INTRODUCTION:

All over the world especially in developing countries, child morbidity and mortality obstruct social and economical development. The cause such morbidity and mortality are the various child hood diseases. Nursing care should be initiated at the right time which in turn can bring down the morbidity and mortality by preventing complication. Respiratory distress syndrome is a leading cause for seeking health care advice.

It is a well recognized fact that the children of today are the citizens of tomorrow. They are the inheritance of God. Every child has right to grow up in a healthy home, school and community. The future development of our children and of their world depends on their enjoyment of good health.

The under five children are vulnerable or special risk group in any population deserving special health care because of their immaturity and the various stages of growth and development.[1]

The syndrome was first described in 1967 and has been referred to by several terms including shock lung, wet lung, post traumatic lung, congestive atelectasis capillary leak syndrome and hyaline membrane disease.[2]

Acute respiratory distress syndrome is a sudden, progressive form of respiratory failure characterized by severe dyspneoa, hypoxemia and diffuse bilateral infiltrates. Respiratory distress syndrome (RDS) is a life threatening lung disorder that commonly affects premature infants. RDS is caused by a lack of pulmonary surfactant, a foamy fluid substance produced by the body between the 34th and 37th week of pregnancy.[3]

Surfactant keeps the air sacs in mature lungs from collapsing and allows them to inflate with air more easily. When an infant is born prematurely, their lungs do not produce enough surfactant and the air sacs collapse, preventing the infant from breathing properly.[4]

Babies born full term rarely develop RDS; most cases are seen in premature babies with under 28 weeks gestation.[5]

Treatment of respiratory distress syndrome (RDS) usually begins as soon as the baby is born, sometimes in the delivery room. Most infants who show signs of RDS are quickly moved to a special intensive care unit called a neonatal intensive care unit (NICU). There they receive around-the-clock treatment from a group of health care professionals who specialize in treating premature infants. Treatment in the NICU is designed to limit stress on the baby and meet his or her basic needs of warmth, nutrition, and protection.

PROBLEM JUSTIFICATION:

Acute respiratory distress syndrome is a sudden and progressive form of acute respiratory failure. In United States acute respiratory distress syndrome is estimated at more than 150,000 cases annually. Despite supportive therapy the mortality rate from acute respiratory distress syndrome is approximately 50%.Patient who has both gram negative septic shock and acute respiratory distress syndrome have a mortality rate of 70%- 90%.[6]

Respiratory distress syndrome (RDS) affected 16,268 infants born alive in the United States in 2005. Annual RDS deaths decreased from 25,000 in the 1960's to 860 in 2005, representing 3.1 percent of infant fatalities. In 1979, the syndrome was still the second-ranking cause of infant deaths; in 2005, it had fallen to seventh. In 2005, the RDS mortality rate among black infants was 46.6 (per 100,000 live births), versus 16.5 among whites- over 2.8 times greater. There were 18,000 hospitalizations in 2005 due to RDS. In 2005 the total economic cost of RDS was estimated to be $2.3 billion.[7]

Acute respiratory distress syndrome in children reported with 60% -70% mortality rates. Sepsis and multiple organ system dysfunctions contribute the most to the high mortality and morbidity. Sepsis is not only the most common cause of acute respiratory distress syndrome, but patient with acute respiratory distress syndrome may be six times more susceptible to infection than patient without acute respiratory distress syndrome. The role of novel therapeutic modalities like inhaled nitric oxide, liquid ventilation and surfactant replacement is under investigation.[8]

Acute respiratory distress syndrome is recognized in children, as well as adults and has been associated with clinical conditions and injuries such as sepsis viral pneumonia, smoke inhalation and near drowning. Respiratory distress is a name applied to respiratory dysfunction in neonates and is primarily a disease related to developmental delay in lung maturation. It is seen almost exclusively in preterm infants. The nurse is to observe and assess the infant’s response to respiratory therapy. Continuous monitoring and close observation are mandatory because an infant’s status can change rapidly.[9]

