Professional Documents
Culture Documents
BANGALORE, KARNATAKA.
FOR DISSERTATION
INTRODUCTION
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Oxygen is a non-metallic gas chemical element symbolized by <<O>>. It is the
fifth constitutive element of the atmosphere and totally bonded to all life forms. The
ancient Greeks and Chinese, believed that the atmosphere contains a substance necessary
for life, and noticed the existence of oxygen. Leonardo da Vinci in 1500 AC. propounded
the theory that the animal kingdom needs an element of the atmosphere to sustain life. In
1600 Robert Boyle propounded the theory that both respiratory function and fire use
The element of oxygen was officially discovered by Joseph Pristley in 1774 and
took the name it carries today by Lavoisier who believed that this element is the
indicators determine the need to an immediate oxygen therapy: hypoxemia, that is, the
low partial pressure of oxygen in the arterial blood, or hypoxia, that is, the necessity of
oxygen in the cells. All the above prove that oxygen is a great medicine for many
pathological cases.1
concentration than cannula, Nasal cannula – provides low moderate oxygen concentration
(22% - 40%). Oxygen tent helps in achievement of lower oxygen concentration (Fi O2 up
to 0.3 – 0.5). Oxygen hood helps in achieving high oxygen concentration (Fi O2 up to
1.00). The mode of delivery is selected on the basis of the concentration needed and the
child’s ability to cooperate in its use. The concentration of oxygen delivered should be
regulated according to the individual child’s needs. There are hazards related to its uses,
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therefore oxygen should be continued only as long as needed. Humidification of the gas
patients. The administration of oxygen in the United States began in the 1920’s. WHO
cyanosis and inability to drink. Oxygen should also be given in a child with grunting and
to the proper oxygen therapy. High flow systems are more dependable devices for
oxygenation and their use needs to be stressed. Patients on oxygen therapy needs close
monitoring. Five million babies die every year in the world. Of them 98% deaths occur in
the developing countries. Of those, one million or 24% are contributed by India. This
high rate of neonatal death is due to asphyxia or lack of oxygen to fetus and new born
baby (20%).4
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Oxygen is an indispensable element of life; its deficiency has deleterious
consequences to all organs of the human body leading eventually to cell dysfunction and
death. Oxygen supplementation is used on a daily basis in clinical practice. Also oxygen
therapy is highly specialized and its prescription must be tailored on an individual basis.
Health care professionals and nurses use oxygen therapy empirically without sufficient
knowledge of its indications, dosage, side effects and toxicity. Oxygen therapy is a
nursing procedure where specific medical orders should be given in order to minimize
An article cited that, oxygen therapy aims to increase the partial pressure of
addition to its therapeutic effects, the adverse effects and drawbacks of oxygen should be
known. Several methods and devices for the administration of supplementary oxygen are
available. Selection of the method should be individualized according to the patient’s age
and disease.6
A study was conducted on omissions and errors during oxygen therapy in Greece.
The sample consisted of 105 head nurses working in 7 hospitals. Data were collected
after interview using an interview schedule. Data are expressed as percentages and
analyzed using Chi-square test. The study findings revealed that 41% of head nurses
believed that oxygen is a gas which improves patients’ dyspnea. Majority of the nurses
(88.6%) stated that there was no protocol for oxygen therapy in the department in which
they worked. It was found that oxygen therapy was commonly started, modified,
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discontinued by nurses in the absence of a medical order. The study results indicate that
Guinea. Objective of the study was to investigate the severity and duration of
evaluation of children with severe or very severe pneumonia was done by comparing
with a retrospective control group for whom oxygen administration was guided by
clinical signs. The researcher evaluated whether there was a survival advantage from
using a protocol for the administration of oxygen based on pulse oximetry. The results
showed that in 151 well, normal children, the mean SpO2 was 95.7% (SD 2.7%). The
median SpO2 among children with severe or very severe pneumonia was 70% (56 – 77);
376 (53.5%) had moderate hypoxaemia (SpO 2 70-84%) ; 202 (28.7%) had severe
hypoxaemia (SpO2 50-69%); and 125 (17.8%) had very severe hypoxaemia (SpO2
<50%). After 10, 20 and 30 days from the beginning of treatment, respectively 102
(6.5%) died. The researcher concluded that there is a need to increase the availability of
the clinical signs and risk factors of hypoxaemia. In moderate sized hospitals a protocol
for the administration of oxygen based on pulse oximetry may improve survival.8
4
A study was conducted on oxygen therapy for children. A need-based preparation
and evaluation of a self-instructional module for staff nurses on care of a child receiving
oxygen therapy. The study was conducted in two phases. A survey approach was used for
Phase –I and one group pre-test, post-test design was adopted for Phase-II. The total
sample of the study was 30 staff nurses, with 6 months experience in Paediatric Ward.
