A Pre Experimental Study to assess the Effectiveness of Structured Teaching Programme on Knowledge and Practice Regarding Nosocomial Infection among the Staff Nurses in Selected Hospitals at Jaipur, Rajasthan

 

Ashok Kumar Sharma

Nursing Tutor, College of Nursing, AIIMS, Rishikesh (U.K.)

 

ABSTRACT:

Nosocomial infections are an important public health problem in many developing countries, particularly in the intensive care unit (ICU). Limited data exists on the incidence and burden of nosocomial infection in the Selected Hospitals at Jaipur, Rajasthan. The number of health care employees having direct contact with a client the type and number of invasive procedures, the therapy received and the length of hospitalization influences the risk of infection. According to this study which indicates that Mean and S.D of Pre Vs Post test knowledge of staff nurses regarding nosocomial infection with there selected socio demographic variables. i.e. Pre test are 12.91±1.700, Post test are 22.04±2.015 as per the table the mean difference of pre Vs post test is (9.125) and the t-ratio was statistically significant as the obtained value (30.953) is higher than the tabulated value (2.00) required for t-ratio to be significant at .05 level of confidence. According to this study which indicates that Mean and S.D of Pre Vs Post test on practice of staff nurses regarding nosocomial infection with there selected socio demographic variables. i.e. Pre test are 9.50±1.293, Post test are 14.41±1.328. As per the table the mean difference of pre Vs post test is (4.913) and the t-ratio was statistically significant as the obtained value (23.706) is higher than the tabulated value (2.00) required for t-ratio to be significant at .05 level of confidence. The study findings showed that there was a significant increase in the knowledge and practice of staff nurses after administration of structured teaching programme and check list regarding nosocomial infection. Hence it was concluded that structured teaching programme and check list has been effective method to increase knowledge and practice of staff nurses regarding nosocomial infection.

 

 

 

INTRODUCTION:

“Infection that were not present before the patient came to a hospital but were acquired by a patient while in the hospital.” The word nosocomial comes from the Greek word ‘nosokomeion’ meaning hospital [Nosos= disease, Komeo= to take care of] Nosocomial infections are infection that results from treatment in a hospital or a health care service unit. Infections are considered nosocomial if they first appear 48 hours or more after hospital admission or with in 30 days after discharge. Nosocomial infection results from delivery of health service in a health care facility. Nosocomial infection is also known as hospital acquired infection or in generic terms health care associated terms.¹

 

Infectious diseases are serious problem to world health. One of the important reasons for high death rate in developing countries is infectious diseases. The term communicable disease also is used in place of infectious diseases, which means that disease can spread from one person to another person.²

 

The number of health care employees having direct contact with a client the type and number of invasive procedures, the therapy received and the length of hospitalization influences the risk of infection. Major sites for nosocomial infection include surgical or traumatic wounds with recent changes in health care delivery the concept of nosocomial infections has sometimes been expanded to include other health care associated infections including infections acquired in institutions other than acute care facilities e.g. nursing homes, infections acquired during hospitalization but not identified until after discharge and infection acquired throughout patient care such as day surgery, dialysis or home parenteral therapy.³

 

NEED FOR THE STUDY:

A prevalence survey conducted under the auspices of WHO in 55 hospitals of 14 countries representing 4 WHO Regions (Europe, Eastern Mediterranean, South East Asia and Western Pacific) showed an average of 8.7% of hospital patients had nosocomial infections. At any time over 1.4 million people world wide suffer from infectious complications acquired in hospital. The highest frequencies of nosocomial infections were reported from hospital.⁴

 

In 2002, the estimated number of HAIs in U.S. hospitals adjusted to include federal facilities was approximately 1.7 million 33,269 HAIs among newborns in high risk nurseries, 19,059 among newborns in well baby nurseries, 417,946 among adults and children in ICUs, 1,266,851 among adults and children outside of ICUs. The estimated deaths associated with HAIs in U.S. hospitals were 98,987 of these, 35,967 were for pneumonia 30,665 for bloodstream infections, 13,088 for urinary tract infections, 8,205 for surgical site infections and 11,062 for infections of other sites. HAIs in hospitals are a significant cause of morbidity and mortality in the united states.⁵