The therapeutic interventions remain mainly supportive. Strategies of conventional mechanical ventilation are directed toward the use of high positive end-expiratory pressures, low positive inspiratory pressure, and permissive hypercapnia. High-frequency oscillatory ventilation and tracheal insufflations are not yet used extensively, although they should contribute to less aggressive ventilation. Surfactant replacement, nitric oxide inhalation, and partial liquid ventilation seem to be promising technologies, but controlled clinical studies are necessary before their wide-spread use. Extracorporeal membrane oxygenation remains the alternative technology in case of failure of conventional support.[10]

It is necessary to assess the knowledge of staff nurses regarding newborn’s respiratory distress syndrome. By assessing this, it helps to improve the knowledge of staff nurses regarding new born’s respiratory distress syndrome. It helps prevent the complication of respiratory distress syndrome among new born.

REVIEW OF LITERATURE:

A. About Acute respiratory Distress Syndrome:

Yu WL et al conducted the study investigated the mortality and predictors of outcome of children with acute respiratory distress syndrome in pediatric intensive care unit. Acute respiratory distress syndrome cases were selected from the 12018 patients admitted in 25 pediatric intensive care units in China,. 105 of the 12018 patients (1.44%) were diagnosed as with acute respiratory distress syndrome. The overall mortality of Acute respiratory distress syndrome was 61.0%,9 times as high as that of the 7269 severe cases in PICU. The study concluded that acute respiratory distress syndrome has a high risk of death, and the infiltration shadows in 2-3 quadrants, pediatric critical illness score and partial pressure of carbon dioxide are independently associated with mortality.[11]

Paret G et al conducted a study to examine a 10 year experience of predisposing factors described about the clinical course and predictors of mortality in children with this syndrome. The method used in this study was the medical records of all admissions to the pediatric intensive care unit. The result was 39 children with the Adult respiratory distress syndrome. Mean age was 7.4 years and the male: female ratio was 24:15.The mortality rate was 61.5%.[12]

Rotta A.T et al conducted a study reviewed the current support and treatment strategies of the acute respiratory distress syndrome. Despite advances in the understanding of the pathogenesis of acute respiratory distress syndrome, this syndrome still results in significant morbidity and mortality. Mechanical ventilation, the main therapeutic modality for acute respiratory distress syndrome, is no longer considered simply a support modality, but a therapy capable of influencing the course of the disease. This text reviews the current knowledge of acute respiratory distress syndrome management, including conventional and non-conventional ventilation, the use of surfactant, nitric oxide, modulators of inflammation, extracorporeal membrane oxygenation and prone position. The last decade was marked by significant advances, such as the concept of protective ventilation for acute respiratory distress syndrome. The benefit of alternative strategies, such as high-frequency oscillatory ventilation, the use of surfactant and immunomodulators continue to be the target of study.[13]

B. Nurses Knowledge on Acute respiratory distress Syndrome:

Burns J P et al conducted a cross sectional study to determine the attitudes and practices of pediatric critical care attending physicians and pediatric critical care nurses on end-of-life care. The survey was completed by 110/130 (85%) physicians and 92/130 (71%) nurses. The study concluded that nearly two-thirds of pediatric critical care physicians and nurses express views on end-of-life care in strong agreement with consensus positions on these issues adopted by national professional organizations. Clinicians with fewer years of pediatric critical care practice are less likely to agree with this consensus. Compared with physicians, nurses are significantly less likely to agree that families are well informed and ethical issues are well discussed when assessing actual practice in their intensive care unit. More collaborative education and regular case review on bioethical issues are needed as part of standard practice in the intensive care unit.[14]

M C Cormick J et al conducted a study discussed about the revival of the use of the prone position as a treatment for acute respiratory distress syndrome (ARDS) has been well documented in the medical literature, but there is little information regarding the difficulties of nursing patients in this position. The purpose of this study was to increase the body of knowledge by exploring the experiences of nurses who had cared for a patient in the prone position. The study evidenced that main difficulties experienced related to the maneuver, including the timing of the move, the number of personnel and the co-ordination required. Problems experienced in providing nursing care related to pressure areas, suctioning, accidental injuries and management of emergencies. Deficits in knowledge of ARDS and skills in handling communication with relatives were also identified. As a result of this exploration, guidelines have been developed, focusing mainly on the manoeuvre, organizational and nursing issues, to provide guidance in caring for a patient when being nursed in the prone position.[15]

