A

PROJECT REPORT

ON

“JOB SATISFACTION AMONG NEUROCRTICICAL CARE NURSES IN A TERTIARY

CARE HOSPITAL-A CROSS SECTIONAL STUDY ”

SUBMITTED

To

CENTRE FOR ONLINE LEARNING

Dr. D.Y .PATIL VIDYADEETH,

PUNE

IN PARTIAL FULFILMENT OF DEGREE OF

MASTERS OF BUSINESS ADMISTRATION

BY

Dr.S.Balaji

STUDENT

1
 PRN:20090197

BATCH 2020-2022

2
 Dr. D.Y. Patil
Vidyapeeth’s CENTRE FOR
ONLINE LEARNING,
Sant Tukaram Nagar, Pune.

CERTIFICATE

This is to certify that Dr.S.Balaji

PRN - 20090197

has completed his internship at MEENAKSHI MISSION HOSPITAL AND

RESEARCH CENTRE MADURAI

Starting from 1/ 10 /21to 31/10/21.

His project work was a part of the MBA (ONLINE LEARNING)

The project is on “JOB SATISFACTION AMONG NEUROCRITICAL NURSES IN

A TERTIARTY CARE HOSPITAL- A CROSS SECTIONAL STUDY”

Which includes research as well as industry practices. He was very sincere and

committed in all tasks.

Course Coordinator Director

Date -

3
 COMPANY LETTER

(TO BE PROVIDED BY THE COMPANY WHERE THE PROJECT WILL BE

CARRIED OUT)

To whomsoever it may concern

This is to certify that Dr.S.BALAJI

PRN - 20090197

has completed his internship at MEENAKSHI MISSION HOSPITAL AND RESEARCH

CENTRE

starting from 1/10/21 to 31/10/21

His / Her project work was a part of the MBA (ONLINE LEARNING)

The project is on JOB SATISFACTION AMONG NEUROCRITICAL NURSES IN A

TERTIARTY CARE HOSPITAL- A CROSS SECTIONAL STUDY

Which includes research as well as industry practices. He/ She was very sincere and committed
in all tasks.

Signature & Seal of Industry Guide

4
 DECLARATION BY STUDENT

This is to declare that I have carried out this project work myself in part fulfillment of the
M.B.A Program of Institute of Distance Learning of Dr. D.Y. Patil Vidyapeeth’s, Pune –
411018

The work is original, has not been copied from anywhere else, and has not been submitted to
any other University / Institute for an award of any degree / diploma.

Date: - Signature:-

Place: Name:

5
 ACKNOWLEDGEMENT

I am delighted to thank my nursing staff members in neuro critical care unit who readily

accepted to be a part of my study.

I wish to thank my D Y Patil Coordinator Mr.Subash Kate who helped me throughout my MBA

course and Dr.Yogesh Jogare sir who guided me for this project .

I thank my father Mr.G.S.Sekher and Mother Mrs.k.Usha who helped me to complete my MBA

course,I also thank my wife Dr.S.V.Varsha and my little daughter B.Aadhya who cooperated

with me to complete my thesis topic.

I also thank Mr.Alagumuni sir who grant me permission to do this thesis in one of the

prestigious tertiary care hospital in South Tamilnadu .

Lastly I thank almighty for guided me from my inner soul to complete this project.

6
 Table of content

Sr. Item Page No

No.
1 Title Page 1

2 Institute Certificate 2

3 Company Certificate 3

4 Declaration by Student 4

5 Acknowledgement 5

6 INDEX 6

7 Executive Summary 8

8 Chapter 1: Introduction (Company Profile 9

& General Introduction of Topic)

& Objective, Scope and Purpose of Study

9 Chapter 2: Literature Review 11

01 Chapter 3: Research methodology 33

11 Chapter 4: Data Analysis 35

12 Chapter 5: Findings, suggestions, 47

recommendation

7
13 Chapter 6: Conclusion 49

14 Bibliography ( Books, Journals, research 50

work)

15 Annexure -A Questionnaire 53

16 C- Photograph, Drawings

8
 EXECUTIVE SUMMARY

Neuro critical care nursing in healthcare is a challenging job ,and even I they are

adequately trained , job satisfaction may not be cent percent even if the management

and seniors are supportive due to various other reason .In this study we tried to find

out the reasons for dis satisfaction among neuro critical care nurses ,and gave

suggestions to improve the satisfaction level of these nurses.

This study is carried out by the principle investigator in a 25 bedded neuro critical

care unit of a big tertiary care hospital in the South Tamilnadu .

Totally 30 nurses are working in this NCCU , they have three shift of duties each

lasting for eight hours.

