Effect of Planned Teaching on knowledge and Practices among staff nurses working in a selected hospital regarding prevention of selected Cardiopulmonary complications in Post-operative CABG patients

 

Ms. Nimmi Louis

Nursing Tutor, Holy Family Institute of Nursing Education, Kurla, Mumbai

*Corresponding Author Email: nimmibobby@gmail.com

 

ABSTRACT:

Coronary Artery Bypass Graft (CABG) surgeryis a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease. Arteries or veins from elsewhere in the patient’s body are grafted to the coronary arteries to bypass atherosclerotic narrowing’s and improve the blood supply to the coronary circulation supplying the myocardium. A study conducted to assess the incidence of post-operative respiratory complications after CABG revealed that thoracic surgery is responsible for majority of pulmonary complications. The diaphragmatic dysfunction, post-operative pain and alveolar collapse resulted in a 50% to 60% decrease in vital capacity and a 30% decrease in residual functional capacity. The use of opioids and other anesthetic agents that are used during surgery make client more prone for development of pulmonary and cardiac complication. The National Surgical Quality Improvement Program (NSQIP) compared hospitalization costs and length of stay among patients with various postoperative complications. Among infectious, cardiovascular, venous thromboembolic, and pulmonary complications, pulmonary complications were by far the most costly and, along with venous thromboembolic complications, required the longest mean hospital stay. For these reasons, identifying patients at risk for pulmonary complications and developing a strategy to reduce the risk is clearly worthwhile. Methodology-Research approach adopted for the study was Descriptive evaluative approach with one group pretest- posttest design. Structured questionnaire and observation checklist were used to collect the data. The reliability of the questionnaire was calculated by test retest method. The tool was administered at two different occasions and the score was compared and calculated using formula of correlation co-efficient. The reliability coefficient for knowledge and practice score was 0.847. Structured questionnaire was used to assess the knowledge and observation checklist was used to assess the practice of staff nurses regarding prevention of selected complications in post-operative CABG patients. The data was analyzed in terms of objectives and hypothesisusing descriptive and inferential statistics. Result- In pretest 22(55%) sample had average knowledge followed by 18(45%) were in good category. The post test score reveals that29(72.5%) sample had excellent knowledge followed by 9(22.5%) samples with good knowledge, very few samples 2(5%) were in average category. In pretest most 27(67.5%) sample had good practices level followed by 12(30%) were in average category and minimum1(2.5%) sample had excellent practices. The post test score reveals that majority 37(92.5%) sample had excellent practice followed by 3(7.5%) samples with good practice. The calculated ‘t’ value for knowledge and practice was found to be 13.43 and 20.54. This suggest that planned teaching programme is effective in improving knowledge and practice regarding prevention of selected cardiopulmonary complications in post-operative CABG patients among staff nurses working in a selected hospital. Conclusion-Staff nurses working in cardiac care units had inadequate knowledge regarding prevention of selected cardiopulmonary complications in post-operative CABG patients, planned teaching programme was found to be effective in improving the knowledge and practices of staff nurses regarding prevention of selected cardiopulmonary complications in post-operative CABG patients thus improving patient care.

 

KEYWORDS: Coronary Artery Bypass Graft, Planned teaching programme, Effectiveness, Knowledge, Practice, Staff nurses

 

 


INTRODUCTION:

“Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work and the only way to do great work is to love what you do. Steve Jobs. The human heart holds a special place among bodily organs, a romanticized symbol of love, courage and compassion. But its functions in the body are as practical as they are necessary. Located in the center of the chest (but tipped to the left), this pump sends blood circulating throughout our body, ensuring that oxygen and nutrients are brought to organs and tissues and that harmful wastes are carried away. The cardiovascular system begins its activity when the fetus is barely 4 weeks old and is the last system to cease activity at the end of life. This body system is so vital that it helps to define the presence of life.

 

Cardiovascular disease (CVD) is the number one cause of death worldwide.  In India it has quadrupled in the last 40 years and WHO estimates that by 2020 close to 60 percent of cardiac patients worldwide will be Indian. It covers a wide array of disorders, including diseases of the cardiac muscle and of the vascular system supplying the heart, brain, and other vital organs. Among cardio vascular diseases Coronary artery disease is the most common type and accounts for the majority of deaths. The main treatment modalities are drug therapy, nutritional therapy, coronary surgical revascularization, percutaneous coronary interventions and coronary artery bypass graft surgery.

