard to clinical experience wise distribution majority of the staff nurses i.e 117 (55.7%) had less than 5 years of clinical experience. This was followed by 68 (32.4%) staff nurses having 6-10 years of clinical experience, followed by 25 (11.9%) who had more than 10 viii

6 years of experience. Hence it was observed that in this study majority of participants had clinical experience of less than 5 years. In current deployment of nurses, majority of the staff nurses i.e 181 (86.19%) were deployed in the Critical Care Unit and 26 (12.38%) staff nurses were deployed in other departments. 03 (1.40%) were deployed in wards. As far as exposure to previous CPR training was concerned, around 128 (60.95%) staff nurses did not have exposure to any CPR training while 82 (39.05%) staff nurses were trained in CPR of AHA certified BLS training. Majority of the staff nurses i.e 53(64.63%) were trained in the year 2009.In 2010 and 2011 only 9(10.68%) were trained. Previous exposure for CPR took place in the year where 82 respondents were trained. Section II: Analysis of data in regard to knowledge of respondents in Pre test, Post test I and Post test II pertaining to AHA Certified BLS Provider Course In Pre-test, nobody was found in the category of Poor score. There were 163 respondents (77.62%) in the Average score category, and 47 respondents (22.38%) in the Good score category. This showed that the respondents on the whole possessed Average knowledge regarding BLS. When the Pre-test knowledge score was compared with Post-test score, it was observed that 7 respondents (3.33%) were under Poor category, 163 (77.62%) respondents were found in the Average category. In the Post test-i76 (36.19%) respondents were found in Average category. This shows that their knowledge level had increased after undergoing training as the scores in the level of knowledge was Good. In Post test II in the knowledge category, it was observed that 166 (79.05%) respondents were under Good category. This shows that the AHA certified BLS training is very effective in retaining the knowledge even after 6 months of training. There is highly significant difference of knowledge score between Pre and Post test I, Pre and Post Test II (after 6 months), Post Test I and Post Test II after 6 months in respondents i.e. p< (Knowledge score significantly increased). Even after 6 months the respondents were able to retain the knowledge; this may be because the ix

7 respondents might have practiced the BLS on patients during their clinical posting. Null Hypothesis is rejected hence H 1is accepted. Section III: Analysis of data in regard to skill set of respondents in Pre test, Post test I and Post test II ( after 6 months) pertaining to AHA Certified BLS Provider Course In the Pre test, the Poor skillset were found in only 2 (0.95%) staff nurses. The Average level skill set were found in 70 (33.33%) staff nurses. The Good level skill set were found in 138 (65.71%) staff nurses. This shows that skill set of the respondents pertaining to AHA certified BLS is reasonably good. In comparison with Post test I, the 12 (5.71%) respondents were found in Average score skill set whereas 198 (94.29%) respondents were found in Good score skill set, even after six months, the Average level skill set were found in 7 (3.33%) staff nurses. The Good level skill set were found in 203 (96.67%) staff nurses. The Skill score of respondents in Good category consistently increased, whereas respondents from Average category have consistently reduced. This clearly indicates that AHA certified BLS training is effective in improving the skill of the staff nurses. Even after 6 months, the skill set level has not changed significantly. This shows that the skill once achieved may be retained by the respondents working in the cardiac unit. Null Hypothesis H0.3is rejected hence H1.3 is accepted. Section IV: Analysis of association drawn between effectiveness of training pertaining to AHA certified BLS Provider Course on knowledge and skill set of respondents with selected demographic variables. There is significant difference of Pre test, Post test I and Posttest II (after 6 months) knowledge score according to different age in study group. It was identified that the respondents in the age group of yrs lacked knowledge in Pre test, however, increase in their knowledge level was evident in Post test-i & Post test-ii. Even after 6 months of training, the score remained high. This clearly shows that the knowledge once gained remains in the memory of the individual for a longer time. Null Hypothesis H0.3is rejected hence H1.3is accepted. x

8 There is highly significant difference of Pre test I skill set score according to age and no significant difference of Post test I and Post Test II (after 6 months) skill score according to age in study group. It was observed that respondents in age group yrs have shown improvement in their skills and it was later increased to level similar to other age groups. This shows that the increase in the skills and retention of the same is not related to age. Null Hypothesis H0.3 is rejected hence H1.3 is accepted. There is a significant difference between male & females in Pre test knowledge score. In Post test I, there is significant difference of knowledge level in males & females, however, level of significance is reduced. In Post test II (after 6 months) very slight significance was evident, which was also not statistically significant. This shows that the BLS Provider Course has no effect on gender on the level of knowledge. Null Hypothesis H0.3is accepted. There is a highly significant difference of Pre test skill score in male &female. In Post test I skill set scores, males scored slightly more than females, which was not statistically significant. In Post Test II skill set scores, females outscored males, but difference was not statistically significant. Null Hypothesis H0.3is accepted. There is significant difference of Post test knowledge score according to qualification. It was observed that the respondents with GNM qualification exhibited more learning curve. However, observation in Post test-ii reveals that the graduate respondents matched up with the knowledge level of GNM nurses. Null Hypothesis H0.3is accepted. There is a highly significant difference of Pre test skill score according to qualification and significant difference of Post test I and Post test II(after 6 months) skill score according to qualification in study group. This shows that in Pre test B.Sc. respondents xi

