A Study to Assess the Effectiveness of Self Instructional Module of Knowledge on Utilization of Emergency Crash Cart System in Hospital among 4th year B.Sc Nursing Students of Selected Nursing Colleges in Mysore

Mr. Paramesha, Mr. Vinay Kumar. G., Mr. Vishakanta Murthy. D.G.

Asst. Lecturer, JSS College Of Nursing Mysore;

*Corresponding Author Email: parameshnagesh@gmail.com

ABSTRACT:

Background: Emergency nurses frequently contact patients in the emergency department before the patient seen by a physician. In this situation, the nurse must be skilled at rapid, accurate physical examination, early recognition of life-threatening illness or injury, the use of advanced monitoring and treatment equipment, and in some cases, the ordering of testing and medication according to "advance treatment guidelines" or "standing orders" set out by the hospital's emergency physician staff.

Objectives:

1. To assess the pre-test knowledge scores of 4th year B.Sc Nursing students on utilization of emergency crash cart system in hospital.

2. To assess the effectiveness of self instructional module of knowledge on utilization of emergency crash cart system in hospital in terms of post test knowledge scores

3. To develop self instructional module on utilization of emergency Crash Cart System in Hospital.

Methods: Quasi experimental one group pre-test and post-test design with evaluative approach was used. Study was carried out in selected Nursing Colleges in Mysore, using simple random sampling. 100 4th year B.Sc Nursing students were selected as samples. Data was collected by a self - administered questionnaire which includes demographic data, and 30 items related to General information (10), Definition, purposes and contents (7), and types of emergency crash cart and its maintenance (20). Self-instructional module was administered after assessing the pre-test. A post test was conducted after 7 days with same tool.

Results: Findings reveal that the among 100 students majority 47(47%) of them were in the age group between 22-25 yrs. 52(52%) were females, and 37(37%) of them were got information from Class Teachers .Pre test revealed that 4th year B.Sc Nursing students were having low level of knowledge with a mean score of 18.35. After giving Self-instructional module post test score increased to 23.69, which shows the effectiveness of Self-instructional module. It has been found that variables like age, sex and source of information shows there will be significant association with Post- test knowledge level.

Interpretation and conclusion: As the mean post test score is significantly higher than that of the pre-test it is evident that the knowledge of 4th year B.Sc Nursing students was improved after the educational intervention. The tool developed can be used to identify individuals in need of educational intervention as well as to assess the effectiveness of emergency crash cart system. Implications of various aspects of nursing care addressed and recommendations for the future research are discussed.

KEYWORDS: Emergency Crash Cart System, Self-Instructional Module and 4th year B.Sc Nursing students.

INTRODUCTION:

Concept of Nurse QWL:

Emergency Nursing is a nursing specialty in which nurse’s care for patients in the emergency or critical phase of their illness or injury. In contrast to practically every other specialty of nursing, in which a patient arrives with a diagnosis applied by a physician and the nurse, must manage the patient's care according to that diagnosis, emergency nurses work with patients in whom a diagnosis has not yet been made and the cause of the problem is not known. Emergency nurses frequently contact patients in the emergency department before the patient sees a physician. In this situation, the nurse must be skilled at rapid, accurate physical examination, early recognition of life-threatening illness or injury, the use of advanced monitoring and treatment equipment, and in some cases, the ordering of testing and medication according to "advance treatment guidelines" or "standing orders" set out by the hospital's emergency physician staff. Emergency nurses most frequently are employed in hospital emergency departments, though they may also work in free-standing urgent care clinics¹.

Crash cart is a specially designed trolley, used for transporting and dispensing medicines and equipments at the emergency site for participating in life saving measures. Crash carts are located in areas of patient care in case of a life-threatening occurrence. Physicians, nurses, pharmacists, and respiratory therapists must become familiar with the contents of this cart. It contains necessary equipments to handle an emergency. A crash cart is enabling healthcare providers to manage medical emergencies easily and confidently².

The cart is characterized by being easily movable and readily accessible into all sides of the cart for quickly viewing and removing equipment and drugs during a crisis. The first cardiac crash cart was created at Bethany Medical Centre in Kansas City, Kansas. One of the doctor’s fathers fabricated the first crash cart. It contained an Ambu-bag, defibrillator paddles, a bed board and Endo-tracheal tubes. A crash cart or code cart (crash trolley in UK medical jargon) is a set of trays/drawers/shelves on wheels used in hospital emergency rooms for transportation and dispensing of emergency medication/equipment at site of medical/surgical emergency for life support protocols like Advanced Cardiac Life Support/Advance Life Support (ACLS/ALS), Paediatric Advanced life Support [PALS] to potentially save someone's life³.

NEED FOR THE STUDY:

A “Crash Cart” is a mobile, compact cart, equipped with various medical aid tools (used mainly for cardiac emergencies). The cart consists of items such as a defibrillator, medications, a suction pump, and other life-saving equipment. Each floor of the Detroit VA has a “Crash Cart” that is used only in the event of a Code Blue Emergency. These days, the Cart is very organized, but not too long ago, this was not the case².

