1. INTRODUCTION:

Cardiovascular disease is the leading global cause of death, accounting for 17.3 million deaths per year, a number that is expected to grow to more than 23.6 million by 2030 [1]. cardiovascular disease not only strikes down a significant fraction of the population without warning but also causes prolonged suffering and disability in an even larger number [2]. Among this cardiovascular diseases, Cardiovascular emergencies account for 30–40% of an acute medical workload that has grown inexorably over the last two decades [3].

In India 9 crore Indian suffer from heart disease and 30% more are at high risk [4]. India, already the diabetes capital of the world with 32 million persons with diabetes, is projected to have 69.8 million in 2025, the count of "hypertensive" individuals is expected to rise from 118 million in 2000 to 214 million in 2025 [5].

The role emergency cardiac medications is inevitable to save the life of patient in critical situations provided the nurse follows the ten rights of administration of medicine. Medication administration errors (MAEs) occur in 3-8% of all non-intravenous drug doses given in UK hospitals; higher rates have been reported for intravenous drugs [6]. As per the society of critical care medicine, the modern nurse should participate and collaborate with the physician and pharmacist in administering and evaluating the effectiveness of drug therapy plan. Along with the doctor, a professional nurse also has to know the responsibilities of administering new and potent drugs. Harmful effects from medications can arise from unintended consequences as well as medication errors. With inadequate education about patient safety and quality, nurses are continually challenged to ensure that their patients receive the right medication at the right time [7]. It is reported in a study that India is recording a whopping 5.2 million injuries each year due to medical errors and adverse events [8].

Sanatombi, D.E., (2010) studied on knowledge of cardiac emergency drugs and its application in clinical practice among undergraduate students of a college of nursing in Karnataka. The study result clearly showed that the students require further input into their knowledge and practice [9]. Similarly Sharma, B., Bhattacharya A., et al. (2009) studied on pharmacovigilance in intensive care unit of Sir Ganga Ram Hospital, New Delhi. In his study he listed the common medication problems which occurs in ICUs are lack of communication among various health providers, inadequate knowledge about drugs, failure to follow protocols or recommended guidelines [10]. Also, in a study which is conducted by Molly D’Souza also found out that the awareness about anticoagulation therapy among nursing staff working in ICU, ICCU of a selected hospital were very less [11]. Furthermore as per the study of Lissa J some of the nurses working in a selected hospital in mysore shows inadequate knowledge regarding medical errors [12]. Again, the study findings from selected hospitals of udupi redgion signifies the importance of updating knowledge of current medications among medical practitioners has been reported [13]. Lack of medication knowledge is a constant problem, and there is a need to continually gain more knowledge about current and new medications [14].

Moreover in a study which is conducted by Arun Sharma in puducherry also recommend for the additional training in the aspect of documentation to enable the medical students for effective reporting when they come across medical errors [16].

Similarly a plethora of studies which had conducted in India as well as different part of the world signifies a major gap in the knowledge of drugs among nurses. Since nurses are the one who spend much of their times with critically ill patients ,the need to improve their knowledge on current medications and its effect on body are inevitable. As today’s nursing students will be tomorrow’s nurses the investigator felt the need to conduct the study on the nursing students and to improve their knowledge regarding emergency cardiac medications by implementing a structured teaching program as this is one of the best teaching method for nursing students, which is proved by many nursing researches, [17,18].

1.1. STATEMENT OF PROBLEM:-

The statement of the problem for the present study was

“A study to assess the effectiveness of structured teaching program on knowledge regarding selected emergency cardiac medications among 3^rd year B. Sc. Nursing students of Rama college of Nursing at Kanpur”.

1.2. OBJECTIVES OF THE STUDY:

The objectives of the study were:

1. To assess the knowledge level of 3^rd year Bsc nursing students regarding selected emergency cardiac drugs.

2. To assess the effectiveness of structured teaching program on knowledge regarding selected emergency cardiac drugs among 3^rd year B.sc nursing students.

3. To find out the association between the pretest knowledge score and the selected demographic variables such as age, sex, type of family and family history of cardiac problem.

1.3. HYPOTHESES:

H1-The mean post test knowledge score is significantly higher than that of the mean pretest score.

H2-There is a significant association between pretest knowledge score and selected demographic variables such as age, sex, type of family and history of cardiac problem.

