A Study to assess the Knowledge on Paediatric Ventilator associated Pneumonia (VAP) among Nursing Students, at selected College, Tirupati

 

Mr. K. Sesha Kumar¹, Prof. Dr. A. Padmaja²

 

ABSTRACT:

Ventilator-associated pneumonia (VAP) is a serious health care- associated infection, resulting in high morbidity and mortality. Nurse’s awareness, education and understanding the preventive measures for ventilator associated pneumonia (VAP) are necessary component in NICU / PICU settings. The aim of the present study was to assess the knowledge on paediatric ventilator associated pneumonia (VAP) among nursing students, at selected college, Tirupati. Objectives: To assess the nursing students knowledge on Paediatric Ventilator Associated Pneumonia (VAP), to find out the association between level of knowledge with selected socio demographic variables, to provide information booklet on Paediatric Ventilator Associated Pneumonia (VAP). Methodology: The research approach used for the study was descriptive research design. One Stage Cluster sampling technique was adopted; College of Nursing, SVIMS, Tirupati was considered as one cluster, by random sampling technique all 3^rd Year B.Sc Nursing Students of  College of Nursing, SVIMS, Tirupati were selected. Data was collected with questionnaire on Paediatric Ventilator Associated Pneumonia (VAP). Results: The major findings of the study was, Out of 96 B.Sc nursing students 30.2% (29) had inadequate knowledge, 26% (25) had moderate knowledge and 43.8% (42) had adequate knowledge regarding Paediatric Ventilator Associated Pneumonia. Level of knowledge regarding practices to prevent Paediatric Ventilator Associated Pneumonia majority 36.5% (35) students had inadequate knowledge, 28.1% (27) students had moderate knowledge, 35.4% (34) students adequate knowledge. There no significant association between level of knowledge and knowledge on practices to prevent on paediatric ventilator associated pneumonia with selected socio demographic variables. Conclusion: The study shows that B.Sc Nursing students have moderate knowledge on Paediatric Ventilator Associated Pneumonia. Based on the findings information booklet was given to all the students (subjects), to improve the level of knowledge.

 

 

 

INTRODUCTION:

Healthcare-associated infections (HAIs) are associated with morbidity, mortality, and prolonged hospitalization, and represent a serious threat to patient safety, cost and hospital and healthcare reputation. Hospitalized children and neonate being immunologically fragile are a particularly vulnerable population.¹ As children differ greatly from adults in their anatomy, physiology and underlying disease, specific aetiology for VAP in them is described.² The quality of care received by a patient in any hospitals depends on the care given by the nurses of that particular hospital. The quality can be improved if the nurses follow evidence-based nursing practices.³

 

NEED FOR THE STUDY:

According to data published by the National Nosocomial Infection Surveillance System (NNIS) program sponsored by the Centre for Disease Control and Prevention (CDC), VAP is the second most frequent cause of nosocomial infection (20% of nosocomial infections) in paediatric intensive care units (PICU), with rates that oscillate from 1.4 to 7 episodes per 1,000 ventilator days. In developing countries the reported rates are significantly higher, ranging from 16.1 to 89 episodes per 1,000 ventilator days.⁴ The nurses should provide special care to the children to prevent nosocomial infections. In India, the incidence of VAP is still high in neonates and children.

 

PROBLEM STATEMENT:

A Study to Assess the Knowledge on Paediatric Ventilator Associated Pneumonia (VAP) among Nursing Students, at selected College, Tirupati.

 

OBJECTIVES:

1.     To assess the nursing students knowledge on Paediatric Ventilator Associated Pneumonia (VAP).

2.     To find out the association between level of knowledge with selected socio demographic variables.

3.     To provide information booklet on Paediatric Ventilator Associated Pneumonia (VAP).

 

OPERATIONAL DEFINITIONS:

ASSESS:

To explore the nursing student’s knowledge on Paediatric Ventilator Associated Pneumonia (VAP) by formulated tool.

 

PAEDIARIC VENTILATOR ASSOCIATED PNEUMONIA (VAP):

Paediatric Ventilator Associated Pneumonia is a type of Health Care Associated infection, which occurs 48 hours (or) later after the initiation of mechanical ventilation in patients who didn’t have pneumonia at the time of intervention.

 

NURSING STUDENTS:

Professional Nursing Undergraduate students who are pursuing 3^rd year B.Sc Nursing.

 

HYPOTHESIS:

Null Hypothesis (H₀): There is no significant association between knowledge regarding Paediatric Ventilator Associated Pneumonia with selected socio demographic variables.

 

ASSUMPTIONS:

·       The level of knowledge among nursing students differs from individual to individual

·       The selected socio demographic variables may have influence on nursing student’s knowledge.

·       Information booklet regarding Paediatric Ventilator Associated Pneumonia would bring the change in knowledge of students.

 

LIMITATIONS:

·       The study is limited to only nursing students who are studying 3^rd year   B. Sc Nursing.