The findings of the study showed high learning need status in most of the areas and the
staff nurses also expressed the desirable need for learning in detail. It was found that age,
total years of experience, experience in paediatric ward and married with or without
children were independent of their learning need. SIM was effective in terms of gain in
patients with hypoxaemia to prevent death. Health care professionals especially nurses
seem to use oxygen therapy without sufficient knowledge of its indications, dosage, side
effects and toxicity. However oxygen therapy is a fundamental part of the nursing care
and is a commonly used nursing procedure. From the available literature reviewed it is
evident that, there is little information for health professionals regarding indications for
administration and deciding on the source for oxygen. So the researcher felt it relevant to
assess the knowledge and practice of paediatric staff nurses regarding oxygen therapy,
and to develop an information booklet with appropriate guidelines on oxygen therapy for
the paediatric nursing professionals. This will help to provide efficient and safe methods
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6.2. REVIEW OF LITERATURE
process. A literature review helps to lay the foundation for a study, and can also inspire
new research ideas. A literature review also plays a role at the end of the study when
oxygen administration decisions. This study aimed to examine the effect of an education
test/post-test quasi-experimental design was used. The intervention was a written self
directed learning package. Outcome measures were (i) factual knowledge measured using
parallel form multiple choice questions and (ii) clinical decisions measured using parallel
form MCQs, parallel form patient scenarios and clinical practice observation. The study
sample consisted of 88 nurses, 37 nurses were in control group and 51 were there in
patients scenario (n=20) and clinical practice observation (n=10). The study findings
patients scenario data and clinical practice observation showed decreased selection of
nasal cannula, increased selection of masks and trend towards selection of higher oxygen
flow rates following education. The researcher concluded that evaluation of educational
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clinical environment, which are valid in terms of the clinical context and culture in which
A study was conducted on comparison of nasal prongs with nasal catheters in the
delivery of oxygen to children with hypoxia. The objective of the study was to estimate
the frequency of complications when nasal catheters or nasal prongs are used to deliver
oxygen. Ninety – nine children between 2 weeks and 5 years of age with hypoxia were
randomized to receive oxygen via nasal catheter (49 children) or nasal prongs (50
oxygen flow rates between the two groups. Mucus production was more of a problem in
the catheter group. Nasal blockage, intolerance to the method of administration, and
nursing effort were generally higher amongst the catheter group, but these differences
were not significant, except for nursing effort, when all age groups were analysed
together.12
A study was conducted to examine the current oxygen prescribing practice and
patients receiving oxygen therapy over a four week period, during pre and post education
sessions. Education was on oxygen prescribing and oxygen therapy. The study findings
showed that oxygen was often poorly prescribed by doctors and at times poorly
administered by nurses. Among the 55 patients audited during pre education, only 5%
had a prescription. This increased to 20% during post education (p=0.042). The initial
audit uncovered 14 issues regarding oxygen delivery. This fall to one post education
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(p<0.001) reassuringly all patients had arterial oxygen saturation recorded. The study
findings concluded that current rates of oxygen prescribing remain unsatisfactory despite
doctors being made aware of the audit findings but education on oxygen therapy
improved the practice of oxygen delivery among nurses to patients in respiratory ward.13
administration is evidence based. The aim of the audit was to review oxygen
administration practices against the guidelines but also to gather information concerning
patients, diagnoses, prescription practices and delivery devices. The notes of 36 infants
and children admitted during a two week (winter) period who received oxygen were
retrospectively reviewed for the audit. The standards for monitoring the amount of
oxygen delivered and oxygenation were found to be high but the prescribing of oxygen
was varied. The most common diagnosis of children receiving oxygen was broncholitis,
and the device used to deliver oxygen most frequently was nasal cannula. Few head
boxes were used and experienced team members noted this as a marked change in
practice. A further examination of the evidence on the use of nasal cannulae for oxygen
care, and safety of the method and complications. In summary, it is concluded that all
low-flow methods, i.e., nasopharyngeal catheters, nasal catheters and prongs, are
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effective in the oxygenation of sick children with severe pneumonia or bronchiolitis.
