RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. NAME OF THE CANDIDATE : BENNY BARAK

AND ADDRESS M.SC NURSING 1ST YEAR
H.K.E.S COLLEGE OF NURSING
BASAVESHWAR HOSPITAL
CAMPUS, SEDAM ROAD,
GULBARGA - 585105

NAME OF THE INSTITUTION : H.K.E.S COLLEGE OF NURSING

BASAVESHWAR HOSPITAL
CAMPUS, SEDAM ROAD,
GULBARGA - 585105

COURSE OF STUDY AND : M.Sc. NURSING, 1ST YEAR

SUBJECT MEDICAL – SURGICAL NURSING

DATE OF ADMISSION : 28/05/2010

TITLE OF THE TOPIC : “A STUDY TO ASSESS THE

EFFECTIVENESS OF PLANNED
TEACHING PROGRAMME ON
CARE OF CLIENT WITH
MECHANICAL VENTILATIOR
AMONG STAFF NURSES
WORKING IN SELECTED
HOSPITALS, AT GULBARGA”

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6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“NURSES ARE THE HEART BEAT OF HEALTH CARE “

Air flows from a region of higher pressure to region of lower pressure. During inspiration, air flows from
the environment into the trachea, bronchi: bronchioles and alveoli. During expiration alveolar gas travels the
same route in reverse. Disorders of the respiratory system are common and are encountered by nurses in every
setting from the community to the intensive care unit1.

Adequate ventilation is dependent on free movement of air through the upper and lower airways. In many
disorders the airways becomes narrowed or blocked as a result of disease, bronchoconstriction , a foreign body or
secretions. Assessment and management of the patient with respiratory disorders are best accomplished when
the approach is multidisciplinary and collaborative.1

The nurse may be expected to care for these patients in a setting outside the intensive care unit. The
nurses should have thorough knowledge of the modes of ventilation, assessment, and trouble shooting of
ventilators and assessment and care of the patients requiring mechanical ventilation.2

Mechanical ventilation is form of artificial respiration that uses breathing machine to assist patients with
breathing. It is used when the lungs are not functioning properly. Mechanical ventilation is a method to
mechanically assist or replace spontaneous breathing3.

Since a wide variety of ventilator are available. The ventilator selected depends on the severity of the
disease process and the length of time that ventilators support is required. Two major types of ventilator are
negative pressure ventilators and positive pressure ventilator.4

Mechanical ventilation is often a life saving intervention, but carries many potential complications
including pneumothorax, airways injury, alveolar damage and ventilator associate pneumonia. It is used to
support a single failing organ system (the lungs) and cannot reverse any underlying disease process5.

6.1 NEED FOR THE STUDY

According to Abraham Maslow’s hierarchy of human needs theory, the most fundamental basic needs of
the human beings are air, water, food and sleep. Among these air or oxygen stands topmost. Breathing is a
process of inspiration and expiration which provides required oxygen to the body to function physiologically
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well. But some of the critical or life threatening conditions such as stroke, major head injury, severe respiratory
distress, can imbalance the normal respiratory function6.

In recent years, management of client with severe respiratory failure has been aimed at developing
different modes of ventilation that will maintain oxygen level and minimize the complications 7. A mechanical
ventilator is a device with positive or negative pressure breathing facility which maintains ventilation and
provides oxygen for a longer period of time to the client8.

Approximately 1.5 million persons receives mechanical ventilation annually in the United States, of these
upto 25% requires prolonged mechanical ventilation. Where as in India there is no clear picture of incidence of
mechanical ventilated clients9.

Care of mechanically ventilated clients is a major challenge as it carries many potential complications
including pneumothorax, airway injury, alveolar damage, and ventilator associated pneumonia8.

Clients on mechanical ventilators are highly dependent and need comprehensive holistic care with
constant attention, and care which includes airway maintenance, fluid electrolyte balance, nutritional needs,
hygiene, elimination needs, coping, comfort, safety and infection prevention10.

Role of professional nurse in caring client with mechanical ventilator is challenging. Nurse should
assume different responsibilities, show enough expertisation and skillful, to safeguard the client life and enhance
the health condition of the client2.

Nurse working in ICU or with mechanically ventilated client should be able to handle different tasks and
be aware of mechanical ventilator device, mode of action, trouble shooting, weaning and various parameters of
ventilators such as Fraction of inspired oxygen (FiO 2), Tidal volume, Oxygen saturation of Haemoglobin,
(SPO2), Partial pressure of oxygen, (PaO2) Partial pressure of carbon dioxide (PaCO2).2

Nurse must be well trained and should develop sound knowledge and practical skills in taking care of
client with mechanical ventilator in order to develop them as effective potential and competent nurse
practitioner11.