·       The period of study is limited to six weeks only

 

REVIEW OF LITERATURE:

Ankita Sharma (2019) conducted a descriptive study to assess the knowledge of staff nurses regarding ventilator associated pneumonia among patients admitted in intensive care units of selected hospitals of city Jalandhar. The aim of the study was to assess the knowledge of staff nurses regarding VAP among mechanically ventilated patients. Results showed that no one have excellent knowledge regarding ventilator associated pneumonia, 6% has good knowledge, 28% has average knowledge and 66% has below average knowledge among staff nurses regarding ventilator associated pneumonia. It was concluded from present study that staff nurses need knowledge regarding VAP.⁵

 

Sulochana Ghirime, Srijana Neupane (2018) conducted a study to find out the knowledge regarding prevention of Ventilator Associated Pneumonia (VAP) among nurses. A descriptive cross-sectional study was conducted to find out the knowledge regarding prevention of VAP among nurses. The findings of the study revealed that 49.1% of the respondents had high knowledge and 7.8% had average knowledge. There was no statistically significant association between respondents' level of knowledge regarding prevention of VAP with respondents' working experience (p-0.493) and qualification (p-0.459).⁶

 

Jayalakshmi Narasimhaiah, Praveena Moorthy (2018) conducted a study to evaluate the effectiveness of structured teaching programme on knowledge regarding prevention of nosocomial infection in children among staff nurses in selected paediatric hospitals. A quantitative research and one group of pre-test and post-test without a control group using pre-experimental design was used for the study. Purposive sampling technique was used to select the sample. The overall pre-test knowledge scores of staff nurses on prevention of nosocomial infection among children was found to be 42.5% and the overall post-test knowledge scores was found to be 85.1% and enhancement in the mean percentage knowledge score of 42.6% was found to be significant at 5% levels for all the aspects under study. Overall findings showed that there is knowledge deficit among staff nurses regarding prevention of nosocomial infections in paediatric hospitals and structured teaching programme was effective in improving their knowledge.⁷

 

METHODOLOGY:

RESEARCH DESIGN:

The research design selected for the present study was descriptive research design.

 

SETTING OF THE STUDY:

The study was conducted at College of Nursing, SVIMS, Tirupati.

 

POPULATION:

Population for the study was B. Sc Nursing 3^rd year students.

 

SAMPLE SIZE:

Sample size consisted of 96 nursing students who are studying 3^rd year B. Sc Nursing.

 

SAMPLING TECHNIQUE:

One Stage Cluster sampling technique; College of Nursing, SVIMS, Tirupati was considered as one cluster, by random sampling technique all 3^rd Year B.Sc Nursing Students of College of Nursing, SVIMS, Tirupati were selected.

 

CRITERIA FOR SAMPLE SELECTION:

Inclusion Criteria:

·       Students those who are studying in College of Nursing ,SVIMS

·       Students whose who are willing to participate in the study.

·       Both male and female 3^rd year B.sc nursing students.

 

Exclusive Criteria:

·       Those who are sick on the day of study.

·       Those who are absent on the day of study.

 

TOOL:

The instrument was organized under the following:

Section –I: Socio- Demographic Data

Section–II: Knowledge questionnaire regarding Paediatric Ventilator Associated Pneumonia.

 

1.     Questionnaire:

Section-I:

It consists of socio demographic data such as age, gender, religion, marital status, type of family, educational status of mother, educational status of father, occupation of mother, occupation of father, number of siblings, family income, does any of the family members admitted in Paediatric Intensive Care Unit, source of information, previous knowledge on Paediatric Ventilator Associated Pneumonia.

 

Section-II:

The section- II consists of Part-A and Part-B.

Part– A consist of 10 multiple choice questions on knowledge regarding Paediatric Ventilator   Associated Pneumonia.

Part- B consists of 15 multiple choice questions regarding knowledge on practices to prevent Paediatric Ventilator Associated Pneumonia.

 

2.     Information booklet:

Information booklet consists of meaning, causative organisms, risk factors, signs & symptoms, complications, diagnosis, treatment, nursing management for VAP and prevention of VAP.

 

Score Interpretation:

Scoring key was prepared for Section –I by coding the socio demographic data. In Section –II each correct answer has a score of ‘one’ mark and wrong answer scores ‘Zero’. The maximum score was 25.

The score was interpreted in the following manner:

 

·       <50% – inadequate knowledge.

·       50-75% – moderate knowledge.

·       >75% – adequate knowledge.

 

RESULTS:

·       Among 96 3^rd year B.Sc Nursing students 30.2% (29) had inadequate knowledge, 26% (25) had moderate knowledge and 43.8% (42) had adequate knowledge regarding Paediatric Ventilator Associated Pneumonia.

·       Among 96 3^rd year B.Sc Nursing students 36.5% (35) students had inadequate knowledge, 28.1% (27) students had moderate knowledge, 35.4% (34) students adequate level of knowledge regarding practices to prevent Paediatric Ventilator Associated Pneumonia.

