Effectiveness of a Planned Teaching Programme on Care of Babies on Mechanical Ventilator among Staff Nurses Working in NICU in Selected Hospitals at Bangalore

Chinna Devi M.

Dean, Faculty of Nursing, SGT University, Gurgaon, Haryana

*Corresponding Author Email: mscpediatrics@gmail.com

ABSTRACT:

In modern Intensive Care management of critical problems, most of the patients need artificial respiration during the stage of their illness. With the availability of variety of ventilators and increasing medical expertise, mechanical ventilation has become easier today. Any patient who is in respiratory failure (i.e) PaO2 is less than 50 mm Hg or PacO2 more than 50 mm Hg needs ventilatory support.

A Study was undertaken to assess the effectiveness of planned teaching programe on care of babies on mechanical ventilator among staff nurses working in NICU in selected hospitals at Bangalore.

Results

The results revealed that the overall mean score was 40.66% in pre-test and 78.22% in post-test. The majority of staff nurses 19 (63.33%) in general aspects 27 (90%) in nursing management had inadequate knowledge in pre-test. After planned teaching programme 17 (56.66%) in general aspect 14 (46.66%) in nursing management had adequate knowledge and remaining were in moderate knowledge.

Paired ‘t’ test showed that there was a significant difference between pre-test and post-test scores with ‘t’ value of 18.4 at p<0.001.

Chi-square revealed that there was no significant association between post test level of knowledge and selected demographic variables except in designation demographic variable

Interpretation and conclusion

The study findings revealed that planned teaching programme on Care of Babies on mechanical ventilator is effective in improving knowledge of staff nurses. The study also reveals that there is no significant association between post-test level of knowledge and selected demographic variables except designation. There is a significant association between the designation of staff nurses with post-test level of knowledge at p<0.01 (df = 1) level of significance.

KEYWORDS: Intensive care, Artificial respiration, Ventilators, Mechanical Ventilation.

INTRODUCTION:

In every child who is born under no matter what circumstances, and of no matter what parents, the potentiality of the human race is born again, and in him too, once more and of each of us, our unique responsibility towards human life.

An important index used to estimate Nation’s health is the health status of children in that country. While such children become sick and hospitalized, they are treated by using various type of equipment’s such as Mechanical Ventilator, especially when they get admitted in ICU the Mechanical ventilator place a vital role to save the life of the children.

“Mechanical Ventilation is defined as beginning with endotracheal tube intubation, maintenance of full and/or partial ventilation support, discontinuation of mechanical ventilation via weaning techniques and concluding with care of infants require chronic mechanical ventilation.” (National Institute of Nursing Research, 1998).

The common indications for mechanical ventilator are Birth Asphyxia, Hyaline Membrane Disease, Meconium Aspiration Syndrome, Septicemia and apnea of prematurity and the complications are septicemia, tube block and air leak. (Riyas P.K. et.al 2003)

NEED FOR THE STUDY:

The current population of the world is 6,420,399,927. Worldwide the neonatal deaths are 3.9 million per year. Current neonatal mortality is 44 deaths per 1000 live births in world. In that India’s total population is 21.34%, 0 to 6 years population is 15.27%. The neonatal mortality rate is 43.4 / 1000 live births; Infant mortality rate is 67 / 1000 live births per year. Karnataka state total population is 17.25%, 0 to 6 years population is 12.49%. Infant mortality rate is 53 / 1000 live births per year. So it is essential for the nurses to take part in reducing the mortality rate. (www.gadive.com).

Luyt Karen, (2002). Study conducted a study on care of infants on mechanical ventilation by nurse managed group and specialist group on 10 ICU patients. It was found that nurse managed group of infants showed significant reduction in duration of weaning infants from mechanical ventilation compared to the specialists register group.

A study conducted on the impact of quiet period and its influence on the infants physiological state of the infants in NICU. The study concluded that the quiet period is vital for the maintenance of normal physiological status than the normal period. (Selvin. M. et.al, 2000).

Continuous Education Programme was conducted on nurses’ responsibilities when the babies are on mechanical ventilators. The responsibilities like administering IV fluids, monitoring vital signs, measuring arterial and mixed venous blood gases before, during and after the treatment, monitoring intake and output, positioning of patient every few hours, suctioning and chest physiotherapy were identified. (Catrina Miller, 1998).

Today Nursing has gone from traditional intuitive nursing to modern cyberspace nursing. Technological advances demand more qualified and specially trained nurses particularly in NICU’s.

In 1998 the Nursing assembly of the American Thoracic Society and the American Nursing Association for the critical care nurses identified research areas include optimum ways to deliver patient care during mechanical ventilator support, maintenance and withdrawal of ventilator support, technology, impact of care on family dynamics, optimum methods and techniques to deliver nursing care.

Whenever mechanical ventilation is initiated the staff nurses have to undertake a huge responsibility since the babies are potential for complications such as airway complications, pulmonary complications of this technique. Therefore close monitoring of the condition is vital. Staff nurses should be careful during feeding, fluid therapy, weaning from mechanical ventilator. So the staff nurses are required training to take care of the babies on mechanical ventilator.

The investigator had experienced that the staff nurses were frequently shifted to the NICU’s. Because of this they had expressed interest to learn the care of babies on mechanical ventilator. So the investigator felt the need to provide planned teaching programme on nursing care of babies on mechanical ventilator to the staff nurses to improve their knowledge and skills to provide care.

STATEMENT OF THE PROBLEM:

“Effectiveness of a planned teaching programme on care of babies on mechanical ventilator among staff nurses working in NICU” in selected hospitals at Bangalore.

