Effect of Planned Teaching Programme on Knowledge regarding ABG Analysis among Staff Nurses working in a selected hospital in Mumbai

Ms. Preeti Manoj Bagul

M.Sc. Child Health Nursing, Nursing Tutor in Holy Family Institute of Nursing Education, Kurla, Mumbai.

*Corresponding Author Email: bagulpreeti@gmail.com

ABSTRACT:

Health is considered as one of the most important values in life. It is a key factor and is regarded as precious. Health as well as longevity should be protected and enhanced as much as possible. Early detection and treatment is one of the measures to prevent illness and also to reduce complications and death. Early diagnosis is key to better management¹.According to Hippocrates (460-377 BC) good health resides in a proper balance among the four humors: blood, phlegm, black bile, and yellow bile, a balance that depends on the generation of life-giving heat within the left ventricle. Among these humors blood is very important as it plays a vital role in maintaining normal body mechanism². The primary function of blood is to transport oxygen from the lungs to the body tissue and CO₂ from the tissues to the lungs. This function is essential in order to prevent the death of tissues due to hypoxia. Many lifesaving diagnostic tests which are performed in clinical set up to identify disease and are very essential tools in screening any deviations from normal functions of the body. The methods used will of course vary from assessment of radial pulse, blood pressure, and pulse oximeter to the increasingly complex invasive hemodynamic monitoring such as interpretation of ABG sample with super specialization health care management in care of the patient. Though there are various diagnostic procedures, ABG analysis can be thought of as a window through which ventilation, respiration, metabolism and acid-base balance can be examined¹. Objectives: To assess the pretest knowledge of staff nurses regarding ABG analysis in a selected hospital. To determine the effect of planned teaching on knowledge of staff nurses regarding ABG analysis in a selected hospital. To find the association between the selected demographic variables such as age, experience and educational qualification. Research Methodology: A descriptive, evaluative approach was used. One group pretest and posttest research design was adopted. A non-probability convenience sampling technique was used and 30 sample from selected hospitals were selected. A structured questionnaire will be prepared to assess the knowledge and observation checklist will be prepared to assess the practice among nurses regarding ABG analysis. The content validity of the questionnaire was done by 4 experts from nursing and medical fields for scrutinizing its adequacy and relevance reliability of questionnaire was done. The reliability of the questionnaire was calculated by the test retest method. Reliability coefficient was0.85 in test retest. Pilot study was initiated after the investigator obtained official permission from the concerned administrative authorities of the selected hospital. Pilot study was conducted from 8^th April to 12^th April 2019. The data gathering process begin on 22 April to 29^th April 2019.In which contents of the consent form were explained. Pretest was initiated and planned teaching program was given. After 5 days posttest was done. This process continued till the investigator obtained the required sample size. Major Findings of The Study: Distribution of sample according to the demographic data – Age Data of age shows that the samples were fully distributed in age in one age group.30 {100%} samples belongs to age group of 20 -25 years .Nil Samples were there in age group of 26 -30 years, 31 – 40 years and 41 – 60 years Distribution of samples according to their demographic data- qualification Data of qualification indicates that maximum samples 26 {86.6%} were from the basic BSc nursing followed by 2{6.7 %} each from GNM and P.B.B.Sc. Nil samples were there in the category of master in nursing. Distribution of sample according to their demographic data – clinical experience. It illustrate that 14 {46.6 %} were having 1 – 3 months experience followed by 9 {30%} samples having 5 – 6 months of experience on next level 5 {16.7%} samples having 3 – 5 months experience and 2 {6.7%} samples having 0 – 1 months experience. Distribution of samples according to the demographic data – area of experience.it illustrate that 14 {46.6%} samples having experience in ICCU followed by 8 {26.7 %} samples having experience in ICU, 5 {16.7%} samples having experience in CARDIAC WARD /SICU and 3 {10.0%} sample having experience in Emergency.

KEYWORDS: ABG Analysis, staff Nurses.