9 had less difference, but not significant when compared to GNM nurses. In Post test-i the difference reduced significantly and in post test-ii it ceased to be significant. Null Hypothesis is rejected hence H 1.3 is accepted. There is significant difference of Pre test knowledge score according to institution and significant difference of Post test I and Post test II (after 6 months) knowledge score according to institution in study group. In Post test-i, the level of significance of difference in knowledge between various hospitals have increased. Even in Post test-ii the difference remained highly significant. Null Hypothesis is rejected hence H 1.3 is accepted. There is a highly significant difference of Pre test, Post test I and Post test II (after 6 months) skill score according to institution in study group. Null Hypothesis is rejected hence H 1.3 is accepted. There is a highly significant difference of Pre test, Post test I and Post test II (after 6 months) skill set score according to institution in study group. Null Hypothesis is rejected hence H 1.3 is accepted. According to the duration of clinical experience there is a significant difference of knowledge score in Pre test, highly significant difference of knowledge score in Post test I and not highly significant difference was observed in Post test II (after 6 months).null Hypothesis H0.3is accepted. According to duration of clinical experience there is highly significant difference of Pre test and Post test II (after 6 months) skill set score. This shows a marked improvement in the skills of respondents with more than 10 year of clinical experience. Null Hypothesis is rejected hence H 1.3 is accepted. There is a highly significant difference of Post test I knowledge score according to current deployment and not significant difference of Pre test and Post test-ii (after 6 xii

10 months) knowledge score according to current deployment in study group. Null Hypothesis is rejected hence H 1.3 is accepted only for Post test. There was a highly significant difference between skill set score of Critical Care Unit, Ward & other areas of work in Pre test. However, the difference was not significant in Post test and Post test II (after 6 months). Moreover, there was substantial difference in skill scores previously, but after the administration of BLS Provider Course, the difference was not so obvious. There is no significant difference of Pre test, Post test I and Post test II (after 6 months) knowledge score according to CPR training undertaken in study group. This shows that irrespective of previous exposure to CPR training, the knowledge about AHA certified BLS Provider course was same among nurses. Null Hypothesis H0.3 is accepted. There is no significant difference of Pre test, Post test I and Post test II (after 6 months) skill set score according to CPR training undertaken in study group. This shows that irrespective of previous exposure to CPR training, the skills of respondents about AHA certified BLS provider course were same. Null Hypothesis H0.3 is accepted. Section V: Correlation between Knowledge and Skill set With regard to co-relation between knowledge and skill set score in study group, in Pre test, p value being >0.05, possibility of co-relation is meager. However, when analytical observation of data is done in regards to Post test I and Post test II, weak positive co-relation exists. This can be interpreted as during the Pre-test respondents may have had deficient knowledge and skills in a significant manner; therefore it was not possible to have positive co-relation with knowledge and skills. xiii

11 During Post test I there was an increase in the knowledge, and new skills acquisition, it showed weak positive co-relation as the skills gained were new to the respondents. During Post test II, after six months, it is possible that there is slight deviation in the knowledge and improvement in the skills; hence a weak positive co-relation is seen. Conclusion: From the above study, it can be concluded that the knowledge has significant impact on skills of the nurses but there is co-relation between knowledge and skills after training. This again proves the fact that if people are knowledgeable they may put the knowledge into practice. As a result, the skills may change as the knowledge advances. However, training gives rise to change in the knowledge and skill for younger professionals. Recommendation: 1. The researcher proposes a broad recommendation that all nurses should be trained in CPR skills irrespective of their area of deployment, professional experiences or area of practice. 2. The researcher recommends that the health care authorities at State and National level should make it mandatory to train all the nurses with CPR courses. 3. Further, a strong recommendation to incorporate CPR training in curriculum of Nursing Programs by making it mandatory for students to undergo AHA certified BLS ACLS provider course during their internship tenure. This will expand the horizon of nursing education. 4. The Sate Registration councils to register a nurse only after verifying his/her CPR training course completion details. This strategy will empower the nurses with updated knowledge and skills pertaining to CPR. 5. Researcher strongly puts the recommendations to policy makers to make it mandatory for the Health Care Professional to be trained in CPR skills. This will aid in reducing the mortality related to cardiac arrest. xiv

12 6. Recommendations are proposed for apex Hospital accrediting bodies viz. National Accreditation Board for Hospitals and Health care Providers (NABH). All staff must undergo CPR Training for the parent Hospital Accreditation. 7. Corporate Hospital staff should be trained in CPR Skills. 8. All governing authorities should create awareness among the vulnerable metropolitan population by educating them through television, radio and print media. This will emerge as a key strategy to save victims who suffer cardiac arrest outside Hospital. 9. The researcher supports the current two year certification period for Basic and advanced life support courses. Researcher also advocates including periodic assessment of rescuer knowledge and skills with reinforcement or refresh information as needed. 10. AHA Certified BLS- ACLS course is a costly package therefore if the training is offered for specific competency by a particular specialist then it is possible to overcome this barrier. 11. As India s healthcare system mostly emerges from Government sectors, it should be one of the main points to remember for officials to educate and prepare nurses of India in such a manner that they are assets, not liability for care providers and consumers. 12. NGOs are active in Urban and Rural Settings, and will prove to be good hand if they are trained in CPR Skill. Certain steps are very easy and can be performed well with ease in emergency. 13. It is always better to train the entire community youth Male, female, robust individuals, on the skill of CPR. Equipped with extra ordinary skill of CPR an individual will feel good and be ready to jump into the scenario of cardiac arrest and save the life. xv