The treating physician team consist of 2 senior consultants and 5 resident doctors and

three medical officers. The management team of the hospital consist of four ward

managers who are in charge of neuro surgery department and 5 operations managers

who are the in charge of entire hospital and a medical administrator of the hospital.

This is a questionnaire based study to find out the satisfaction level of the neuro

critical care nurses and at the end of the study suggestions are given , if they are

implemented properly definitely the satisfaction level among the neuro critical care

nurses definitely improve.

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CHAPTER -1 INTRODUCTION
Job satisfaction of critical care nurses has become a popular topic of recent research

studies in healthcare within the United States [1,2,3,4]and globally [5] Ongoing

changes in the healthcare system, emphasis on cost-effectiveness and use of new

sophisticated equipment create challenges to nurses caring for the critically ill patient

with implications to job satisfaction.

Dissatisfaction and shortage of critical care nurses impact patient[6,7], nurse retention

[8]and cost effectiveness .Critical care nurses also function under an increased level

of stress [9]

The shortage of nurses in critical care is unsafe for patient care, expensive for the

healthcare organization and increases stress levels . By 2015, there will be a need for

114,000 more critical care nurses in the U.S. resulting from nurses leaving the critical

care setting to work elsewhere [10]

Above five million patients are admitted each year into critical care units with

numbers increasing from higher life expectancy of people [11].With a higher

population of aging patients in the intensive care setting the demand for critical care

nurses is greater

This study was conducted at a tertiary care hospital in a two tire city in South

Tamilnadu. Neurocritical care Unit in this hospital consist of 20 beds and taken care

by set of 5 - 6 nurses during each shift (eight hours per shift).

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Most of the patients admitted in this Neuro critical care unit are traumatic brain injury

patients (Moderate to severe head injury) and neuro oncology and neuro vascular

patients.

These patients are very vulnerable and need close monitoring of GCS, vitals and

Pupillary reaction. Most of the patients are either intubated and tracheostiomized and

need regular Endotracheal tube care and tracheostomy tube care. Sometimes some

patient may have drop in GCS and need immediate surgical intervention so close

monitoring is absolutely necessary.

So taking care of these patients is very difficult for nurses unless they are properly

trained. But at the end of the day most of the nurses working here feel overburdened

but clinical outcome by the timely intervention make them feel happy.

This study is a questionnaire survey study to know the job satisfaction among the

nurses working in the neuro critical unit in this hospital. Based on this questionnaire

study necessary changes and suggestions will be given which can be implemented to

increase the job satisfaction of neuro critical nurses and to improve the patient

outcome.

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CHAPTER-2 REVIEW OF LITERATURE

Nurses are the backbone of the healthcare industry and they are the first person to

attend the patients in the wards and critical care units in case of emergencies. So it is

necessary for them to closely access the patient and inform the duty doctors and

consultants for further patient care.

In neuro critical care nursing nurses should monitor the patient closely and monitor

the following parameters

GCS [12]

A. Pupillary response

B. Vitals Like Heart rate, BP, temperature, respiratory rate

C. Intake and output charting

In special circumstances

1. ICP monitoring

2. Jugular venous oxygen saturation

Other than this basic works for patient should be carried out such as :

1. Giving medication and Injections to the patient

2. Frequent change of position and back care to prevent bed sores

3. To give general nursing care like mouth care, grooming, dressings etc

4. To assist the doctors in minor procedures like suturing, wound dressings and

drain tube removal.

12
Other than these patient care related work they should also do some basic

administrative work and monitoring work like checking the crash cart drugs ,

checking the bed sheets and pillow count, sending the soiled linen to laundry and

getting back the same, shifting the patient from ward to NCCU and vice versa,

shifting the patients to CT scans and MRI with the help of ward assistants and she

also wants to control and instruct the ward assistants for proper patient care

She should also want to communicate with the

1. Doctors: Regarding patient blood test and CT scan reports

2. Administration :Regarding patient bill payment and inform the ward manager

before shifting the patients from ward to NCCU and vice versa

3. Patient attenders :Regarding patient’s health status

GLASGOW COMA SCALE

Glasgow Coma Scale (GCS) Appropriate clinical assessment of neurological status

provides the nurse with the most sensitive measure of neurological deterioration. The

Glasgow Coma Scale (GCS) is the tool generally used by nurses in the UK to assess

neurological function

Unfortunately, this tool becomes less reliable when the patient is artificially sedated

with medication. However, it is essential that every critical care nurse has an adequate

understanding of the GCS and its potential limitations in critical illness

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 It consists of three assessment areas—eye opening, verbal response, and motor

function.