 

The present study aimed to investigate the incidence of nosocomial infection (NI) among the patients admitted in the intensive care unit (ICU) in the medical ward of tertiary care hospitals in (S.M.S Medical College Jaipur and Jhalawar Medical College) Rajasthan state. This was a cross sectional hospital based study. The patients admitted in the ICU without evidence of initial infection were included in the study. Bacterial strains were identified with the help of gram staining and biochemical tests. Mainly facultative anaerobes and aerobic bacteria such as Staphylococcus aureus, E. coli, Klebsiella, Pseudomonas species etc. were taken into consideration. More than half (57.3%) of the patients were 40 years and 53% were males. The incidence of NI was 24.9% (95%CI=18.6-31.1%). Age, sex, education, occupation and SES were significantly associated with the incidence of NI. The Acinetobacter baumanii (83.2%) was the most common organism found followed by Pseudomonous aeruginosa (73.5%) Escherichia coli (72.5%), Staphylococcus aureus (53.3%), Klebsiella pneumoniae (41.3%), Coagulase negative staphylococcus (33.4%) and Enterococcus faecalis (22.2%). The nosocomial infection is one of major problems in the ICUs in the hospitals. Researcher suggest large scale studies to be carried out among indian population for prevention and management of nosocomial infections as this was small sample size study. The study on the community acquired infections should also be conducted.⁶

 

The present study was conducted at Selected Hospitals, Jaipur, a 150 bedded tertiary care hospital functional since the mid of the year 2007 and located in the state of Rajasthan. A retrospective study of all pathogens isolated from urine specimens of patients who attended the out patient departments (OPDs) of hospital with suspected UTI between July 2007 and December 2009 was conducted. Patients with a history of inpatient admission a week prior to their presentation in our OPDs were excluded from the study to rule out hospital acquired infections. Only one specimen per patient was included. Only patients with significant bacteriuria (>10⁵ cfu/ml) were included for the microbiological analysis. 2012 consecutive urine specimens from symptomatic UTI cases attending to the outpatient clinics were processed in the Microbiology lab. Bacterial isolates obtained were identified using biochemical reactions. Antimicrobial susceptibility testing was performed by the Kirby Bauer disc diffusion method. Extended spectrum beta lactamase (ESBL) production was determined by the double disk approximation test and the Clinical and Laboratory Standards Institute (formerly NCCLS) confirmatory method. ⁷

 

Lifelong learning is essential for the nurse to maintain and increase competence in nursing practice. There are many different means to meet continuing professional development needs. Formal means include continuing education, staff development, academic education and research activities. However many individuals also continue their professional growth through informal means such as consultation, professional reading, experimential learning and self directed activities. The purpose here is to help the nurses to maintain and improve their competencies as required for the delivery of quality care to the consumer. Interventions in the form of ward based educational programme specifically designed nursing compliance perceive gaps in their knowledge and would welcome the opportunity to be updated regularly.

The researcher felt a need for conducting the study among the staff nurses as with his previous experiences in clinical practice that the knowledge and practice level of staff nurses is not incompetent for prevention of nosocomial infection, nosocomial infection is a major challenging life threatening condition which the patients is facing and with the help of this study the researcher will be able to fill the gap between knowledge and practice among the staff nurses related to nosocomial infection.

 

OBJECTIVES OF THE STUDY:

1.       To assess the pre test knowledge and practice of staff nurses regarding nosocomial infection.

2.       To assess the post test knowledge and practice of staff nurses regarding nosocomial infection.

3.       To evaluate the effectiveness of structured teaching program regarding nosocomial infection among staff nurses.

4.       To find out the association of level of post test knowledge and practice of staff nurses with selected sociodemographic variables.