2. MATERIAL AND METHODS:

2.1. RESEARCH DESIGN:

The research approach adopted for this study will be pre experimental and the design will be one group pretestpost test design.

Setting of the study: The study was conducted in Rama College of Nursing Mandhana, Kanpur.

2.2. VARIABLES:

Independent variable:

Structured teaching program regarding selected cardiac emergency drugs.

Dependent variable:

Knowledge of 3^rd year B.sc nursing students regarding selected emergency cardiac medications

Demographic variable: - Age, Sex, family history of cardiovascular problems and type of family.

2.3. POPULATON:

The population for the study were Nursing students of Rama College Of Nursing.

2.4. SAMPLE:

The sample of the study were 30 students of 3^rd year B.sc nursing of Rama College of Nursing who fulfilled the sampling criteria.

2.5. SAMPLING TECHNIQUE:

With the help of purposive sampling technique, 30 student nurses were selected as sample for the study.

2.6. DEVELOPMENT and DESCRIPTION OF TOOLS USED IN THE STUDY:-

The tool to assess the knowledge of emergency cardiac medication was developed by the investigator as no standardized tool was available. Validity and reliability of the tool was checked. The tool consists of 2 sections. The tool used for the study includes:

Section A:

Baseline proforma which includes the socio-demographic data like age, sex, family history of cardiac problem and type of family.

Section B:

Structured questionnaire for assessing knowledge regarding emergency cardiac medication.

A questionnaire consisting of 30 items were used to determine the knowledge regarding emergency cardiac medication. It included questions related to 07 emergency cardiac drugs which includes dopamine, nitroglycerin, amiodarone, adrenaline, atropine, digoxin and dobutamine. The tool was prepared by the investigator under the guidance of experts from the field of nursing and medicine.

The reliability of the structured questionnaire was checked by test retest method. The tool was administered among 5 students of Bsc nursing 3rdyear in rama college of nursing Using Karl Pearson’s formula for correlation coefficient

r = 0.86 for structured questionnaire

The tool was found to be reliable.

The reliability of the tool was checked during the test re-test method.

2.7. DATA COLLECTION PROCEDURE:

The data collection was completed within the period of 2 weeks, from 18/04/2016. After obtaining samples willingness data were collected from 30 students of 3^rdyear B.sc nursing by using the structured questionnaire and structured teaching program was given on the same day and post-test was conducted on 5^th day after structured teaching program with the same pretest questionnaire.

2.8. PLAN FOR DATA ANALYSIS:

The data obtained from 30 sample wsa analyzed by adopting appropriate statistical methods. Paired‘t’ test would be applied on the assumption of normality to test the significance of the average scores on knowledge before and after the administration of structured teaching program. Chi-square test would be applied to see whether there exists any association between pretest knowledge scores and demographic variables under study, i.e. age, sex, education, years of experience, and area of work of the sample.

3. RESULT

3.1.Distribution of samples based onsocio-demographic data:

1. Among the total samples 50% of the sample belong to the age group of 18-21 years and 50% in the age group of 21-23 years.

2. Majority (95%) of the sample were females and only 5% of the sample were male among the samples.

3. Only 16.66% 3^rdsamples had a family history of cardiac problems while majority(83.33) of the students didn’t had any family history of cardiac problem.

4. From the total samples, most of them (70%) were belongs to nuclear family and only 30% belongs to joint family.

3.2. Pretest knowledge regarding emergency cardiac medication

Table 3.1. Distribution of 3^rd year B.Sc nursing students according pretest to knowledge score regarding emergency cardiac medication.

Pretest Knowledge of students on Emergency cardiac medication
Poor		Average		Good		Excellent
No.	%	No.	%	No.	%	No.	%
9	30	21	70	00	00	00	00

3.3. Posttest knowledge score regarding emergency cardiac medication.

Table 3.2. Distribution of 3^rdyear B.Sc nursing students according to post test knowledge regarding emergency cardiac medication

Post test Knowledge of students on Emergency cardiac medication
Poor		Average		Good		Excellent
No.	%	No.	%	No.	%	No.	%
00	00	21	66.66	05	16.67	05	16.67

3.4. Effectiveness of structured teaching programm regarding selected cardiac emergency drugs

Table 3.3. Comparison of pre test post test knowledge score n =30

Knowledge	Pre-test		Post-test
Knowledge	Frequency	Percent	Frequency	Percent
Poor	09	30	00	00
Average	21	70	22	73.33
Good	00	00	05	16.67
Excellent	00	00	03	10
Total	30	100	30	100

From the above given table it is clear that 70% of students had shown average knowledge and 30% had shown poor knowledge whereas in post test there was no student had shown poor performance, more over 10% of students had shown excellent knowledge and 16.67% shown good performance

3.5. Significance of difference between pre-test knowledge and post-test knowledge scores.

The null hypothesis for H₂ was stated as follows.