The maximum possible score is 15 and the minimum possible score is 3.

The GCS measures the following functions:

Eye Opening (E)

 4 = spontaneous

 3 = to sound

 2 = to pressure

 1 = none

 NT = not testable

Verbal Response (V)

 5 = orientated

 4 = confused

 3 = words, but not coherent

 2 = sounds, but no words

 1 = none

 NT = not testable

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 Motor Response (M)

 6 = obeys command

 5 = localizing

 4 = normal flexion

 3 = abnormal flexion

 2 = extension

 1 = none

 NT = not testable

Clinicians use this scale to rate the best eye opening response, the best verbal

response, and the best motor response an individual makes. The final GCS score or

grade is the sum of these numbers.

Using the Glasgow Coma Scale

A patient's Glasgow Coma Score (GCS) should be documented on a coma scale

chart. This allows for improvement or deterioration in a patient's condition to be

quickly and clearly communicated.

Individual elements, as well as the sum of the score, are important. The individual

elements of a patient's GCS can be documented numerically (e.g. E2V4M6) as

well as added together to give a total Coma Score (e.g E2V4M6 = 12). For

example, a score may be expressed as GCS 12 = E2 V4 M6 at 4:32.

15
 Every brain injury is different, but generally, brain injury is classified as:

 Severe: GCS 8 or less

 Moderate: GCS 9-12

 Mild: GCS 13-15

PUPILLARY RESPONSE

Pupil changes are attributable to pressure on the third cranial nerve (oculomotor

nerve), and normally indicate pressure that may be a result of the early stages of

tentorial herniation. Initial changes occur ipsilaterally (on the same side as injury), but

later changes are contralateral (on the opposite side to injury). Pupil changes tend to

present progressively. Initial and later changes are as follows:

• Pupil shape becomes ovoid.

• Pupil begins to dilate ipsilaterally, but still reacts to light.

• Pupil fixes ipsilaterally.

• Contralateral changes occur.

Physiological changes

There is a pattern of physiological changes as intracranial pressure increases. This

pattern is referred to as Cushing’s triad, and represents the body’s attempt to

compensate for rising intracranial pressure and the effects of increasing pressure on

the brainstem. Changes include:

• hypertension with a widening pulse pressure

• bradycardia caused by midbrain compression

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• alterations to respiratory rate (may not be apparent in ventilated

patients).

COMPARATIVE MOTOR ASSESMENT

Motor assessment is part of the GCS, but during GCS assessment ‘best

motor function’ is tested. Comparative motor function testing is observing for

differentiation in sides; therefore this test is looking for signs of contralateral

weakness or hemiparesis. Contralateral changes occur because the nerve fibers cross

over at the decussation of pyramids in the medulla oblongata. Subjective assessment

of limb power may be unreliable, so it is normally preferable to use an objective

assessment.

Other signs of rising intracranial pressure It is important that the critical care nurse

also monitors the patient for other signs that may indicate a rising ICP, including fluid

and temperature regulation problems.

DIABETES INSIPIDUS

Diabetes insipidus may occur as the intracranial pressure rises. As tentorial herniation

begins, pressure increases around the area of the hypothalamus and pituitary gland.

Pressure on the posterior part of the pituitary gland inhibits the production of

antidiuretic hormone, and massive diuresis occurs. Therefore it is important to

observe for any increases in urine output that are not attributable to increased fluid

intake (e.g. from volume resuscitation). Synthetic antidiuretic hormone may be

administered to prevent hypovolaemia, which would worsen cerebral blood flow and

potentially further increase ICP.

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PYREXIA

Temperature increases may also reflect increasing pressure on the hypothalamus.

However, they may also indicate the presence of infection, so should be viewed

alongside the patient’s white cell count and other markers of infection.

MONITORING

Alongside assessment of neurological status using the GCS and associated tools, some

critically ill patients may require more advanced neurological monitoring. This is

especially important once the patient is sedated, as traditional forms of assessment

then become less reliable.

A number of monitoring tools are available for this. They include:

• intracranial pressure monitoring

• cerebral (brain) oxygen monitoring

• transcranial Doppler monitoring

• electroencephalogram (EEG)

• sedation monitoring

INTRACRANIAL MONITORING

Intracranial pressure is the pressure exerted within the cranium by the brain, the

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blood, and the cerebrospinal fluid. Therefore if one of these three components

changes, the pressure within the cranium (i.e. the ICP) will alter. Although the

Monro–Kellie hypothesis describes the ability for some compensation to occur, this is

relatively limited, so it is important to have an accurate reflection of ICP in some

critically ill patients.

Normal ICP

• Normal ICP is generally considered to be < 10 mmHg.