 

HYPOTHESIS:-

H₁: The post test knowledge will be significantly higher than the pre test knowledge of staff nurses regarding nosocomial infection.

H₂: The post test practice will be significantly higher than the pre test practice of staff nurses regarding nosocomial infection.

H₃: There will be significant association between post test knowledge of staff nurses regarding nosocomial infection with there selected sociodemographic variables.

H₄: There will be significant association between post test practice of staff nurses regarding nosocomial infection with there selected sociodemographic variables.

 

CONCEPTUAL FRAMEWORK-:

The conceptual framework adopted for the study is based on king’s goal attainment theory with the concepts of perception, goal setting, action, interaction and transaction first introduced by Imogene Kings in 1960s.

 

MATERIAL AND METHOD-:

Research Approach- Evaluative Approach

Research Design- Pre experimental one group pre test post test design.

Setting- Selected Hospitals, Jaipur

Sample Size- 80 Staff Nurses

Sampling Technique- Non- probability convenient sampling technique.

 

The tools consisted of following 3 parts:-

Section I: Demographic Performa with Characteristics- age, gender, religion, educational qualification, working areas, years of experience, previous exposure to STP and any in-service education programme on nosocomial infection).

 

Section II: Structured questionnaire, It consists of 25 items divided into 5 areas.

·         Introduction, definition and etiology.

·         Route of transmission and sites.

·         Preventing measures and clinical manifestation.

·         Microorganism responsible for infection.

·         Effective antibiotics and disinfectant.

 

Section III: This part consists of Check List:

It consists of 16 items.

 

RESULTS:

SECTION – 1 Description of sample characteristics:

 

Table - 1.1 Frequency and percentage distribution of demographic profile of staff nurse with respected to age N=80

S. N	Demographic variable	Character	f	%
1.	Age	<25 years	29	36.2
2.		26-28 years	24	30.0
3.		29-32 years	12	15.0
4.		>32 years	15	18.8

 

 

Graph 1.1 :Percentage distribution of staff nurse according to age

 

Table - 1.2 Frequency and percentage distribution of demographic profile of staff nurse with respected to gender N=80

S.N	Demographic variable	Character	f	%
1.	Gender	Male	47	58.80
2.		Female	33	41.20

 

 

Graph: 1.2 Percentage distribution of staff nurse according to gender

 

Table -1.3 Frequency and percentage distribution of demographic profile of staff nurse with respected to religion                  N= 80

S.N	Demographic variable	Characters	f	%
1.	Religion	Hindu	58	72.5
2.		Christian	17	21.3
3.		Muslim	5	6.3
4.		Others	0	0

 

 

Graph 1.3 Percentage distribution of staff nurse according to religion

 

Table –1.4 Frequency and percentage distribution of demographic profile of staff nurse with respected to educational qualification

N = 80

S. N	Demographic variable	Character	f	%
1.	Educational qualifications	GNM	55	68.8
2.		P.B. B.Sc. Nursing	12	15.0
3.		B.Sc.Nursing	8	10.0
4.		Other certified course	5	6.2

 

 

Graph:1.4 Percentage distribution of staff nurse according to educational qualification

 

Table –1.5 Frequency and percentage distribution of demographic profile of staff nurse with respected to working area N=80

S.N.	Demographic variable	Character	f	%
1.	Working area	ICU	39	48.8
2.		General ward	24	30.0
3.		Surgical ward	8	10.0
4.		Other	9	11.2

 

 

Graph:-1.5 Percentage distribution of staff nurse according to working area

 

Table-1.6 Frequency and percentage distribution of demographic profile of staff nurse with respected to total year of experience N=80

S.N.	Demographic variable	Character	f	%
1.	Total year of experience	<1 years	15	18.8
2.		1-5 years	30	37.4
3.		6-10 years	19	23.8
4.		>10 years	16	20.0

 

 

Graph:-1.6 Percentage distribution of staff nurse according to total year of experience