Pelosi P et al conducted a study reviewed to discuss nurses knowledge on the physiological and clinical effects of prone positioning in patients with ARDS. The main physiological aims of prone positioning are: 1) to improve oxygenation; 2) to improve respiratory mechanics; 3) to homogenize the pleural pressure gradient, the alveolar inflation and the ventilation distribution; 4) to increase lung volume and reduce the amount of atelectatic regions; 5) to facilitate the drainage of secretions; and 6) to reduce ventilator-associated lung injury. The study revealed that the nurses require guidance and practice towards these aspects.[16]

Dennison CR et al conducted a study to evaluate perceived attitudes, knowledge, and behaviors regarding the use of low tidal volume ventilation in acute respiratory distress syndrome among physicians, nurses, and respiratory therapists in intensive care units. The study revealed that barriers related to clinician attitudes, behaviors, and intensive care unit organization was significantly higher among nurses and respiratory therapists vs. physicians. Knowledge-related barriers also were significantly higher among nurses vs. physicians and respiratory therapists. Important organizational and clinician barriers, including knowledge deficits, regarding low tidal volume ventilation were reported, particularly among nurses and resident physicians. Addressing these barriers may be important for increasing implementation of low tidal volume ventilation.[17]

OBJECTIVE:

1. To assess the knowledge level of Staff Nurses regarding Newborn’s respiratory Distress syndrome in terms of pre test score.

2. To develop a Self Instructional Module regarding Newborn’s respiratory distress syndrome.

3. To assess the Effectiveness of Self Instructional Module by comparing pre and post test knowledge difference.

4. To determine the association between the post test knowledge score with selected demographic variables

POPOULATION, SAMPLE AND SETTING:

The convenience sample comprises of staff nurses who are qualified in Diploma and Degree Nursing working in Hospital, Thrissur N = 60 were involved in the study. Non probability method of purposive sampling technique was used. The study was conducted at Community and Maternity hospital of Thrissur, Kerala.

ELIGIBILITY CRITERIA:

· Staff nurses who are qualified in degree and diploma nursing

· Staff nurse with adequate knowledge about new-born’s respiratory distress syndrome

INCLUSIVE CRITERIA:

· Staff nurses who are willing to participate in the study

· Staff nurses who are present during the period of data collection

· Staff nurses who are qualified in diploma and degree nursing

· Staff nurses who speak and understand Tamil or English

EXCLUSIVE CRITERIA:

· Staff nurses who are not willing to participate in the study

· Staff nurses who are not available during the study

PROTECTION OF HUMAN SUBJECTS:

This study proposal was submitted to the Institutional Ethical Committee and clearance was received. Participation will be strictly voluntary with implied consent assumed with return of the completed questionnaires. No names will be used for data collection. There are no risks identified for being included in this study.

RESEARCH DESIGN:

A quasi-experimental research design with evaluative research approach was used. The researchers evaluated the New-Borns Respiratory Distress Syndrome in Thrissur, Kerala.

TOOLS OF DATA COLLECTION:

Self-administered questionnaire the researchers constructed a questionnaire sheet after reviewing the related literature. It was divided in 2 parts.

First part:

Included assessment of personal data

(Age, Sex, Educational qualification, experience)

Second part:

Knowledge items on Newborn’s respiratory distress syndrome

VALIDITY AND RELIABILITY:

These tools were reviewed by jury of 7 expertise’s in the field of child health to test its contents and face validity. Prior to data collection, Pilot study was conducted for (N = 10). It was conducted to evaluate the efficiency and content validity of the tool, to find the possible obstacles and problems that might be faced during data collection. Nurses included in the pilot study were excluded from the sample, to avoid contamination of research sample. A data collection for this study was carried out in the period from the beginning of the second semester in the academic year 2016/2017. The researchers first explained the aim of the study to the participants and reassured that information collected would be treated confidential and that would be used only for the purpose of the research.