In past years, there have been various issues with efficiency and organization of the “Crash Carts”. The two main issues prior to its reinvention and revamping, were that (1) the materials on the cart were not easily found, and (2) there were no clear instructions on how to use critical items on the crash cart. There were also issues with over-stuffing of items, and the excessive shifting of various items when the cart was on the move, or even when the drawers of the cart were opened and shut. Knowing that the most critical aspects of the “Crash Cart” organization were time and access to materials, the Detroit VA’s Systems Redesign Team was asked to help. The team lives by what they call the “5 S’s”: Sort, Strengthen, Shine, Standardize, and Sustain. The Detroit VA’s Systems Redesign Team will take an issue or problem, break it down to its core elements, and then sort those elements. Once that is done, they figure out where exactly these elements can be improved upon, and become the most effective. Once that is developed, they then figure out how to organize it in the neatest and cleanest way. They then make the things they sorted, strengthened and shined, the more effective way of doing things, in other words, it becomes the new standard. Finally once the first “4 S’s” are complete, it comes down to simply sustaining that standard, as well as always striving to better it, improve upon it and update it⁴.

In collaboration with Renee Peterson, Assistant Chief of Nursing Services, the Detroit VA’s Systems Redesign Team revamped the cart to what it is today. They brought down the cumbersome number of 37 items to a more manageable 23. Using various bins within the medical drawers, the issue of sliding and the mixing up of various medical tools and medicine was addressed. They also made it significantly easier for the medical tools to be relocated by labeling where every single item goes directly on the cart. The cart is also loaded with various instruction books for first responders. Not only are the lives of clinicians made easier, but the improvements make for better care for our Veteran patients⁴.These improvements will make using the carts more effective, and more efficient. The Systems Redesign team says that when actually timed, nurses using the cart cut their action time drastically⁴.

Organizing a crash or code cart requires knowing the progression of the "Advanced Cardiac Life Support" process, established by the American Heart Association. Crash carts, found in most health care facilities, have five, seven or nine drawers containing supplies used when responding to a life-threatening emergency. Found in strategic locations throughout the hospital or health care facility, crash carts should be easily accessible to health care providers, inventoried, and restocked on a regular basis⁵.

The investigator had come across many incidents in his experience in nursing profession where many nurses were not having Knowledge regarding crash carts is very important that emergency nurses should develop the skills regarding organization, uses and care of crash carts in hospitals. Hence, from these instincts the investigator was motivated and planned for doing awareness programme with the help of a teaching material⁵.

OBJECTIVES OF THE STUDY:

1. To assess the pre-test knowledge scores of 4^th year B.Sc Nursing students on utilization of emergency crash cart system in hospital.

2. To assess the effectiveness of self instructional module of knowledge on utilization of emergency crash cart system in hospital in terms of Post-test knowledge scores.

3. To develop self instructional module on utilization of emergency crash cart system in hospital.

HYPOTHESIS:

H₁: There will be significant difference in pre- test and post-test knowledge scores of 4^th year B.Sc Nursing students on utilization of crash cart system in Hospital.

H₂: There will be significant association between Pre-test knowledge score among 4^th year B.Sc Nursing students with their selected personal variables

METHODOLOGY:

Research approach / design: Quasi experimental one group pre-test and post-test design with evaluative approach was adopted in this study.

Study Variables: Knowledge on utilization of Crash Cart System in Hospital.

Selected Personal Variables: Age, sex and information

Setting of the study: The study was conducted in selected Nursing Colleges in Mysore.

Population: Population comprises of 4th year B.Sc Nursing students studying in selected Nursing Colleges in Mysore.

Sample and sample size: The sample for the study comprises of 4^th year B.Sc Nursing students, studying in selected Nursing Colleges in Mysore. In the present study, one hundred (100) samples were selected.

Sampling technique: In the present study the simple random sampling technique was used to select the samples.

SAMPLING CRITERIA:

Inclusion Criteria

1. 4th year B.Sc Nursing students studying in selected Nursing Colleges in Mysore.

2. 4th year B.Sc Nursing students who are willing to participate in the study and randomly selected.

Exclusion criteria:

1. 4th year B.Sc Nursing students who are absent during the period of data collection.

RESULTS:

SECTION I: Description of selected personal variables of 4^th Year B.Sc. Nursing Students.

Frequency and percentage distribution of 4^th Year B.Sc. Nursing students according to their selected personal variables

Sl No	Sample Characteristics	Frequency	Percentage (%)
1.	Age in Years
	22-25 yrs	47	47
	26-29yrs	46	46
	30 yrs and above	7	7
2.	Sex
	Male	48	48
	Female	52	52
3.	Source of Information
	Books and journals	14	14
	Mass Media	32	32
	Teachers class	37	37
	Clinical side	17	17

The data represented in the above table shows that majority 47(47%) of them were 22-25 yrs old and 52(52%) were females. The data represented in the table also shows that, 37(37%) of them were got information from Teachers class.