• ICP of > 20 mmHg is normally treated in critical care.

• Prolonged increases in ICP are associated with increased neurological damage and

increased mortality rates.

CEREBRAL PERFUSION PRESSURE

Although ICP may be useful in the management of the critically ill patient, cerebral

perfusion pressure (CPP) may provide a better guide to brain perfusion. CPP is

calculated by the monitor if ICP measurement is in situ.

The calculation generally used is CPP = MAP – ICP. Normal CPP is

70–90 mmHg.

ICP and CPP measurements are normally utilized to:

• diagnose cerebral pressure and perfusion problems

• monitor the effects of medical and nursing interventions on ICP

• enable calculation of CPP

• guide treatment plans.

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ICP monitoring

Several types of monitoring tools are available. The gold standard is considered to be

ventricular monitoring, where the ICP probe is inserted into the lateral ventricles. The

benefit of intraventricular systems is that CSF drainage may be facilitated to reduce

an increased ICP.

Other types of ICP monitoring include subdural monitoring and parenchymal

monitoring.

Risks associated with ICP measurement include:

• infection

• haemorrhage

• poor positioning

• malfunction

• obstruction.

BRAIN TISSUE OXYGENATION MONITORING

The need to monitor brain oxygen levels directly has led to the development of tools

that can measure (among other parameters) brain tissue oxygen levels.

These tools provide values for the partial pressure of brain oxygen

(PbtO2). This gives more accurate information about oxygen delivery and demand,

and may be used to measure local areas of oxygenation within the brain.

20
This may then be utilized to guide therapy.

• Normal PbtO2

: 25–50 mmHg.

• Ischaemic PbtO2

: < 15 mmHg

• Brain cell death PbtO2

: < 5 mmHg.

These monitors are usually ‘multimodal’, and have the facility to measure local brain

temperature and ICP.

When using systems that measure brain oxygenation it is important to

remember that this information must be considered alongside other variables to

provide a holistic picture of the patient’s condition.

TRANSCRANIAL DOPPLER

The transcranial Doppler is a non-invasive tool that utilizes ultrasound technology to

measure blood velocity in the cerebral arteries (usually the middle cerebral artery, but

it can also assess the anterior and posterior cerebral arteries, the ophthalmic artery,

and the internal carotid artery).

The Doppler works by emitting a signal from a probe which generates

a wavelength signal as it is reflected by the red blood cells. This in turn is converted

to a waveform which provides important information about the blood flow in that

vessel. The Doppler machine is able to provide information about systolic, diastolic,

21
and mean blood flow velocity. It may be used in several different groups of patients to

provide information to guide treatment

Uses include:

• assessment of vasospasm and hyper-perfusion states in patients with

subarachnoid haemorrhage and traumatic brain injury

• estimation of cerebral perfusion pressure when invasive monitoring is not or cannot

be used

• determination of the adequacy of collateral blood flow during carotid artery surgery

• assessment of embolisms in patients with stroke or transient ischaemic attack (TIA).

ELECTROENCEPHALOGRAMS

The electroencephalogram (EEG) may be a useful tool for highlighting some

problems in neurological patients. However, it is important to note that it does require

skilled interpretation to determine changes to the patient. Put simply, the EEG

measures voltage fluctuations within the brain. This activity is recorded by using

surface or needle electrodes and is then converted to a trace on the EEG monitor.

Within critical care areas it may be used:

• to monitor cerebral activity

• to monitor patients with epilepsy, especially when muscle relaxants are

being used, as these may prevent outward signs of seizure activity

• to confirm the diagnosis of epilepsy

• to help to predict the outcome for a patient in a coma

• as an adjunct in determining brainstem death (not part of the formal

process for determining brainstem death in the UK;

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• to monitor cerebral activity when using barbiturates (thiopental,

phenobarbitone, phenobarbital) in head injury patients.

TRAUMATIC BRAIN INJURY

Definition

Traumatic brain injury occurs when there is damage to the brain as a result of trauma.

Trauma may be caused by:

• acceleration injuries, in which a moving object strikes the head

• acceleration and deceleration injuries, in which the head strikes a

stationary object

• coup and contrecoup mechanisms of injury, in which the brain moves

backward and forward within the cranial cavity

• rotational injuries, in which neurons within the brain are rotated and stretched

• penetration injuries, in which a sharp object penetrates the brain.

Head injuries are classified in several ways. A key classification is into primary and

secondary injuries.

• Primary injury occurs at the time of trauma. The effects of primary

injury may be irreversible.

• Secondary injury occurs after the initial event and worsens the initial damage.