 

Table – 1.7 Frequency and percentage distribution of demographic profile of staff nurses with respected to prior exposure to STP

 N=80

S. N.	Demographic variable	Character	f	%
1.	Prior Exposure to STP	Yes	19	23.8
2.		No	61	76.2

 

Graph:- 1.7 Percentage distribution of staff nurses according to prior exposure to STP

 

Table –1.8 Frequency and percentage distribution of demographic profile of staff nurses with respected to any in service education N=80

S.N.	Demographic variable	Character	f	%
1.	In-service education	Yes	32	39.5
2.		No	48	60.0

 

 

Graph:-1.8 Percentage distribution of staff nurse according to In-Service education

 

Section B:- Table –2.1 Pre test knowledge level of staff nurses regarding NI with there selected sociodemographic variables

Level of Knowledge	Frequency	Percentage (%)
Inadequate Knowledge	51	63.8
Moderate Knowledge	14	17.4
Adequate Knowledge	15	18.8
Overall	80	100.0

 

 

 

 

Table –2.2 Post test knowledge level of staff nurses regarding NI with there selected sociodemographic variables

 

 

 

Table – 2.3 Pre test practice level of staff nurses regarding NI with there selected sociodemographic variables

 

 

 

Table –2.4 Post test practice level of staff nurses regarding NI with there selected sociodemographic variables

Level of practice	Frequency	Percentage (%)
Inadequate practice	15	18.8
Moderate practice	15	18.8
Adequate practice	50	62.4
Overall	80	100.0

 

 

Table 2.5 Comparision between pre test knowledge and post test knowledge

S .no	Level of knowledge	Pre test		Post test
		No	%	No	%
1	Inadequate (< 50%)	51	63.8	20	25
2	Moderate (50-75%)	14	17.4	13	16.3
3	Adequate (> 75%)	15	18.8	47	58.7

 

 

Graph - Percentage distribution of staff nurses according to pre and post test level of knowledge

 

Table -2.6 Comparision between pre test practice and post test practice

S .no	Level of practice	Pre test		Post test
		No	%	No	%
1	Inadequate (< 50%)	54	67.5	15	18.8
2	Moderate (50-75%)	23	28.8	15	18.8
3	Adequate (> 75%)	3	3.8	50	62.4

 

 

 

 

 

 

Table –2.7 Comparison of Pre test and Post test knowledge of staff nurses regarding NI with there selected sociodemographic variables

Group	N	Mean	Std. Deviation	Mean Difference	t-test
Pre-test	80	12.91	1.700	9.125	30.953
Post-test	80	22.04	2.015

 

 

Graph - Comparison of pre and post test knowledge of staff nurses regarding NI

 

Table –2.8 Comparison of Pre test and Post test practice of staff nurses regarding NI with there selected sociodemographic variables

Group	N	Mean	Std. Deviation	Mean Difference	t-test
Pre-test	80	9.50	1.293	4.913	23.706
Post –test	80	14.41	1.328

 

 

 

 

 

 

Table – 2.9 Abstract of Chi-square results of socio demographic characteristics and knowledge and practice of Staff Nurses regarding nosocomial infection.

 

 

 

 

 

MAJOR FINDINGS OF THE STUDY:

The major findings of the study were based on the objective of the study.

 

SECTION – I:

Findings related to Demographic characteristics by frequency and percentage:

The study findings revealed that 36.3% of the respondents belong to the age group of <25 year and 30% of the respondents belong to the age group of 26 to 28 years and 15% of responds belongs to the age group of 29 to 32 years and 18.8% of respondent belong to the age group above 32 years. In the study 58.8 % of male nurses and 41.3% of female nurses were participated. In this study 72.5% belongs to hindu religion, 21.3% belongs to Christian, 6.3 belongs to muslim religion. 68.8% the respondents had completed diploma in general nursing and midwifery course and 10% the respondents had completed basic B.Sc. nursing course and 15% the respondents had completed P.B. B.Sc. nursing course and 6.3% of the staff had any other certified courses. In the study 30% nurses were included from general ward, 48.8% were from intensive care unit, 10% were from surgical wards and 11.3% were from other areas. 18.8% of the respondents had a clinical experience of < 1 years, 37.5% of the respondents had a clinical experience of 1-5 years, 23.8% of the respondents had a clinical experience of 6-10 years and 20% respodent had >10 years of experience. 39.5% of staff nurses had received in-service education on nosocomial infection during their working period and 60% were not received any in-service education on nosocomial infection. 23.8% of staff nurses had been exposed to STP on nosocomial infection and 76.2% were not exposed to STP on nosocomial infection.

 

SECTION- II:

Testing of hypothesis:

1. Findings related to Analysis of data related to pre-test knowledge regarding nosocomial infection among the staff nurses.

About 63.80% (51) of staff nurses had inadequate Knowledge, 17.40% (14) of staff nurses had moderate Knowledge, whereas 18.80% (15) of staff nurses had adequate knowledge regarding nosocomial infection

 

2. Findings related to Analysis of data related to post-test knowledge regarding nosocomial infection among the staff nurses:

About 25% (20) of staff nurses had inadequate knowledge, 16.70% (13) of staff nurses had moderate knowledge, whereas 58.70% (47) of staff nurses had adequate knowledge regarding nosocomial infection. From the above results it was found that the STP is effective in improving knowledge of staff nurses. Sampled subjects were having adequate knowledge regarding nosocomial infection.

3. Findings related to Analysis of data related to pre-test practice regarding nosocomial infection among the staff nurses:

About 67.50 % (54) of staff nurses had inadequate Knowledge, 28.80% (23) of staff nurses had moderate knowledge, whereas 3.80% (3) of staff nurses had adequate practice level regarding nosocomial infection.

 

4. Findings related to Analysis of data related to post-test practice regarding nosocomial infection among the staff nurses.:

About 18.8% (15) of staff nurses had inadequate knowledge, 18.80 % (15) of staff nurses had moderate knowledge, whereas 62.40% (50) of staff nurses had adequate practice level regarding nosocomial infection.

 

5. Findings related to Analysis of data related to the effectiveness of structured teaching programme by comparing pre test and post test scores.:

According to table 2.7, which indicates that Mean and S.D of Pre Vs Post test knowledge of staff nurses regarding nosocomial infection with there selected socio demographic variables. i.e. Pre test are 12.91±1.700, Post test are 22.04±2.015 as per the table the mean difference of pre Vs post test is (9.125) and the t-ratio was statistically significant as the obtained value (30.953) is higher than the tabulated value (2.00) required for t-ratio to be significant at .05 level of confidence.

 

According to table 2.8, which indicates that Mean and S.D of Pre Vs Post test on practice of staff nurses regarding nosocomial infection with there selected socio demographic variables. i.e. Pre test are 9.50±1.293, Post test are 14.41±1.328. As per the table the mean difference of pre Vs post test is (4.913) and the t-ratio was statistically significant as the obtained value (23.706) is higher than the tabulated value (2.00) required for t-ratio to be significant at .05 level of confidence.

 

6. Findings related to the Analysis of data to find out the association between knowledge and practice regarding nosocomial infection among the staff nurses.:

Three demographic variable i.e. age, educational qualification and total year of experience are significant with the post test knowledge and practice scores of staff nurses regarding nosocomial infection.

 

INTERPRETATION AND CONCLUSION:

The study findings showed that there was a significant increase in the knowledge and practice of staff nurses after administration of structured teaching programme and check list regarding nosocomial infection. Hence it was concluded that structured teaching programme and check list has been effective method to increase knowledge and practice of staff nurses regarding nosocomial infection.

 

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Received on 01.07.2017          Modified on 15.07.2017

Accepted on 28.08.2017      ©A&V Publications All right reserved