·       There is no significant association between level of knowledge on paediatric ventilator associated pneumonia with selected socio demographic variables among B.Sc Nursing 3^rd Year students.

·       There is no significant association between level of knowledge on practices to prevent paediatric ventilator associated pneumonia with selected socio demographic variables among B.Sc Nursing 3^rd Year students.

 

CONCLUSION:

Out of 96 found 30.2% (29) had inadequate knowledge, 26% (25) had moderate knowledge and 43.8% (42) had adequate knowledge regarding Paediatric Ventilator Associated Pneumonia. Level of knowledge regarding practices to prevent Paediatric Ventilator Associated Pneumonia majority 36.5% (35) students had inadequate knowledge, 28.1% (27) students had moderate knowledge, 35.4% (34) students adequate knowledge. Based on the findings information booklet was given to improve the level of knowledge regarding Paediatric Ventilator Associated Pneumonia.

 

NURSING IMPLICATIONS:

The findings of the study have implications in various areas of nursing profession, that is, nursing service, nursing education, nursing administration and nursing research.

 

Nursing Services:

·       Nurses should update the knowledge regarding through Paediatric Ventilator Associated Pneumonia (VAP) workshops, conferences, etc.

·       Continuous Nursing Education programmes can be conducted from time to time so that the nurses keep themselves updated with the latest standard guidelines.

·       Ventilator Associated Pneumonia (VAP) could be reduced through the use of good nursing care from the nurses in NICU/PICU.

 

Nursing Education:

·       Nursing students who are posted in neonatal /paediatric intensive care units should able to know the preventive measures for Ventilator associated Pneumonia.

·       The nurses should update with new protocols and polices for prevention of VAP in neonatal /paediatric ICU’s. 

·       Nurse educators can also develop video tape study material, slides planned with the LED projector etc regarding ventilator associated pneumonia and its prevention, so that the nursing students will better understand and practice in clinical area.

 

Nursing Administration:

·       Nurse administrator should motivate & develop the nursing personnel by implementing various teaching programmes like demonstration, hands on skill training practices related to prevention of ventilator associated pneumonia to increase the knowledge of staff nurses.

·       Nurse administrator should keep a separate budget for in-service education/ CNE Programmes, so that it can be conducted regularly. 

·       The nurse administrators can train the nurses in the implementation of the Modified Neonatal/ Paediatric VAP Preventive Care Bundle for the Newborns/ Children.

 

Nursing Research:

·       Researchers must focus on developing appropriate protocols for reducing the incidence of the Ventilator Associated Pneumonia in newborn/ children.

·       The new knowledge obtained through the study would enhance evidence based nursing practice.

 

RECOMMENDATIONS:

·       The study can be conducted with larger sample in another setting which provides care for critically ill paediatric patients.

·       A quasi-experimental study can be conducted with the help of structured teaching programme regarding ventilator associated pneumonia in PICU/NICU among 3^rd & 4^th year B. Sc Nursing students.

·       A comparative study could be conducted among nursing students and staff nurses regarding prevention of ventilator associated pneumonia in PICU/NICU’S.

 

REFERENCES:

1.     Vemula Nikhil, et.al. Update on Ventilator Associated Pneumonia in Neonates and Children. Journal of Paediatric Association of India. 2016; 6(1): 33-49.

2.     Preeti Malhotra, et.al. Comparative study of incidence, risk factors, etiological agents and outcome of early and late ventilator associated pneumonia in paediatric intensive care unit at a tertiary care centre. International Journal of Contemporary Pediatrics. 2018; 5(3):708-713.

3.     V. Hemavathy, et.al. A study to assess the effectiveness of structured teaching program on knowledge regarding prevention of ventilator associated pneumonia among the staff nurse working in intensive care unit. International Journal of Current Advanced Research. 2017; 6(2):2324-2325.

4.     Maria Cernada, et.al. Ventilator-Associated Pneumonia in Neonatal Patients: An Update. Neonatology. 2014; 105:98–107.

5.     Ankita Sharma. A Descriptive Study to assess the knowledge of staff nurses regarding ventilator associated pneumonia (VAP) among patient admitted in intensive care unit at selected hospital, Jalandhar (Punjab). IOSR Journal of Nursing and Health Science. 2019; 8. (2): 56-59.

6.     Sulochana Ghirime, Srijana Neupane. A study to find out the knowledge regarding prevention of Ventilator Associated Pneumonia (VAP) among nurses in a tertiary hospital, Rupandehi, Nepal. Journal of Universal College of Medical Sciences. 2018; 6(17): 27-31.

7.     JayalakshmiNarasimhaiah, PraveenaMoorthy. Effectiveness of Structural Teaching Programme on Knowledge Regarding Prevention of Nosocomial Infection among Staff Nurses in Selected Paediatric Hospitals of Bengaluru, Karnataka, India. J. Evolution Med. Dent. Sci. 2018; 7(35): 3811-3815.

 

 

 

Received on 04.07.2019         Modified on 20.07.2019

Accepted on 07.08.2019      ©A&V Publications All right reserved