Secondary injury may be caused by hypoxia, hyercapnia,

hypotension, infection, ischaemia, cerebral oedema, seizures, or

hyperglycaemia. Much of the management of the head-injured patient is

geared toward prevention of secondary damage.

23
Alongside the classification into primary and secondary injuries, head injuries may

also be categorized according to the area affected.

• Extradural haematoma—a collection of blood between the skull and

the outside of the dura, often as a result of middle cerebral artery

laceration. Patients often present with a brief period of lucidity followed by rapid

neurological deterioration. The arterial bleed may quickly compromise the patient and

cause herniation.

• Subdural haematoma—a collection of blood between the dura and the

arachnoid layer, often caused by tearing of the bridging veins. It may present as an

acute, subacute, or chronic injury. It has a worse prognosis than extradural

haematoma.

• Contusions—caused by laceration of vessels in the microvasculature,

which results in bleeding or bruising into the brain tissue. Cerebral

contusions may develop into an intracerebral haematoma.

• Intracerebral or intraparenchymal haematoma—a collection of blood

within the parenchyma. It may be caused by trauma or hypertension

(stroke), and it can result in delayed neurological deterioration.

• Subarachnoid haemorrhage—a collection of blood within the

subarachnoid space. It may be caused by an aneurysm or by tearing of

the microvessels in the arachnoid layer as a result of trauma. The patient may require

cerebral angiography to exclude an aneurysmal bleed.

• Diffuse axonal injury—caused by tearing of the neuronal axons. It is normally

24
associated with rotational and acceleration–deceleration injury.

It usually worsens during the first 12–24 hours. The patient may present in a deep

coma with little alteration to the initial CT scan. Later scans may show severe cerebral

oedema

Assessment findings

Patients will present with:

• changes to neurological function noted from in-depth neurological

assessment

• deteriorating levels of consciousness (those with a GCS score of < 8normally require

intubation)

• changes on the CT scan

• possible haemodynamic changes (hypertension, bradycardia).

Treatment

Treatment aims to prevent secondary injury and should follow an ABCDE

approach.

• The patient’s ability to maintain their airway should be assessed.

• The patient should be intubated if the GCS score is < 8.3

• Intubation may also be necessary if the patient requires scanning and cannot

cooperate due to decreasing levels of consciousness. Intubation might also be deemed

necessary for inter-hospital transfer to a specialist centre.

• Adequate respiratory assessment is vital in all patients. This group of patients may

be susceptible to aspiration pneumonia, especially if consciousness was lost prior to

25
hospitalization.

• Care should be taken to maintain oxygen saturations above 95%. This may require

supplemental oxygen.

• Consideration must be given to other significant injuries that might have an impact

on respiratory function.

• If the patient is intubated, mechanical ventilation will be required.

• Arterial blood gases may be manipulated using ventilation. High levels of CO2 will

increase ICP. Low levels will reduce cerebral blood pressure.

Normal parameters are usually as follows:

• PaO2

: 13 kPa

• PaCO2

: 4.5–5 kPa.

• Ventilated patients should have optimum levels of sedation and analgesia to prevent

increases in ICP.

• Chest physiotherapy and regular turning are required to reduce the likelihood of

chest infection and associated hypoxia. Sedation may be required prior to the

commencement of chest physiotherapy.

Pre-oxygenation may be required prior to suctioning.

• Patients should be nursed at 30° to avoid VAP.

• Care should be taken with positioning if the patient has a suspected spinal injury.

• Cardiovascular and fluid assessment is required for all patients.

• Continuous cardiac monitoring should be commenced for all patients.

26
• Fluid replacement may be given to initially increase blood pressure.

This should be isotonic in nature, and 5% glucose should be avoided (as it will

increase blood glucose levels and potentially cause fluid shifts and/or the

development of cerebral oedema).

• Fluid output should be monitored carefully. A sudden increase in output may be

suggestive of diabetes insipidus.

• In patients with severe head injury, blood pressure is normally artificially elevated

with inotropes to maintain cerebral perfusion pressure.

In patients in whom CPP is not recordable (i.e. those without ICP

monitoring) it may be desirable to aim for a higher mean blood pressure using

inotropic support.

• Temperature should be monitored carefully. Pyrexia will increase oxygen demand

and potentially worsen cerebral oedema.

• Manipulation of temperature using therapeutic hypothermia may be required in an

attempt to reduce cerebral oedema.

• Blood electrolytes should be closely monitored for signs of abnormalities.

• VTE assessment and prophylaxis will be required.

• Regular neurological assessment using the GCS, pupil size, limb assessment, and

cardiovascular changes should be conducted at least hourly for patients with a GCS

score of >9.

