Study to Assess the Effectiveness of Structured Teaching programme on Knowledge regarding four score (full outline of unresponsiveness) coma scale among Staff Nurses working in Intensive care units in selected Hospitals

 

Mr. Mahesh Bamani*

Assistant Professor, Dr. Deepak Patil Nursing Institute, Borpadle, Kolhapur.

 

ABSTRACT:

A study was conducted to assess the effectiveness of structured teaching programmer on knowledge regarding four score (full outline of unresponsiveness) coma scale among staff nurses working in intensive care units in selected hospitals. The study was conducted at selected at selected hospitals Miraj, among staff nurses working in ICUs. Who were selected by using purposive sampling technique? The study results of assessment of knowledge categorized in three parameters i.e. good knowledge, average knowledge and poor knowledge. Majority 47(94%) of samples had average knowledge score, while 3(6%) of them had poor knowledge score and none 0 (0%) of them had good knowledge score regarding FOUR score coma scale.

 

 

INTRODUCTION:

Unconscious a condition of being unaware of one’s surroundings, as in sleep, or of being unresponsive to stimulation as a result of hypoxia, resulting from respiratory insufficiency or shock; from metabolic or chemical brain depressants, such as drugs, poisons, ketones, or electrolyte, imbalance; or from a form of pathologic condition, such as trauma, seizures, cerebral vascular accident or brain tumor or infection.¹

 

Following severe brain damage and coma, some patients may awaken (i.e., open the eyes) but remain unresponsive (i.e., only showing reflex movements). This clinical syndrome is called vegetative/unresponsive state.

 

Neurological assessment of comatose patients and their outcome prediction is complex due to the difficulty of capturing distinct details of the clinical examination.²

 

TITLE OF THE STUDY:

“Study to assess the effectiveness of structured teaching programme on knowledge regarding FOUR score (full outline of unresponsiveness) coma scale among staff nurses working in intensive care units in selected hospitals.”

 

OBJECTIVES:

1.     To assess the existing level of knowledge regarding FOUR score coma scale among staff nurses working ICU’S of selected hospitals.

2.     To assess the effectiveness of structured teaching programme on knowledge regarding FOUR score coma scale among staff nurses working ICU’S of selected hospitals.

3.     To find the association between pretest knowledge regarding FOUR score coma scale with selected socio demographic variables among staff nurses working ICU’S of selected hospitals.

 

NEED FOR THE STUDY:

Government of India Ministry of Road Transport and highways (Transport Research Wing) had published recent information regarding number of accidents and number of traumatic injuries and deaths (2016). In India 2016: Accidents- 4,80,652, Deaths- 1,50,785, Person Injured- 4,94,624. In every day: 1,317 Accidents take place and 413 Persons killed on Indian Roads.In hour: 55 Accidents take place and 17 Persons killed on Indian Roads.³

 

The GCS initially intended to assess the level of consciousness after head injury in neurosurgical intensive care units. Over the years, considerable limitations have been identified for this scale: the inconsistent inter-observer reliability, the impossibility to test the verbal component in intubated patients, the exclusion of the brainstem reflexes, the incapacity to detect subtle changes in neurological examination, and the lack of correlation between outcome and GCS scores. Wijdicks et al. recently presented a new coma scale named the Full Outline of Unresponsiveness as an alternative to GCS at the mayo clinic in Rochester, in the year 2005. The literature review shows that FOUR score coma scale is most reliable than GCS. The investigator felt to explore the knowledge of nurses and improve knowledge about new FOUR score coma scale as there were no studies conducted till now.⁴

 

HYPOTHESIS:

H₀:   There will be no significant difference between pre and post-test knowledge score regarding FOUR score coma scale among staff nurses working in ICU’s of selected hospitals

H₁:   There will be significant difference between pre and post-test knowledge score regarding FOUR score among ICU staff nurses in selected hospitals.

H₂:   There will be significant association between pretest knowledge scores with selected demographic variables among ICU staff nurses in selected hospitals

 

METHEDOLOGY:

Evaluative approach was adopted to assess the knowledge and determine the effectiveness of structured teaching program on knowledge regarding FOUR score coma scale among staff nurses working in ICUs. Ethical clearance was obtained from institution. Formal administrative permission was obtained from Aditya super specialty hospital sangli and Wanless hospital miraj. A total 50 ICU staff nurses were selected through purposive sampling technique. The data was gathered in pre test through questionnaires, after that STP was administered and again post test was conducted by same questionnaires and scores are recorded. The collected data was analyzed by using descriptive and inferential statistics.

