INTRODUCTION:

Moderate and late preterm infants (32to 36weeks gestational age) account for the largest group of infants hospitalized in neonatal intensive care unit (NICU)³. Respiratory distress syndrome (RDS) is a major cause of neonatal respiratory morbidity and mortality.

For many years, neonates with RDS have been managed with a combination of tracheal intubation and surfactant replacement therapy (SRT) administered with mechanical ventilation. Surfactant replacement therapy in preterm infants has been proven effective in reducing pulmonary morbidity and mortality, and has been a major treatment in intubated preterm infants with respiratory distress after birth⁴.

Non invasive respiratory support is currently the accepted strategy of neonatal care and its basic philosophy is to maximize the alveolar area available for gas exchange by minimizing atelectrauma. Inherent to this strategy are the early initiation of continuous positive airway pressure (CPAP) and appropriate and optimum use of surfactant to prevent the need for intubation and prolonged ventilation thus avoiding the additional insults of barotraumas and volutrauma⁵.

NEED FOR THE STUDY:

Moderate and late preterm infants account for the largest group of infants hospitalized in neonatal intensive care unit. Respiratory distress syndrome and pneumothorax causes significant morbidity in those infants³. Upto 14% and 2.5% of all late preterm infants hospitalized in Canadian NICU presented with RDS and pneumothorax, respectively. It is well established that invasive mechanical ventilation (MV), even for a short period, may cause or exacerbate pre existing lung injuries. A growing literature supports that avoidance of mechanical ventilation in every preterm infants improves respiratory outcomes. Selective administration of surfactant after an initial period of nasal continuous positive airway pressure is now recognized as an appropriate option for RDS management.³

Minimally invasive surfactant therapy has been used as an alternative and appears to potentially reduce the incidence of mechanical ventilation exposure. End expiratory lung volume is improved after MIST and is associated with oxygenation improvement³.

François Olivier et al. conducted a multi centre randomized control trial to assess the efficacy of minimally invasive surfactant therapy in moderate and late preterm infants in three Canadian centres. Patients were randomized to standard management or to the intervention if they required nasal continuous positive airway pressure of 6 cm H2 O and 35% FiO2 in the first 24 hours of life. Patients from the intervention group received MIST immediately after inclusion. The primary outcome was either need for MV or development of a pneumothorax requiring a chest tube. To ensure that clinicians were not biased toward delaying intubation in the intervention group, clinical failure criteria were also used as a primary outcome. The primary outcome was analyzed using bivariate and multivariate logistic regressions. This study reveals that Among 45 randomized patients, 24 were assigned to MIST and 21 to standard management. Eight infants (33%) from the intervention group met the primary outcome criteria versus 19 (90%) in the control group (absolute risk reduction 0.57, 95% confidence interval 0.54 to 0.60). One patient in each group reached the primary outcome because of pneumothorax occurrence. The other patients were exposed to MV. None of the patients reached the clinical failure criteria. MIST for respiratory distress syndrome management in moderate and late preterm infants was associated with a significant reduction of MV exposure and pneumothorax occurrence³.

Joyce Joseph conducted a study to assess the Effectiveness of Structured Teaching Programme on Knowledge of Student Nurses Regarding Surfactant Therapy in Selected Nursing Colleges in Mangalore. A quantitative pre experimental study approach with one group pre-test post-test design was used. Under simple random sampling technique lottery method was used to draw 60 nursing students from the population. The tool used for this study was structured knowledge questionnaire. The pre-test findings show that student nurses have poor knowledge on surfactant therapy. Whereas following the structured teaching programme, post-test shows an increase in knowledge scores. Data analysis will be done by using both descriptive and inferential statistics. The findings of the study proved that the nursing students lacked knowledge regarding surfactant therapy. In the post-test, most (98.3%) of the nursing students had adequate knowledge and only one sample (1.7%) had moderately adequate knowledge on surfactant therapy, whereas in pre-test, majority (61.7%) of students had moderately adequate knowledge and 38.3% had inadequate knowledge on surfactant therapy. The findings of the study thus proved that the STP is effective strategy in improving the knowledge of the nursing students. The findings of the study proved that the structured teaching programme is an effective measure to enhance the knowledge of nursing students regarding surfactant therapy⁶.

The above study have proved that students do not have enough knowledge about minimally invasive surfactant therapy and they expect adequate information regarding minimally invasive surfactant therapy. Therefore it’s a necessity to teach the students about minimally invasive surfactant therapy.

PROBLEM STATEMENT:

A study to assess the effectiveness of Video Assisted Teaching program on knowledge regarding minimally invasive surfactant therapy among nursing students in selected nursing colleges, Satna.

OBJECTIVES:

· To assess the existing knowledge regarding minimally invasive surfactant therapy among nursing students.