• Changes in neurological assessment findings should be escalated immediately.

27
• In patients who are sedated, neurological assessment will be dependent upon pupil

assessment, cardiovascular changes, and potential changes in fluid output. Pupil

assessment should be performed at least hourly, or more often if the patient’s

condition deteriorates.

• Patients should receive appropriate levels of sedation and analgesia. Boluses may be

required prior to care delivery, but care should be taken to avoid sudden drug-related

hypotension.

• When ICP monitoring is being used, care should be taken to maintain ICP and CPP

within set parameters. If the ICP rises, a stepwise approach should be taken to

determine the cause of the increase, and appropriate treatment to reduce the ICP

should be initiated.

• Medical intervention should be sought if ICP remains elevated despite attempts to

reduce it.

• Care should be taken to ensure that consideration is given to other injuries that may

have resulted from trauma

• Patients will require early establishment of nutritional support. This is likely to be

enteral, and care should be taken to avoid nasogastric tube insertion in patients with

skull fractures.

• Medication may cause a tendency to constipation, so early assessment of elimination

needs and appropriate medication is essential.

• Psychological care and communication should be provided for the patient and their

family.

• Pressure area assessment and appropriate interventions will be required.

28
SEIZURES

Definition

Status epilepticus is a clinical term that refers to:

• continuous seizures lasting at least 5 min

• two or more seizures without a period of consciousness between them.

The most common type of status epilepticus is generalized or tonic–clonic seizures.

However, it is important to note that other seizure types may fit into this category.

Causes

There are many factors that may cause the patient to develop status epilepticus. These

include:

• pre-existing epilepsy

• non-compliance with anticonvulsant therapy

• traumatic brain injury

• subarachnoid haemorrhage or stroke

• CNS infection

• cerebral tumours

• cerebral hypoxia

• metabolic abnormalities

• drug toxicity

• chronic alcoholism.

Assessment

The patient will present with signs of generalized seizures that either:

29
• are longer than 5 min in duration or

• involve no recovery of consciousness between seizures.

Treatment

Management should follow an ABC approach.

• The patient should be positioned lying on their side to maintain their airway.

• An artificial airway may be inserted, but only if it is possible to do so without

injuring the patient. This will not be possible during the tonic phase of the seizure.

• Patients with refractory status epilepticus may require intubation.

• Suctioning may be required to maintain airway patency.

• High-flow oxygen should be administered.

• Respiration should be assessed, and if no respiration is apparent, appropriate

respiratory resuscitation should be commenced.

• Patients who are intubated will require mechanical ventilation.

• Cardiovascular status should be evaluated with an appropriate CVS assessment.

• Intravenous access should be secured.

• IV fluids may be required.

• A neurological assessment should be conducted and the cause of the seizure

identified where possible

30
DUTIES OF NURSES

Giving medication and Injections to the patient :Critical care nurses in NCCU also

want to provide the correct dosage of medication punctually and these are lifesaving

drugs. Eg Mannitol given at right time before shifting to Operation theatre saves life

of the patient. Similarly antibiotics should be given at correct dosage at right intervals.

Some drugs like nimodipine should be given six times a day for aneurysmal rupture

patient.

After giving each medication nurses should sign in the drug chart and mention the

time at which the drugs are given.

Frequent change of position and back care to prevent bed sore is absolutely necessary

as most of the patients in neuro critical care unit is unconscious and if position is not

changed frequently, patient may develop pressure sore.

Nurses will coordinate with physio therapist to mobilize the patients within ward for

physiotherapy.

She also wants to spend time to give general nursing care like mouth care, grooming,

dressings etc. for the patient and she should give wholesome care to the patient.

She wants to assist the doctors in minor procedures like suturing, wound dressings

and drain tube removals and provide necessary equipments and dressing materials to

31
the doctors.

Other than these patient care related work they should also do some basic

administrative work and monitoring work like

CHECKING THE CRASH CART DRUGS

These are the essential drugs which are needed in case of emergency and it is one of

the main duties for nurse to make all these drugs available at any point of the time.

CHECKING THE BED SHEETS

Checking the bed sheets and pillow count, sending the soiled linen to laundry and

getting back the same are some of the ancillary works for the nurse and it is necessary

for her maintain the pillow count linen count etc.

SHIFTING THE PATIENTS

She should help in shifting the patient from ward to NCCU and vice versa while

doing this she should communicate the ward manager, treating doctor, and patient

relatives while shifting the patient inside or outside NCCU. She should shift patients

for imaging whenever necessary and shift to operation shifting of the patient.