Nasal prongs are the safest method of oxygen delivery, but nasopharyngeal catheters and
nasal catheters are more easily available and less expensive. However, if they are used,
they need close supervision to avoid serious complications. Nasal prongs are the method
A prospective study was carried out to assess the knowledge level of nurses
working in hospitals concerning the oxygen supply to patients and the safety regulations
that rule it. The study sample consists of 672 nurses. Data was collected by means of a
questionnaire, which contained 35 closed ended questions. The study findings revealed
that nurses have adequate knowledge in matters of oxygen therapy and the nurses who
The study findings concluded that the results while not disappointing, prove the constant
need to renew knowledge with systematically organized programmes and the need to
realize the responsibility one must show and have while exercising the profession as a
nurse.16
A study was conducted on hypoxaemia among children. The aim of the study was
hypoxaemia. The researcher also established baseline mortality rate data for all children
retrospectively over 3 years. A total of 1313 admissions were studied prospectively in the
five hospitals. Altogether, 384 (29.25%, CI 26.8-31.8) had hypoxaemia, defined as SpO2
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<90%. The incidence of hypoxaemia was much greater in highland hospitals (40% of all
admissions) than on the coast (10% of all admissions). Clinical signs proposed by WHO
as indicators for oxygen would have missed 29% of children with hypoxaemia and, if
these clinical signs were used, 30% of children without hypoxaemia would have been
improve the detection of hypoxaemia and the availability of oxygen has been trailed in
these five hospitals and a programme of clinical and technical training in the use and
Oxygen was administered to all the children by head box, face mask, nasopharyngeal
delivered at a flow rate of 4 l/min in the head box and by face mask and at a rate of 1
l/min for nasopharyngeal catheter and twin-holed prenasal catheter. The study findings
revealed that, there was a significant rise in PaO2 and SaO2 values with all the oxygen
delivery methods. The number of children who achieved PaO2 of > 90 mmHg with
oxygen delivered by head box was 53 (69 %), with face mask 37 (57 %), with
nasopharyngeal catheter 13 (26 %), and with twin-holed prenasal catheter 18 (25 %). A
further pilot study involving 10 children was carried out to compare the efficacy of head
box and twin-holed prenasal catheter at an identical oxygen flow rate of 4 l/min. The
number of children achieving PaO2 of > 90 mmHg were comparable, i.e. seven (70 %)
and eight (80 %) when the oxygen was delivered by head box and twin-holed prenasal
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catheter, respectively. The study findings conclude that both head box and twin-holed
prenasal catheter are equally effective, acceptable and safe methods for administration of
use of nasal prongs with nasopharyngeal catheters among hypoxic children. One hundred
and twenty-one children between the ages of 2 weeks and 5 years with hypoxia due to
ALRI were randomized to receive oxygen via a catheter (61 children) and via nasal
prongs (60 children). The two groups were similar in terms of diagnoses, clinical severity,
oxygen saturation on admission, case fatality rates and incidence of hypoxemic episodes.
The oxygen flow rates required on the day of admission for adequate oxygenation (SaO2
> 90%) ranged from 0.8 liters per minute to 1.2 liters per minute. The required
oxygen flow rate decreased during the course of treatment. The study findings revealed
that ulceration or bleeding of the nose was significantly more common in the catheter
group (19.7% Vs 6.7%, p < 0.05). Abdominal distension and nasal perforation were not
seen in either group. This study suggests that nasal prongs are safer, more comfortable
and require less nursing expertise than nasopharyngeal catheters for administration of
oxygen to children.19
consideration for treating hypoxaemia when face mask therapy is impractical or when
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patient intolerance or non-compliance regularly interrupt treatment. The effectiveness of
the NPO route has been validated in post anesthetic care and paediatric intensive care
units, but use in the ICU remains minimal. Recent research in an ICU setting has shown
patients. The study findings conclude that, NPO administered via a fine catheter
advanced into the nasopharynx, should be considered when face masks or nasal prongs
are impractical or poorly tolerated and, because of its effectiveness and improved
comfort, in patients for whom traditional non- invasive oxygen therapy is indicated.20
About118 children between 7 days and 5 years of age with oxygen saturation (SaO 2) less
than 90% were randomly selected to receive oxygen by nasopharyngeal catheter (n=56)
and nasal prongs (n=62). A crossover study to determine the flow rate necessary to
achieve SaO2 of 95% was performed in 60 children. This study results shows that among
112 children oxygenated by the allocated method, in six, oxygenation was poor with
either method. In the crossover study the prongs needed, on average, 26% higher oxygen
flow rates than the nasopharyngeal catheter to obtain a SaO 2 of 95% (p=0.003). Complete
group and in 8 (13%) in the prongs group (p<0.001). The researcher concluded that nasal
prongs are less prone to complications, and oxygenation in children is equally effective,
and they are more appropriate method than the nasopharyngeal catheter for oxygen
delivery to children.21
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6.3. STATEMENT OF THE PROBLEM:
1. assess the paediatric staff nurses knowledge regarding oxygen therapy in children.