PROCEDURE:

Two steps were involved in the development of this study

Step 1-Approval of Human Research Review Committee

Step 2-Implementation of the study in Community and Maternity Hospital

PLAN FOR DATA ANALYSIS:

The collected data was analyzed by the descriptive and inferential data analysis:

· Frequency and percent will be used to describe the demographic characters of staff nurses.

· Descriptive measures such as mean, standard deviation will be used assess the pre and post knowledge on Newborn’s respiratory distress syndrome.

· Paired t-test will be worked out to compare the pre and post knowledge on Newborn’s respiratory distress syndrome

· Chi-square analysis will be carried out to bring out the association between post test knowledge on Newborn’s respiratory syndrome of staff nurses and their demographic characters.

CONCLUSION:

This study aims to assess the knowledge level of Staff Nurses regarding Newborn’s respiratory Distress syndrome and to develop a self-instructional module regarding Newborn’s respiratory Distress syndrome. A quasi-experimental research design with evaluative research approach was utilized in this study.

REFERENCES:

1. Dorothy R. Marlow Barhara. A Redding, "Text book of paediaric nursing" 6th edition, W.B. Saunders company' Publications 1988

2. Joyce M. Black and Hawks. “Medical surgical nursing” Volume 2, published by Elsevier, New Delhi.2005.

3. Health A to Z. Respiratory Distress Syndrome. Accessed on April 25, 2008

4. Greene A. Medline Plus Medical Encyclopedia. Neonatal Respiratory Distress Syndrome. September 5, 2007. Accessed on April 7, 2008.

5. Centers for Disease Control and Prevention. National Center for Health Statistics. Vital Statistics. Accessed on January 7, 2008.

6. Lewis, Heitkemper, Derksen. Medical Surgical Nursing, Mosby publication. 2007

7. Beaufils F, Mercier JC, Farnoux C, Saizou C, Thébaud B. Acute respiratory distress syndrome in children: Curr Opin Pediatr. 1997 Jun; 9(3):207-12.

8. Timmons OD et.al, Mortality rate and Prognostic variables in children with Acute Respiratory distress syndrome, Journals of pediatrics, 2005:896-899.

9. Marylyn J. Hockenberry. Essentials of pediatric nursing 7th edition, Mosby Publication. 2005.

10. Cutler LR. Acute respiratory distress syndrome: an overview. Intensive Crit Care Nurs. 1996 Dec; 12(6):316-26.

11. Yu WL.et al, Multicenter study of mortality and risk factors in children with acute Respiratory distress syndrome in china, Journals of Zhonghua Yi Xue Za Zhi 2007: Dec; 87(46):3295-3297.

12. Paret G. et al, Acute respiratory distress syndrome in children, Journals of Israel Medical association, 1999 Nov; 1(3):149-153.

13. Rotta AT, Kunrath CL, Wiryawan B.Management of the acute respiratory distress syndrome. J Pediatr (Rio J). 2003 Nov; 79 Suppl 2:S149-60. J Pediatr (Rio J) 2003 Nov; 79 Suppl 2:S149-60.

14. Burns JP, Mitchell C, Griffith JL, Truog RD. End-of-life care in the pediatric intensive care unit: attitudes and practices of pediatric critical care physicians and nurses. Crit Care Med. 2001 Mar; 29(3):695-6.

15. McCormick J, Blackwood B. Nursing the ARDS patient in the prone position: the experience of qualified ICU nurses. Intensive Crit Care Nurs. 2001 ec; 17(6):331-40

16. Pelosi P, Brazzi L, Gattinoni L. Prone position in acute respiratory distress syndrome. Eur Respir J. 2002 Oct; 20(4):1017-28.

17. Dennison CR, Mendez-Tellez PA, Wang W, Pronovost PJ, Needham DM. Barriers to low tidal volume ventilation in acute respiratory distress syndrome: survey development, validation, and results. Crit Care Med. 2007 Dec; 35(12):2747-54.

Received on 14.05.2017 Modified on 20.07.2017

Int. J. Nur. Edu. and Research. 2017; 5(4): 431-435.

DOI: 10.5958/2454-2660.2017.00092.8