BACKGROUND OF THE STUDY:

Arterial blood gas (ABG) analysis is the most effective way to evaluate acid-base balance and oxygenation. Deviation from a normal value will indicate that the client is experiencing an acid-base imbalance. Measurement of ABGs involves analysis of six components: pH, PaCO₂, PaO₂, oxygen saturation, base excess, (HCO₃), H⁺ ions.^16,17

Arterial blood gases are analyzed with a great frequency. Nurses are usually involved in taking and analyzing the ABGs and normally they report these results to the doctors or anesthesiologists. Out of these results the anesthesiologists will then prescribe further treatment for the critically ill patient. Hence, it is important that nurses are familiar with the information obtained to be able to detect the disturbances in ventilation, oxygen delivery and acid–base balance¹⁸.

The first biologic use of a platinum cathode for oxygen monitoring was reported in 1938by Blinks and Scow, who was studying photosynthesis. Their report led to the tissue oxygen studies of Davies, Brink, and Bronk. Clark, by covering cathode and anode with a polyethylene membrane, changed the polar graphic cathode from a sensor of oxygen availability by diffusion to a measure of oxygen tension (PO₂) in the solution and thereby facilitated an enormous expansion of the study of the respiratory physiology of blood oxygen after 1956.¹⁹ Clark’s electrode led to the development of the present commercial blood gas systems that measure pH, carbon dioxide tension (PCO₂), and PO₂ and calculate many derived variables. Variations on Clark’s electrode were designed for in vivo catheter-tip recording; gas phase oxygen monitoring; determining oxygen content of blood by releasing hemoglobin-bound oxygen and measuring PO₂; and determining oxygen consumption in cell cultures (thus replacing Warburg manometry). By reducing the cathode diameter, Staub and others eliminated the need for stirring the blood samples.

Concurrent research with aerometric or polar graphic oxygen measurement led Hersch to develop the means of determining oxygen content by coulometer in large cells that consumed all the injected oxygen. Methods of applying no insulating, but protein impermeable, membranes to cathodes and of recessing cathodes into glass permitted measurement of PO₂ in tissues and fluids with microelectrode.

STATEMENT OF THE PROBLEM:

Effect of Planned Teaching Programme on Knowledge regarding ABG analysis among Staff Nurses working in a Selected Hospital in Mumbai.

OBJECTIVES:

· To assess the pretest knowledge of staff nurses regarding ABG analysis in a selected hospital.

· To determine the effect of planned teaching on knowledge of staff nurses regarding ABG analysis in a selected hospital.

· To find the association between the selected demographic variables such as age, experience and educational qualification.

RESEARCH METHODOLOGY:

A descriptive, evaluative approach was used. One group pretest and posttest research design was adopted. A non-probability convenience sampling technique was used and 30 sample from selected hospitals were selected. A structured questionnaire will be prepared to assess the knowledge and observation checklist will be prepared to assess the practice among nurses regarding ABG analysis. The content validity of the questionnaire was done by 4 experts from nursing and medical fields for scrutinizing its adequacy and relevance reliability of questionnaire was done. The reliability of the questionnaire was calculated by the test retest method. Reliability coefficient was0.85 in test retest. Pilot study was initiated after the investigator obtained official permission from the concerned administrative authorities of the selected hospital. Pilot study was conducted from 8^th April to 12^th April 2019. The data gathering process begin on 22 April to 29^th April 2019. In which contents of the consent form were explained. Pretest was initiated and planned teaching program was given. After 5 days posttest was done. This process continued till the investigator obtained the required sample size.

MAJOR FINDINGS OF THE STUDY:

Distribution of sample according to the demographic data – Age:

Data of age shows that the samples were fully distributed in age in one age group. 30 {100%} samples belongs to age group of 20 -25 years. Nil Samples were there in age group of 26 -30 years, 31 – 40 years and 41 – 60 years

Distribution of samples according to their demographic data- qualification:

Data of qualification indicates that maximum samples 26 {86.6%} were from the basic BSc nursing followed by 2{6.7%} each from GNM and P.B.B.Sc. Nil samples were there in the category of master in nursing.

Distribution of sample according to their demographic data – clinical experience:

It illustrate that 14 {46.6%} were having 1 – 3 months experience followed by 9 {30%} samples having 5 – 6 months of experience on next level 5{16.7%} samples having 3 – 5 months experience and 2{6.7%} samples having 0 – 1 months experience.

Distribution of samples according to the demographic data – area of experience.