H₀₁: There is no difference between pre test and post test knowledge score.

Table 3.4. Significance of difference between pretest knowledge and posttest knowledge scores. n =30

KNOWLEDGE

SCORE

Pre-test

Mean

11.5

2.73

13.904

0.0001

Post-test

17.5

3.77

The structured teaching program has been developed to impart knowledge among 3^rd year B.Sc nursing students. The effectiveness of structured teaching programme was tested and found to be effective.

The mean score before and after administration of structured teaching programme has shown a significance difference. The mean total knowledge score before intervention was 11.5 which has increased to 17.5 after intervention. The paired ‘t’ test (13.904) was found to be significant at a very high level (p=0.0001)

From the above inference, it is made clear that structured teaching programme had a positive impact on knowledge among B.Sc nursing students (p<0.0001). So H0₁ is rejected.

3.6. Association between pretest knowledge score and socio-demographic variables.

Age and sex has shown a significant association with their knowledge score. In contrast type of family and family history of cardiac problems failed to show an positive association with the knowledge scores of samples.

4. DISCUSSION:

In the present study the overall Pre -test knowledge scores regarding the selected cardiac emergency drugs among 3^rd year BSc nursing students showed that majority (70%) of the sample had average knowledge score and only 30% of the sample had poor knowledge score. overall mean score and standard deviation of Pre test knowledge scores were 11.5 and ±2.73 respectively. This study was supported by a pre-experimental study which is conducted by Rajendra D (2014) titled “A study to assess the effectiveness of planned teaching programmed on knowledge of emergency cardiac drugs among the staff nurses working in critical care unit in selected hospital at Mangalore.”.The study Findings revealed that, majority of respondents 70% had only average knowledge, only 10% of the respondents had good knowledge and 20% of the respondents had poor knowledge regarding emergency drugs. Overall mean score and standard deviation of Pre test knowledge score regarding cardiac emergency drugs among the staff nurses were 26.0 and ± 6.93 respectively[15].

Moreover In the present study, the mean post test knowledge score was 17.5 which is apparently higher than the mean pre test knowledge scores 11.5 and the mean difference was 6. The calculated paired ‘t’ test value (t ═ 13.09, P< 0.0001) which represents significant gain of knowledge through the structured teaching program. The present study was supported by an experimental study conducted by Paul Nicholas (2009) among staff nurses working in cardiac hospital at Bangalore. The study revealed that post-test mean knowledge score found higher 87.73% (43.67) when compared with pre-test mean knowledge score value which was 52%[16]..

Furthermore, the study conducted by SC Basak also proved by his study, titled “Evaluation of the Impact of an Educational Workshop for Community Pharmacists” that educational intervention is one of the best strategy to improve the knowledge among the medical professionals. This study also supported the investigators with their result[17-20]. Same like the present study, this study also had shown a significant change in the post test knowledge score after the implementation of an educational program. The average post-score was 10.57 which is better than the pre-test score was 5.10.

Chi-square test were computed to determine the association between the pre-test knowledge score with the selected demographic variables. In the present study it is proved that there was no association of knowledge score with selected variables like family history of cardiac problem and type of family. This finding was supported by the study conducted by R. N. Krishnan et. al. From their findings, it concluded that there was no significant association between knowledge score and family history of cardiac problem and type of family of samples[21].

5. CONCLUSION:

From the study findings the investigator reached the conclusion that the structured teaching program was an effective strategy to improve the knowledge among staff nurses as there is drastic difference in the pretest mean score and post test mean score. Also, study result showed that there was no association of knowledge score with the demographic variables like type of family and family history of cardiac problem. Whereas, there was a signification association of pretest knowledge score with age and sex of the samples are evident from the study findings.

6. CONFLICT OF INTEREST:

The author declare no conflict of interest.

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Received on 19.05.2018 Modified on 18.06.2018

Asian J. Nursing Education and Research. 2018; 8(4): 462-466.

DOI: 10.5958/2349-2996.2018.00093.9