 

Coronary artery bypass graft surgery is a surgery to restore the flow of blood to the heart, when a blockage or partial blockage occurs in these arteries. Postoperative care of the coronary artery bypass graft surgery patient is challenging, because changes can occur rapidly. The preoperative condition of the patient as well as intra-operative events should be considered in postoperative care.

 

Most patients in the post-operative period are at high risk of development of post-operative complication such as leaks from operative site, infection, bleeding and respiratory failure.

 

The overall incidence of respiratory complication after CABG accounts for 50% as per world statistics. It is essential for the nurse to anticipate the possible complications so that appropriate interventions are initiated in a timely manner in order to ensure a positive outcome for the patient and also to decrease the mortality rate among cardiac patients.

 

OBJECTIVES:

1.       To assess the knowledge of staff nurses regarding prevention of selected cardiopulmonary complications in post-operative CABG patients in selected hospital.

2.       To assess the practices of staff nurses regarding prevention of selected cardiopulmonary complications in post-operative CABG patients in selected hospital.

3.       To determine the effect of planned teaching on knowledge of staff nurses regarding prevention of selected cardiopulmonary complications in post-operative CABG patients in selected hospital.

4.       To determine the effect of planned teaching on practices of staff nurses regarding prevention of selected cardiopulmonary complications in post-operative CABG patients in selected hospital.

5.       To find the association between knowledge and practice with selected demographic variables such as age, experience and educational qualification.

 

HYPOTHESIS:

H0       There will be no change in the knowledge score of staff nurses regarding prevention of selected cardiopulmonary complications in post-operative CABG patients after the planned teaching.

(H0)1   There will be no change in the practice score of staff nurses regarding prevention of selected cardiopulmonary complications in post-operative CABG patients after the planned teaching.

(H0)2 There will be no association between selected demographic variables and knowledge and practice scores of staff nurses after planned teaching.

 

MATERIAL AND METHODS:

In the view of the objectives of the present study, a descriptive evaluative research approach was considered to be the most suitable for the study. The independent variable is the planned teaching and the dependent variable is knowledge and practices among staff nurses regarding prevention of selected cardiopulmonary complications in post-operative CABG patients. Thus, the design adopted for the study was one group pre-test and post-test design. In order to carry out the study and to get adequate number of samples, the study was conducted in cardiac care units of selected hospital. The sample consisted of 40 staff nurses working in Cardiac Care Unit in selected hospital of Mumbai. The sampling technique used was non-probability convenient sampling. A structured questionnaire was prepared to assess the knowledge and observation checklist was prepared to assess the practice among staff nurses regarding prevention of selected cardiopulmonary complications in post-operative CABG patients. The tool was given to 10 experts from the field of medicine, surgery and nursing. The reliability of the questionnaire was calculated by test retest method. The reliability coefficient for knowledge and practice score was 0.847. The result showed that there was high degree of correlation and so the tool was found to be reliable. A pilot study was carried out after investigator obtained written permission from the concerned authorities. 4 samples were selected and their written informed consent for the participation in the study was taken.

 

RESULT:

SECTION I: Analysis of demographic variables:

1.     Majority of sample 27 (67.5 %) samples were in 21-25 years of age category.

2.     Data related to educational status shows that maximum samples 34 (85 %) were from the basic BSc nursing followed by 5 (12.5 %) samples studied up to the General nursing and midwifery   and very few 1(2.5 %) completed post basic BSc nursing. Nil samples were there in the category of masters in nursing.

3.     Maximum samples 27(67.5%) were having 1-3 years followed by 10(25%) had 3 months to one-year experience, on next level 3(7.5%) were having 3-5 years of experience. Nil sample were there in 5 years and above category.

4.     Maximum samples 40(100%) had not attended in-service education regarding prevention of complications in post op CABG patients.

 

SECTION II:

Comparison of mean of pre and post scores of overall knowledge

 

Table 1- Distribution of sample based on pre and post of overall knowledge level N=40

Sr. no

Overall Knowledge level

Pre-test

Post test

F

%

F

%

1

Poor (0 - 4)

0

0

0

0

2

Average (5 - 8)

22

55.0

2

5.0

3

Good (9 - 12)

18

45.0

9

22.5

4

Excellent (13- 15)

0

0

29

72.5

 

Total

40

100

40

100

 

SECTION III: Comparison of mean of pre and post scores of overall practices

 

Table 2- Distribution of sample based on pre and post of overall Practice level

Sr no.