She should also want to communicate with the

1)Doctors: Regarding patient blood test and CT scan reports and carry out the orders

of doctors and communicate the same to patient attenders

2)Administration: She should communicate with Administration Regarding patient

32
bill payment and inform the ward manager before shifting the patients from ward to

NCCU and vice versa as mentioned earlier.

3)Patient’s Attenders: She should speak with Patient attenders regarding patient’s

health status and convey the doctor’s message in his absence. So nurses should act as

a multifaceted person.

33
CHAPTER-3 RESEARCH METHODOLGY

This study is based on a questionnaire study, and we asked a set of 10 question to 30

nurses working in our NCCU and their response is tabulated, and respondent name is

blinded. Based on their response we will get to know their job satisfaction. Based on

their response’s suggestions will be management to improve the work outcome the

nurses and make the environment more suitable for nurses to work.

So as we mentioned earlier nurse want to work as a multifaceted talented person,and

should have control over her subordinates and work together with management and

doctors and smoothly coordinate with the entire organization .

34
1 The management, Organization and my seniors are

supportive to me.

2 They have provided adequate training to me and I have

learnt new skills from them.

3 I am encouraged by my superiors and they also take my

suggestions and feedback.

4 I am appropriately recognized and appreciated for the job

which I do.

5 I am satisfied with my chances for promotion

6 I used to get opportunities to improve my professional

skills.

7 I have accurate written job description and work

assignment is clearly explained to me.

8 The amount of work which I expected to finish each week

is reasonable and I am evaluated on basis of standard

performance scales.

9 My department provides all necessary resources

,equipments, and supplies to perform my duties.

10 My co workers work well together with me and I feel that

I can easily communicate with members from all level of

organization .

35
CHAPTER 5 DATA ANALYSIS

This study is based on a questionnaire study,and we asked a set of 10 question to 30

nurses working in our NCCU and their response is tabulated and respondent name is

blinded.Based on their response we will get to know their job satisfaction. Based on

their responses suggestions will be management to improve the work outcome the

nurses and make the environment more suitable for nurses to work.

Now let us discuss the data obtained in our questioner study

36
1) The management, Organization and my seniors are supportive to me.

To have a good work outcome , management and seniors work smoothly with the

nurses.

28 nurses agreed that management is supportive and two denied

1)The management, Organization and my seniors are supportive to

me.

7%

93%

AGREE DISAGREE

2) They have provided adequate training to me and I have learnt new skills from

them.

As mentioned earlier nurses should work as a multitalented person and want to

monitor neurocritical care patients closely and inform GCS, Pupillary response and

other vitals to the consultants and want to carry out their orders. So for this adequate

training.

37
24 nurses agreed that adequate training was given to them by the management this

and six denied

2)They have provided adequate training to me and I have learnt new

skills from them.

20%

80%

AGREE DISAGREE

3) I am encouraged by my superiors and they also take my suggestions and feedback.

Seniors should encourage their junior nurses ,and should take their suggestions and

feedback and implement the same if possible to boost the morale of the juniors.

23 nurses agreed management get their suggestions and feedback and seniors

encourage them and seven denied.

38
 3)I am encouraged by my superiors and they also take my
suggestions and feedback.

23%

77%

AGREE DISAGREE
.

4 ) I am appropriately recognized and appreciated for the job which I do.

Whatever be the job the if the staff member is recognized and encouraged for the

same , they will feel happy and perform their duty with full satisfaction.

24 nurses agreed they are aptly recognized by the management and six denied.

39
 4) I am appropriately recognized and appreciated for the job which I
do.

20%

80%

AGREE DISAGREE

5) I am satisfied with my chances for promotion

As a token of recognition people who work hard and sincere must be recognized

should get promoted to next level in seniority,it is not only for seniority in hierarchy

but also for monetary benefit.

20 nurses agreed that they have adequate chances for promotion and this and ten

denied

40
 5) I am satisfied with my chances for promotion

33%

67%

AGREE DISAGREE

6) I used to get opportunities to improve my professional skills

Each employee in an institute wish to improve their professional skills to serve the

institute

25 nurses agreed that the institute is helping to help their professional skills and 5

denied.

41
 6) I used to get opportunities to improve my professional skills

17%

83%

AGREE DISAGREE

7) I have accurate written job description and work assignment is clearly explained to

me.

Accurate description of job and work assignment is very important to carry out the

work properly.

22 nurses agreed that they have clear job description and 8 denied.

42
 7) I have accurate written job description and work assignment is
clearly explained to me.

27%

73%

AGREE DISAGREE

8) The amount of work which I expected to finish each week is reasonable and I am

evaluated on basis of standard performance scales

When the work is completed by the staff nurse it must be properly assessed and

rewarded for the same and there should be proper performance assessment scale for

the same.