SECTION II:

Distribution of Subjects according level of Pre Test Knowledge Regarding Utilization of Emergency Crash Cart System. n=100

Level of Knowledge	Frequency	Percentage
Adequate	23	23
Moderately adequate	65	65
Inadequate	12	12

The above table shows that in pre test 23(23%) of them were having adequate knowledge, 65(65%) of them were having moderately adequate knowledge and 12(12%) of them were having inadequate knowledge.

SECTION III:

Distribution of Subjects according their Post- Test Knowledge regarding Utilization of Emergency Crash Cart System. n=100

Level of Knowledge	Frequency	Percentage
Adequate	73	73
Moderately adequate	27	27
Inadequate	00	00

The above table shows that in post test 73(73%) of them were having adequate knowledge, 27(27%) of them were having moderately adequate knowledge and none of them were having inadequate knowledge.

Comparison of Pre-test and Post- test Knowledge scores to determine the effectiveness of Self-Instructional Module

Sl. No.	Aspect wise Analysis		MEAN	SD	Mean difference	‘t’ value	df	Significance
1.	General Information	Pre	1.82	0.82	0.61	5.5	99	S
		Post	2.43	0.72
2.	Definition, Purposes and Contents	Pre	4.11	1.35	1.27	6.55	99	S
		Post	5.38	1.41
3.	Types of Emergency Crash Cart and its Maintenance	Pre	12.42	2.27	3.46	8.45	99	S
		Post	15.88	2.89
6.	Over all Knowledge Score	Pre	18.35	3.89	5.34	9.18	99	S
		Post	23.69	4.19

Sl. No.	Selected Personal variables	Pre-test Median Knowledge Score(19)		c² value	df	Inference
Sl. No.	Selected Personal variables	≤Median	≥ Median	c² value	df	Inference
1.	Age in yrs
	18-21 yrs	25	22	0.294	2	NS
	22-25 yrs	23	23
	26-29yrs	3	4
2.	Sex
	Male	25	23	0.043	1	NS
	Female	26	26	0.043	1	NS
3.	Source of information
	Books and journals	5	9	4.890	3	NS
	Mass Media	17	15
	Teachers class	23	14
	From Clinical side	6	11

Note: NS: Nothing significant, S^*: Significant, df: Degree of freedom, p<0.05 At df=1: critical value is 3.84, At df=2: critical value is 5.59,At df=3: critical value is 7.82, Yaete’s correction done for the observed value less than 5.

IMPLICATIONS:

The findings of the study have implications in the field of nursing, most of the hospitals are well established with advanced health care settings and also patients expects effective care within short duration that can be fulfilled by updates of advanced health care practices. Findings of the study can be used by the nurse educators to educate nursing students and staffs in health care settings to provide effective care by proper utilization of emergency crash cart.

LIMITATIONS:

· The study was limited to only 100 samples.

· The study does not have a control group.

· The study was limited to only 4^th year B.Sc Nursing students present in selected nursing colleges.

· Sampling technique used was simple random sampling technique hence representativeness is limited.

RECOMMENDATIONS:

1. The present study was conducted on a small sample, a more extensive study on large sample is recommended to arrive at generalization.

2. A follow up study need to be conducted to find the effectiveness in terms of retention of knowledge and to reinforce health promotion behaviour.

3. Teaching and demonstration materials regarding utilization of emergency crash cart system can be demonstrated in hospitals, community health and primary health centres.

4. A special training centre for nursing staffs has to be established in each hospital.

5. Health authorities can conduct conference and workshop regarding utilization of emergency crash cart system to provide effective emergency care.

CONCLUSION:

The findings of the study revealed that, the knowledge of 4^th year B.Sc Nursing students regarding utilization of emergency crash cart system in hospital was inadequate when assessed in pre-test. The self instructional module tested in this study was found to be effective in improving the knowledge of subjects. Self instructional module is an effective teaching method in improving the knowledge of 4th year B.Sc Nursing students. The study proved that there is no significant association between pre-test scores and demographic variables like age, sex and Source of information.

REFERENCE:

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2. Baker KN, Flynn EA, Pepper GA, et.al. Emergency Medication Error Observed in 36 Health Care Facilities. Achieves of Internal Medicine 2002; 162: 1897-1903.

3. Balasaraswathy(1995). A study to determine the effectiveness of self-instructional module for nurses on administration of emergency drugs to critically ill patients of selected hospitals in Mangalore. Master science in nursing, Mangalore University.

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Received on 04.09.2015 Modified on 21.09.2015

Asian J. Nur. Edu. and Research. 2016; 6(2): 209-213.

DOI: 10.5958/2349-2996.2016.00038.0