Overall Practice level

Pre-test

Post test

F

%

F

%

1

Poor (0 - 5)

0

0

0

0

2

Average (6 - 10)

12

30

0

0

3

Good (11 - 15)

27

67.5

3

7.5

4

Excellent (16- 20)

1

2.5

37

92.5

 

Total

40

100

40

100

 


SECTION IV: Effectiveness of planned teaching programme by comparing pretest and posttest knowledge scores

 

Table 3- Mean, SD, Mean % of the knowledge scores in pretest and post test

Knowledge Comparison

Mean

S. D.

M.D.

SEMD

t value

Pvalue

Overall Knowledge

Pre-test

8.05

2.11

4.95

0.37

13.43

0.000

Post test

13.0

1.66

 

SECTION IV: Effectiveness of planned teaching programme by comparing pretest and posttest practice scores

 

Table 4- Mean, SD, Mean % of the practice scores in pretest and post test

Practice Comparison

Mean

S. D.

M.D.

SEMD

t value

P value

Overall Practice

Pre-test

11.68

2.09

6.45

0.31

20.54

0.000

Post test

18.13

1.45

 


SECTION V: Association of demographic variables with posttest knowledge and practice scores:

Based on the ‘F’ test for unpaired sample shows that the calculated ‘F’ value for Age, Education and Experience is less than the table ‘F’ value significant at 0.05 levels, this suggest that knowledge and practice is independent of the demographic variables hence there is no association between posttest knowledge and practice with selected demographic variables such as Age, Education and Experience.

 

CONCLUSION:

Knowledge and practices of staff nurses regarding prevention of selected complications in post-operative CABG patients was inadequate before the administration of planned teaching. The knowledge and practice level of staff nurses in the post-test was significantly higher than the pre-test score. The findings of the study proved that teaching through planned teaching source is really effective to increase and improve the knowledge and practice of the staff nurses. The study reveals that it is important to have regular in-service education programmes for nurses to improve their knowledge and practice skills while caring for the patients in order to impart quality care and prevent complications.

 

IMPLICATIONS:

The present study has its implication in nursing service, nursing administration, nursing education and nursing research.

 

Nursing service:

Nursing service includes preventive, promotive, curative and rehabilitative services. Having knowledge regarding prevention of selected complications in post-operative CABG patients among staff nurses is very essential as it helps to detect various complications before they occur and to diagnose various conditions.

 

Nursing administration:

The findings of the study can be used by the nurse administrators to improve the quality of nursing care. Various policies and protocols could be prepared by the nurse administrators regarding prevention of selected complications in post-operative CABG patients. In-service education programs can be planned for nurses, emphasizing the need for acquiring the skill of caring for patients after CABG surgeries.

 

Nursing education:

Nursing education is means through which nurses are prepared to practice in various settings. The results of the study can be used by nursing teachers as an informative illustration to nursing students. The planned teaching prepared could be used by the nurse educators in providing in-service education programmes to update the knowledge of nurses.

 

Nursing research:

The results of the study can be added to the references, the tool and the methodology can be used for further references, by nurses and students to become more aware about the new conditions, diseases and activities. Nursing research is an essential aspect of nursing as it uplifts the profession, develop new norms and enhance the body of nursing knowledge. It also improves the image and perception of nursing in society, which is urgently required for the future of nursing.

 

LIMITATIONS:

1.     Time span of the study was short.

2.     There were no male nurses in the sample group.

3.     There were no MSc nurses in the sample group.

 

RECOMMENDATIONS:

On the basis of the present study, the following recommendation for conducting further studies are made

1    The study can be replicated on larger sample so that the findings can be generalized.

2    A similar study can be conducted to compare the effectiveness of planned teaching with other teaching methods.

3    A similar study can be conducted in experimental approach, i.e. pre-test and post- test experimental and control group.

4    The study can include demonstration of procedures and see the effectiveness of it.

 

 

 

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Received on 28.03.2019         Modified on 21.05.2019

Accepted on 21.06.2019      ©A&V Publications All right reserved

Asian J. Nursing Education and Research. 2019; 9(3):349-353.  

DOI: 10.5958/2349-2996.2019.00075.2