22 nurses agreed that there is a proper performance assessment and 8 denied

43
 8)The amount of work which I expected to finish each week is
reasonable and I am evaluated on basis of standard performance
scales

27%

73%

AGREE DISAGREE

9) My department provides all necessary resources, equipment, and supplies to

perform my duties.

For proper performance of duty, necessary equipment and resources must be provided

by the institute.

24 nurses agreed that the necessary resources are given and six denied.

44
 9)My department provides all necessary resources ,equipments, and
supplies to perform my duties.

20%

80%

AGREE DISAGREE

10) My co workers work well together with me and I feel that I can easily

communicate with members from all level of organization.

In any institute all workers must cooperate with each other and complete their job for

the welfare of the institute nurses should communicate with higher officials freely to

carry out her job smoothly.

26 nurses agreed that they work well together and 4 denied.

45
10) My co workers work well together with me and I feel that I can
easily communicate with members from all level of organization .

13%

87%

AGREE DISAGREE

46
CHAPTER -4 DATA ANALYSIS

So as per our questionnaire based study 79.3 % have job satisfaction and 20.6 %

doesn’t have job satisfaction

OVER ALL JOB SATISFACTION AMONG NEURO

CRITICAL CARE NURSES

21%
SATISFIED
NOT SATISFIED

79%

So as per our study 79.3 % have job satisfaction and 20.6 % doesnt have job

satisfaction

CHAPTER 5 FINDINGS,SUGGESSTION,RECOMMENDATION

47
1)The management, Organization and my seniors are supportive to me.

The management and seniors should help their juniors and train, guide them

accordingly and get the work done. Management can arrange nurses training

programme periodically and teach what is right and what is wrong.

2)They have provided adequate training to me and I have learnt new skills from them.

As mentioned earlier management should arrange training programme and skill labs

for the nurses and train them adequately to improve the patient care.

3)I am encouraged by my superiors and they also take my suggestions and feedback.

Superiors and management should keep suggestion boxes or periodic interview with

the nursing staff and get their feedback and suggestions and if possible, implement the

same and make the working environment more friendly.

4)I am appropriately recognized and appreciated for the job which I do.

Management should recognize the work of the nursing staff and can help them by

giving monetary aids, or promotions or a small gift or recognition by announcing the

nurse as the “Best nurse for the month or year” etc as a small token of recognition.

5)I am satisfied with my chances for promotion

As mentioned earlier as a part of recognition nurses should get promoted and get both

monetary and non monetary benefits.

6)I used to get opportunities to improve my professional skills.

Skill labs should be made and periodic teaching sessions should be conducted to

improve the professional skills of the nurses.

7)I have accurate written job description and work assignment is clearly explained to

me.

48
Management should provide accurate written job description weekly which self

explanatory

8)The amount of work which I expected to finish each week is reasonable and I am

evaluated on basis of standard performance scales.

The weekly job description which is provided must be monitored by nursing

superintend periodically and evaluated and reviews must be given to improve the

patient care.

9)My department provides all necessary resources ,equipments, and supplies to

perform my duties.

The management should provide necessary equipments and resources for the patient

care. If any equipment is broken or not working properly should be replaced

promptly.

10)My co workers work well together with me and I feel that I can easily

communicate with members from all level of organization .

The nursing staff should have smooth horizontal and vertical communication with the

management staff members to give a wholesome care to the patients

CHAPTER -6 CONCLUSION

critical care nursing especially neuro critical care is a one of the challenging jobs in

the healthcare industry. these nurses are provided with adequate training to take care

of neuro critical care patients.

Though adequate training is provided, seniors and management is supportive there

49
may be few dissatisfied nursing staff due to various reasons. If the above suggestions

are implemented definitely satisfaction level of neurocritical care nurses will improve.

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52
 ANNEXURE – A

AGREE DISAGREE

1 The management, Organization and my seniors

are supportive to me.

2 They have provided adequate training to me and I

have learnt new skills from them.

53
3 I am encouraged by my superiors and they also
take my suggestions and feedback.

4 I am appropriately recognized and appreciated for

the job which I do.

5 I am satisfied with my chances for promotion

6 I used to get opportunities to improve my

professional skills.

7 I have accurate written job description and work

assignment is clearly explained to me.

8 The amount of work which I expected to finish

each week is reasonable and I am evaluated on
basis of standard performance scales.

9 My department provides all necessary

resources ,equipments, and supplies to perform
my duties.

10 My co workers work well together with me and I

feel that I can easily communicate with members
from all level of organization .

54