2. assess the practice of oxygen therapy for children among paediatric staff nurses.
4. associate the mean knowledge scores with the selected demographic variables.
6.5 HYPOTHESIS:
H1: There is a significant positive correlation between the mean knowledge and
H2: There is a significant association between the mean pre-test knowledge scores and
H3: There is a significant association between the mean practice scores and selected
demographic variables.
1. Assess:
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It refers to the process used to identify the level of knowledge and practice of
2. Knowledge:
nurses regarding oxygen therapy as evident through their knowledge scores which is
knowledge.
3. Practice:
4. Oxygen therapy:
This is the treatment with oxygen, a colour less, odour less gas intended to relieve
It refers to the registered nurses working in the branch of nursing concerned with
6. Information Booklet:
It refers to a bulletin booklet prepared by the investigator and valid by experts, which
contains information regarding various aspects of oxygen therapy for paediatric staff
nurses.
14
In this study it refers to age, education and years of experience of paediatric staff
nurses.
6.7. ASSUMPTIONS:
skill in performance.
6.8. DELIMITATIONS:
knowledge questionnaire.
- practice will be assessed on the basis of one observation as observed with the
observation checklist.
15
Sample size : 100 Paediatric staff nurses
Setting of the study : Colombo Asia Hospital, Indira Gandhi Institute of Child
INCLUSION CRITERIA
EXCLUSION CRITERIA
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A structured knowledge questionnaire will be prepared to assess the knowledge of
will also be prepared for paediatric staff nurses regarding oxygen therapy. Content
validity of the tools will be ascertained in consultation with guide and experts from
half method. An inter rater reliability will be done for the observation checklist which is
Prior to the study, written permission will be obtained from the concerned
authority. Further consent will be taken from the participants regarding their willingness
to participate in the study. The proposed period of data collection will be in August 2009.
relationship between knowledge and practice regarding oxygen therapy among staff
nurses.
A Chi-square will be done to find out association between knowledge and practice
17
7.3. DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR
YES.
YES.
c) Consent will be obtained from the paediatric staff nurses before conducting the
study.
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8. LIST OF REFERENCES
2. Wong’s. A text book of Nursing Care of Infants and Children. 8th ed. Missouri;
Mosby Publication; 2007; P.No.1287-1288.
3. Dutta AK, Aggarwal A, Singh A. A text book of Recent Trend in Paediatric. 3rd ed,
Blunmer JE; Mosby Publication; 1992; P.No. 352-353.
5. J.D. Fulmer and G.L. Sinder. American College of Chest Physicians (ACCP).
National Heart Lung and Blood Institute Conference on oxygen therapy. Chest:
86 (1984) (2), PP. 234-247.
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9. Machado A, Bhaduri A, George A. Oxygen therapy for children Need- based
preparation and evaluation of a self-instructional module for staff nurses on care
of a child receiving oxygen therapy. Nursing Journal of India. 1998 Jun; 89(6):
125-7.
10. Polit F Denise. A text book of Nursing research Principles and Methods 7th ed.
Philadelphia. Lippincott Publications. 2004. P. No:88,89,722.
11. Considine J, BottiM, Thomas S. The effects of education on hypothetical and actual
oxygen administration decisions. Nurse Education Today 2007 Aug; 27(6): 651-
60.
17. Wandi F, Peel D, Duke T. Hypoxaemia among children in rural hospitals in Papua
New Guinea: epidemiology and resource availability—a study to support a
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national oxygen programme. Annual Tropical Paediatrics. 2006 Dec; 26(4):
277-84.
18. Kumar RM, Kabra SK, Singh M. Efficacy and acceptability of different modes of
oxygen administration in children. Journal Tropical Pediatrics. 1997 Feb; 43(1):
47-9.
20. East wood GM, Dennis MJ. Nasopharyngeal oxygen as a safe and comfortable
alternative to face mask oxygen therapy. Australia Critical Care. 2006 Feb;
19(1): 22-4.
21. Weber MW, Palmer A, Oparaugo A, Mulholland EK. Comparison of nasal prongs
and nasopharyngeal catheter for the delivery of oxygen in children with
hypoxemia because of a lower respiratory tract infection. Journal of Pediatrics.
1995 Sep; 127(3): 378-83.
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9. SIGNATURE OF CANDIDATE
11.
NAME AND DESIGNATION Mrs. ASHA ANDREWS
11.2 SIGNATURE
11.4 SIGNATURE
12.
12.2 SIGNATURE
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