· To determine the effectiveness of video assisted teaching on knowledge regarding minimally invasive surfactant therapy among nursing students by comparing pre test and post test knowledge score.

· To find out the association between the pre test knowledge score of student nurses with selected demographic variables.

HYPOTHESIS:

H₁: The mean post test knowledge score on minimally invasive surfactant therapy among nursing students, who have learned through video assisted teaching program, will be significantly higher than their mean pretest score at 0.05 level of significance.

H₂: There is a significant association between pre test knowledge score of student nurses regarding minimally invasive surfactant therapy with their selected demographic variables

METHODOLOGY:

Research approach:

Quantitative evaluative approach.

Research design:

Pre experimental one group pre test post test design.

Setting:

Data collected from selected nursing colleges, Satna.

Sample and sampling technique:

40 student nurses were selected by using simple random sampling method.

Variables:

Independent variable:

Video assisted teaching program regarding minimally invasive surfactant therapy.

Dependent variable:

Knowledge regarding minimally invasive surfactant therapy.

Description of Tool:

Part I: Demographic data.

Part II: Structured knowledge questionnaire regarding minimally invasive therapy.

Validity of tool

6 experts, comprising of 2 nurse educators from the department of Obstetrics and Gynecology, 2 from the department of pediatrics, 1 professor from department of neonatology and 1 Statistician, established content validity of the tool.

Reliability of tool:

The data of the structured knowledge questionnaire was analysed by split half method and the reliability coefficient was calculated using Spearman Brown Prophecy formula. The reliability co- efficient of the tool was found to be 0.93. Hence the tool was found to be reliable.

Data collection:

A pretest was conducted by using structured knowledge questionnaire and on the same day the video assisted teaching program regarding minimally invasive surfactant therapy was administered to them. After 7 days, post test was conducted with the same questionnaire for the same group of student Nurses to assess the effectiveness of video assisted teaching program.

Analysis and interpretation of data:

The collected data were analyzed in terms of both descriptive and inferential statistics.

RESULTS:

Table.1: Section 1: Analysis of sample characteristics

Sl. No	Demographic characteristics	Frequency	%
1.	Age(yrs)
	19- 21	9	22.5%
	22-24	29	72.5%
	Above 24	2	5%
2.	Gender
	Female	36	90%
	Male	4	10%
3.	Clinical area exposure
	Pediatric ward	10	25%
	NICU	10	25%
	Both pediatric ward and NICU	20	50%
4.	Type of Hospital
	Government hospital	20	50%
	Private hospital	0	0%
	Both government and private	20	50%
5.	Source of information
	Medical and nursing personnel	5	12.5%
	Print media	4	10%
	Social media	1	2.5%
	No information	30	75%
6.	Workshops or seminars attended regarding minimally invasive surfactant therapy
	Yes	5	12.5%
	No	35	87.5%

Table 2: Section II: Evaluate the effectiveness of video assisted teaching program by comparing pre and post test knowledge score

Parameter	Mean	S. D	SEM	Range	Mean%	t -value	Result
Pre-test	8.2	2.6	0.41	6-15	25.6%	31.8	Sig P<0.05
Post-test	25.2	2.2	0.35	17-30	78.8%
Improvement	17

The mean score is increased in the post test. The mean score in the post test is 25.2 and the mean score in the pre test is 8.2. The variation is decreased in post test when compared to pre test.SD in the post test is 2.2 and in the pre test is 2.6. The mean is improved by 17. The calculated value of t is 31.8 which is highly significant. The results undoubtedly confirm that the video assisted teaching program was effective in improving the knowledge on minimally invasive surfactant therapy among the student nurses.

Table 3: Section III: Association between the demographic variables and knowledge of student nurses regarding minimally invasive surfactant therapy in Pre-test.

S. No	Characteristics	Chi-square value	Df	Result	P-value
1	Age	6	2	Sig	P<0.05
2	Gender	0.01	1	NS	P>0.05
3	Clinical area exposure	6.89	2	Sig	P<0.05
4	Type of hospital	2.8	2	NS	P>0.05
5	Source of information	18.7	3	Sig	P<0.05
6	In-service education/seminars attended	6.02	1	Sig	P<0.05

NS – Not significant at 5% level (i.e., P > 0.05)

Sig – Significant at 5% level (i.e., P < 0.05)

From the table, age, clinical area, source of information and seminars attended are significant. The remaining characters are not significant.

DISCUSSION:

The main objective of the study was to assess the effectiveness of video assisted teaching on minimally invasive surfactant therapy among student nurses by comparing pre test and post test knowledge score:

The pre-test findings of the study revealed that the overall score in the pre-test was mean 8.2, standard deviation 2.6 and mean score percentage was 25.6%. This shows that the knowledge of student nurses regarding minimally invasive surfactant therapy was inadequate.