 

RESULTS:

Section I: Demographic data of ICU staff nurses:

According to gender majority of subjects 38(76%) were females, minimum 12(24%) were males, According to professional qualification majority of the subjects 22(44%) were RGNM, minimum 11(22%) were B.B.Sc.(N) and remaining 17(34%) were P.B. BSc. (N), According to years of experience majority of the subjects 19(38%) had 1-5 years of experience, minimum 9(18%) subjects had 6-10 years and >10 years of experience respectively and remaining 13 (26) subjects had < 1 year of experience.

 

Table 1: Distribution of subjects with regards to demographic variables in terms of frequency and percentage         n= 50

Demographic Variable	F	%
Gender
Male	12	24
Female	38	76
Professional Qualification
RGNM	22	44
Post Basic B.Sc. Nursing	17	34
Basic B.Sc. Nursing	11	22
Years of Experience
Below 1 year	13	26
1-5 years	19	38
6-10 years	9	18
>10 years	9	18

 

Section II: Assessment of existing level of knowledge

Table No 2: Existing level of knowledge of staff nurses on FOUR score coma scale   n=50

Level of Knowledge	Pretest
	F	%
Poor (Score 0-10)	3	6%
Average (Score 11-20)	47	94%
Good (Score >20)	0	0%

 

Table No 2 revealed that in pretest, majority of subjects 47 (94%) had average knowledge score, 3 (6%) of them had poor knowledge score and none of them 0 (0%) had good knowledge score regarding FOUR score coma scale.

 

Section III: Paired t-test for evaluating effectiveness of structured teaching on section wise knowledge of staff nurses.

Table No 3: Paired t-test                                                                                                                                                                n=50

 

 

SECTION IV: Association between pretest knowledge score and selected demographic variables.

Table no. 4: Chi-square test for association between pretest knowledge score and selected demographic variables

Demographic Variables		Pretest Knowledge			Chi-square value X2	df	p	Significance
		Poor	Average	Good
Gender	Male	0	12	0		12	0.14	Not significant
	Female	7	31	0	17.1
Professional qualification	RGNM	5	17	0		36	0.35	Not significant
	Post Basic B.Sc. Nursing	1	16	0	25.5
	Basic B.Sc. Nursing	1	10	0
Years of experience	Below 1 year	3	10	0		24	0.37	Not significant
	1-5 years	0	19	0	38.6
	6-10 years	1	8	0
	>10 years	3	6	0

 

 

Table no. 3. Reveals that t-Values for this comparison were 16.3, 11.7 and 18.9 with 49 df and p value for this comparison were 0.000 respectively, which was less than 0.05. Structured teaching programme proved significantly effective in improving the knowledge of staff nurses regarding FOUR score coma scale.

 

Table no. 4. Reveals that x² value corresponding to all the demographic variables were larger (>0.05), there is no evidence against null hypothesis. None of the demographic variables were found to have significant association with pretest knowledge of staff nurses regarding FOUR score coma scale.

 

RECOMMENDATIONS:

1.     A study can be conducted to assess knowledge and practice regarding FOUR score coma scale among staff nurses working in ICU.

2.     Comparative study can be conducted between ICU Nurses and ward nurses regarding knowledge of FOUR score coma scale.

3.     A similar study can be conducted to assess the knowledge regarding FOURscore coma scale on larger sample.

 

CONCLUSION:

The study concludes that research hypothesis (H₁) was accepted as structured teaching programme is proved to be significantly effective in improving the knowledge of staff nurses regarding FOUR score coma scale.

 

ACKNOWLEDGEMENT:

I extend my sincere thanks to Mrs. H W Kadam, Mr. Bhalchandra Awale, Mrs. Sangeeta Satwekar, Mrs. Jessica Waghmare, Mrs. Suman Pawar, U Prakar, Jessy Jacob, Dr. Sharad Sawant, Dr. Swati Deepak Patil and participants of study.

 

REFERENCES:

1.      Anderson KN, Anderson L, Glanze WD. Mosby’s Medical Nursing and Allied Health Dictionary. 4^th ed., Missouri, Mosby Publications.1994:1612.

2.      Laureys S, Celesia GG, Cohadon F, et al. Unresponsive wakefulness syndrome: a new name for the vegetative state or phallic syndrome. BMC Med. 2010; 8:68

3.      Press Information Bureau, Government of India Ministry of Road Transport and Highways (06-September-2017 18:34 IST)

4.      Bruno Marie, Ldoux Didier, Lambermont Bernard, et al. Comparison of the Full Outline of Unresponsiveness and Glasgow Liege Scale/ Glasgow coma scale in an intensive care unit population. Nuerocritic care. 2011; 15:447-453

 

 

 

Received on 12.10.2020          Modified on 13.11.2020

Accepted on 11.12.2020        © AandV Publications all right reserved