It illustrate that 14 {46.6%} samples having experience in ICCU followed by 8 {26.7%} samples having experience in ICU, 5 {16.7%} samples having experience in Cardiac Ward /SICU and 3 {10.0%} sample having experience in Emergency.

Knowledge of the sample in relation to various aspects of ABG analysis was assessed before and after implementation of planned teaching program. Drastic improvement was observed in response to arterial blood is used for ABG nalysis, PH, PaCO₂, PaO₂, HCO₃ are observed, radiologist cannot perform ABG Analysis in which only 30(100%), 28(93.3%), 9(30%) had replied right in pretest, whereas 30(100%), 30(100%), 30(100%) samples respectively had responded right in posttest.

In response to ABG analysis is a diagnostic procedure, it can be performed cat any time, 20-25 degree Celsius is the room temperature for ABG blood storage showed good improvement 17{56.7%}, 22{73.3%}, 5{16.7%} in pretest, whereas 30{100%}, 30{100%}, 22{73.3%} has replied right in posttest.

In response to Allen test is the prior test to ABG analysis, severe vascular diseases is not an indication, critical; ill is not a contraindication, radial, brachial femoral dorsalis Pedi’s is the sites of ABG analysis showed good improvement 3{10%}, 3{10%}, 1{3.3%}, 27{90%}, in pretest and 30{100%}, 16{53.3%}, 22{73.3%}, 30{100%} in posttest.

Significant change was observed in response to heparin is used in ABGanalysis, it used fo0r anticoagulant.0.5 to 1.0ml is the dose of heparin, 45 to 60 degree is the angle off needle insertion, 2 to 5 minutes pressure should be applied in puncture sites, showed satisfactory improvement 24{80%}, 20{66.7%}, 18{60%}, 2{6.7%}, 9{30%} in pretest while in posttest it showed 30{100%}, 28{93.3%}, 30{100%}, 21{70%}, 22{73.3%}.

In response to the normal value of HCO₃, alkalosis occur when HCO3 is higher, sample should be stored in ice, complication of ABG analysis, kidney and lung is associated with ABG analysis.it showed average improvement 15{50%}, 5{16.7%}, 25{83.3%}, 20{66.6%}, 4{13.3%} in pretest and in posttest 25{83.3%}, 24{80%}, 30{100%}, 23{76.6%}, 28{93.3%}.

In response to normal PH level, alkalosis occurs when pH is higher, the role of paO2 is oxygenation, normal value of paO2 is 80 to 100%, hypoxemia occur when paO2 is low, it shows good improvement 13{43.3%}, 8{26.7%}, 15{50%}, 9{30%}, 11{36.7%} in pretest and 29{96.6%}, 20{66.6%}, 27{90%}, 22{73.3%}, 25{83.3%} in posttest.

In response to normal value of paco2, respiratory system is related to ABG analysis, paO2 is called as metabolic parameter, 10 to 15 minutes pressure to be applied when patient is on anticoagulant therapy, hco3 indicate bicarbonate level shows average improvement, 9{30%}, 25{83.3%}, 2{6.7%}, 1{3.3%}, 16{53.3%} in pretest and 24{80%}, 30{100%}, 19{63.3%}, 20{66.6%}, 23{76.6%} in posttest.

In pretest most 19{63.3%}, sample had average knowledge followed by 11{36.7%} were in poor category, none of the sample were in excellent and good range. The posttest reveals the most 22{73.3%} sample had excellent knowledge followed by 8{26.7%} sample with good knowledge, none of the sample were in poor and average category.

Posttest knowledge scores computed SD (standard Deviation) is 1.62 and calculated‘t’ value is 27.9. Which proved that planned teaching program was effective in improvement of knowledge of sample.

Association of demographic variables with knowledge of sample showed that age and socio-economic status was not associated with gained in knowledge, whereas qualification and years and areas of experience group had more improvement than less experiences group.

CONCLUSION:

This study has helped to assess the knowledge of staff nurses regarding ABG analysis. The knowledge of staff nurses in posttest was significantly higher than the pretest score. The finding of the study proved that teaching through planned teaching source is really effective to increase and upgrade the knowledge of staff nurses.

The study reveals that it is important to have regular in-service education programs for nurses to improve their knowledge and practice skills while caring for the patient in order to prevent complication and errors in ABG analysis.

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