OBJECTIVES:

1. To assess the level of knowledge regarding care of babies on mechanical ventilator among staff nurses.

2. To assess the effectiveness of planned teaching programme among staff nurses.

3. To find the association between the level of knowledge of staff nurses with the selected demographic variables.

METERIALS AND METHODS:

A pre-experimental evaluative study was conducted in NICU’s of M.S. Ramaiah Medical Teaching Hospital, Bangalore. Samples selected were 30 staff nurses working in NICU, non-probability convenient sampling technique was used for the study. Data was collected with the help of a structured knowledge questionnaire.

Research approach.

Evaluative research design was adopted.

Research design

The research design selected for the present study was pre-experimental research with one group pre-test, post-test design

Setting of the study

The study was conducted in the Neonatal Intensive care unit of M.S. Ramaiah Medical Teaching Hospital.

The above hospital is located within the campus of M.S.R. Institutions.

Population

The target population of the study was the staff nurses working in NICU’s of M.S. Ramaiah Medical Teaching Hospital, Bangalore, Karnataka.

Sample

The sample comprised of 30 staff nurses working in NICU, M.S. Ramaiah Medical Teaching Hospital.

Sampling Technique

The sample was selected by non-probability Convenient sampling method.

ANALYSIS:

Demographic variables of the staff nurses.

Table 1: Frequency and percentage distribution of demographic variables of staff nurses. n = 30

SI No.

Demographic Variable

Frequency (F)

Percentage (%)

Age

a. 20 – 29

b. 30 – 39

c. 40 – 49

d. > 50

93.33

6.66

Gender

a. Male

b. Female

100

Professional Qualification

a. GNM

b. B.Sc (N)

93.33

6.66

Designation

a. Staff Nurse

b. Senior Staff Nurse

96.66

3.33

Experience in NICU

a. <1 Year

b. 1 – 3 years

c. 3 – 5 years

d. > 5 years

73.33

16.66

6.66

3.33

Experience in caring babies on Mechanical ventilator

a. < 1 year

b. 1 – 3 years

c. 3 – 5 years

d. >5 years

73.33

16.66

6.66

3.33

Exposure to Inservice training programme

a. Yes

b. No

100

The above table 1 showed that maximum number of staff nurses 28 (93.33%) were in the age group of 20 – 29 years and all of them were female gender 30 (100%).

Majority of staff nurses 28 (93.33%) had diploma education and 22 (73.33) were having <1 year of experience. It reveals that none of them were exposed to any sort of In-service training programme.

Fig. 1 Distritubion of the age of staff nurses

Fig. 2 Designation of Staff Nurses

Fig. 3 Distribution of years of experience of NICU

Association of selected demographic variables with the Post-test level of knowledge.

Table 7: Association between demographic variables and the post-test level of knowledge among staff nurses regarding care of babies on mechanical ventilator. n = 30

SI No.

Demographic Variables

Moderate knowledge

50 – 75%

Adequate knowledge

> 75%

Chi-square value

Age

a. 20 – 29

b. 30 – 39

c. 40 – 49

d. > 50

46.42

53.57

X²= 0.49

d_f = 1

P <0.05 (NS)

Gender

a. Male

b. Female

46.66

53.33

X²= 1.81

d_f = 1

P <0.05 (NS)

Professional Qualification

a. GNM

b. B.Sc N

100

X²= 2.51

d_f = 1

P <0.05 (NS)

Designation

a. Staff Nurse

b. Senior Staff Nurse

44.82

100

55.17

X²= 9.59 **

d_f = 1

P < 0.01

Experience in NICU

a. <1 Year

b. 1 – 3 years

c. 3 – 5 years

d. > 5 years

59.09

40.9

100

X²= 4.76

d_f = 3

P < 0.05 (NS)

Experience in caring babies on Mechanical ventilator

a. < 1 year

b. 1 – 3 years

c. 3 – 5 years

d. >5 years

59.09

40.9

100

X²= 4.76

d_f = 3

P <0.05 (NS)

Exposure to Inservice training programme

a. Yes

b. No

46.66

53.33

X²= 1.81

d_f = 1

P <0.05 (NS)

** p<0.01 level of significance

Table 7 deals with the association of staff nurses demographic variables with the post-test level of knowledge.

It showed that there is a significant association between the designation of staff nurses with post-test level of knowledge at p< 0.01 (d_f = 1) level of significance. Hence the null hypothesis stated was rejected.

The other demographic variables like age, sex, professional qualification, experience in NICU, Experience in caring babies on mechanical ventilator, exposures to in-service training programme are not having any significant association with the post-test levels of knowledge. Hence the null hypothesis stating that there is no association between findings of the study and selected demographic variables was accepted.

Hence the null hypothesis stated was rejected and re-stating that there is a significant difference between pre-test level of knowledge and post-test level of knowledge regarding care of babies on mechanical ventilator among staff nurses.

CONCLUSION:

The present study to assess the knowledge of staff nurses on care of babies on mechanical ventilator and found that none of them were had adequate knowledge in the pre-test and a maximum number of staff nurses 53.33% had adequate knowledge in post -test. It shows that there is a significant improvement in knowledge of staff nurses after the planned teaching programme. Thus planned teaching programme is effective in improving the knowledge of staff nurses regarding care of babies on mechanical ventilator.

The planned teaching programme has enhanced the knowledge of staff nurses and thereby improved skills, which are essential for effective and skilled nursing care. The staff nurses expressed that the planned teaching was very informative and it would help them to identify the danger signs during ventilation and intervene at the earliest to prevent complications.

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