These findings are consistent with the findings of Joyce Joseph. Joyce Joseph conducted a study to assess the Effectiveness of Structured Teaching Programme on Knowledge of Student Nurses Regarding Surfactant Therapy in Selected Nursing Colleges in Mangalore. A quantitative pre experimental study approach with one group pre-test post-test design was used. Under simple random sampling technique lottery method was used to draw 60 nursing students from the population. The tool used for this study was structured knowledge questionnaire. The pre-test findings show that student nurses have poor knowledge on surfactant therapy. Whereas following the structured teaching programme, post-test shows an increase in knowledge scores. Data analysis will be done by using both descriptive and inferential statistics. The findings of the study proved that the nursing students lacked knowledge regarding surfactant therapy. In the post-test, most (98.3%) of the nursing students had adequate knowledge and only one sample (1.7%) had moderately adequate knowledge on surfactant therapy, whereas in pre-test, majority (61.7%) of students had moderately adequate knowledge and 38.3% had inadequate knowledge on surfactant therapy. The findings of the study thus proved that the STP is effective strategy in improving the knowledge of the nursing students. The findings of the study proved that the structured teaching programme is an effective measure to enhance the knowledge of nursing students regarding surfactant therapy⁶.

These findings provokes for imparting adequate knowledge and the need for teaching programs to improve knowledge of student nurses on minimally invasive surfactant therapy.

CONCLUSION:

Minimally invasive surfactant therapy is a method of surfactant administration without intubation in spontaneously breathing preterm infants with RDS⁴. A preterm baby needs more care compared to the term baby; surfactant therapy takes essential part in the care of RDS babies⁶.

In this study, pre test findings shows that the student nurses had inadequate knowledge regarding minimally invasive surfactant therapy. The mean score in the post test is 25.2, SD in the post test is 2.2 and the mean is improved by 17. The calculated value of t is 31.8 which is highly significant. The results undoubtedly confirm that the video assisted teaching program was effective in improving the knowledge on minimally invasive surfactant therapy among the student nurses. Knowledge of surfactant therapy during student period will help them in future when working in neonatal ICU. Therefore, it is very essential to give adequate information to the student nurses about the surfactant therapy and care of the child with Respiratory Distress Syndrome.

REFERENCES:

1. Xing-An Wang, Lih-Ju Chen, Shan-Ming Chen, Pen-Hua Su, Jia-Yuh Chen,.Minimally invasive surfactant therapy versus intubation for surfactant administration in very low birth weight infants with respiratory distress syndrome, Pediatrics and Neonatology,Volume 61, Issue 2,2020, Pages 210-215, ISSN 1875-9572, https://doi.org/10.1016/j.pedneo.2019.11.002. https://www.sciencedirect.com/science/article/pii/S187595721930542X

2. F.J. Canals Candela, C. Vizcaíno Díaz, M.J. Ferrández Berenguer, M.I. Serrano Robles, C. Vázquez Gomis, J.L. Quiles Durá. Surfactant replacement therapy with a minimally invasive technique: Experience in a tertiary hospital. Annals of Pediatrics, Vol. 84. Issue 2.

3. François Olivier, MD MSc FRCPC, Sophie Nadeau, MD FRCPC, Sylvie Bélanger, MD FRCPC, Anne-Sophie Julien, MSc, Edith Massé, MD FRCPC, Nabeel Ali, MD FRCPC, Georges Caouette, MD MSc FRCPC, Bruno Piedboeuf, MD FRCPC, Efficacy of minimally invasive surfactant therapy in moderate and late preterm infants: A multicentre randomized control trial, Paediatrics and Child Health, Volume 22, Issue 3, 1 June 2017, Pages 120-124, https://doi.org/10.1093/pch/pxx033. https://academic.oup.com/pch/article/22/3/120/3769253

4. Shim GH. Update of minimally invasive surfactant therapy. Korean J Pediatr. 2017 Sep; 60(9): 273-281. doi: 10.3345/kjp.2017.60.9.273. Epub 2017 Sep 21. PMID: 29042870; PMCID: PMC5638833. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5638833/#:~:text=Overcoming %20this%20problem%2C%20minimally%20invasive,mask%2C%20and%20a%20thin%20catheter .

5. Gengaimuthu K. Minimally Invasive Surfactant Therapy: An Analytical Report of Our Prospective Dubai Cohort. Cureus. 2020 Jun 5;12(6):e8455. doi: 10.7759/cureus.8455. PMID: 32642365; PMCID: PMC7336671. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7336671

6. Joyce Joseph. Knowledge regarding surfactant therapy among student nurses. American Journal of Advances in Nursing Research. 2017; 4(2): 54-56. file:///E:/Journal%20articles/surfactant/1497352711_54-56.pdf

Received on 29.09.2022 Modified on 08.10.2022

Int. J. Nur. Edu. and Research. 2022; 10(4):330-334.

DOI: 10.52711/2454-2660.2022.00076