Hence the investigator is interested to assess the knowledge of staff nurses regarding care of a client with
mechanical ventilator. Based on their knowledge levels and needed curricular requirements, the investigator is
interested to prepare planned teaching programme with the guidance of experts in the field and intervenes the
planned teaching programme, demonstrates the apparatus to the group of staff nurses i,e. sample. Again, after
giving a gap of seven days the investigator will assess their knowledge to see the effectiveness of planned
teaching programme.

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6.2 REVIEW OF LITERATURE

A study was conducted on role of mechanical ventilation and development of multi-drug resistance
organism in hospital acquired pneumonia in Sanjay Gandhi postgraduate institute of Medical Science at
Lucknow during 2001. The respiratory specimens were collected from 148 mechanically ventilated patients and
sent for cytology, bacterial culture and antimicrobial sensitivity. Result revealed that, overall rate of HAP was
53.9% mortality rate was 47.3% and attributable risk of mortality with ventilators was 72.3% and occurrence of
VAP was 81.7%. Study also concluded that number of ICU isolates were MDR in comparison of those from the
non ICU setting mechanical ventilation and duration of ICU stay emerged as important risk factors for
development of HAP and VAP12.

A study was conducted on ventilatory management of respiratory failure in patient with severe Guillain
Barre syndrome in post graduate institute of Medical Education and Research at Chandigarh in 2003. Total 11-
adult patients of GBS of respiratory failure admitted in respiratory intensive care unit with mechanical
ventilation support for a period of 2 months were studied over a period of years. Result revealed that, 7 patients
developed ventilator associated pneumonia or sepsis and 8 patients died and 1 discharged13.

The quantitative study was conducted with aim of to assess the knowledge of health professionals about
prevention of pneumonia associated to mechanical ventilation (PAMV) in two public Hospitals of Fortaleza
Ceara State from June to July 2006. Data were collected by using likert scale among 104 professionals. Result
obtained suggested that, knowledge of Health Professional of ICUS about prevention of PAMV was
insignificant14.

A study was conducted to determine the factors that influence nurse sedation administration to
mechanically ventilated patients. Data were collected by among 1250 members of the American Association of
Critical Care nurses by using nurse sedation practice scale. Result revealed that, nurse attitude towards efficacy
of sedation were mechanically ventilated patients was positively co-related with nurses report of their sedation
practices. (r(s)=.28, p<001) and their intent to administer sedation (r(s) = .58, P<.001), finally study concluded
that modifying nurses attitudes on sedation and the experience of mechanical ventilation may be necessary to
change sedation practices with mechanically ventilated clients15.

A descriptive study was carried out in 1998 “To assess the knowledge and practices of nursing personal
regarding immediate post operative care of cardiac surgery client on ventilator in Cardio Thoracic Intensive Care
Unit in selected Hospitals of Hyderabad”. 30 nurses working in CTICU with at least 6 months experience were

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selected by purposive sampling. Data was collected by observational checklist and questionnaire. The study
revealed that majority of nurses had below average knowledge and practices and more than one third of nurses
had above average knowledge and practices16.

A study was conducted in North America in 1993 to assess the theoretical knowledge of the nurses and
endotracheal suctioning and their ability to apply this knowledge regarding suctioning. 24 registered nurses were
asked a series of questions regarding suctioning. All participants believed that the clients require suctioning
every 1 to 3 hours with 17 performing it every 2 to 3 hours. No differences were apparent between experienced
and less experienced nurses. It is a concern that many nurses rely upon deterioration in the client’s condition to
indicate when suctioning is required. The study suggested that there is need for a policy for suctioning and
provision of clear guidelines for education of all staff17.

STATEMENT OF PROBLEM

“A study to assess the effectiveness of planned teaching programme on care of client with mechanical
ventilator among staff nurses working in selected hospitals, at gulbarga”

6.3 OBJECTIVE OF THE STUDY

 To assess knowledge and practice on care of client with mechanical ventilator among staff nurses by pre-
test score.
 To develop and implement the planned teaching programme on care client with mechanical ventilator.
 To find out the effectiveness of planned, teaching programme on care of client with mechanical ventilator
among staff nurses by post-test score.
 To find out association between knowledge and practice on care of client with mechanical ventilator with
their selected demographical variables viz age, gender, marital status, education etc.

6.4 OPERATIONAL DEFINITIONS

Assess : It refers to the evaluate the value of planned teaching programme on care of clients on mechanical
ventilator among staff nurses.

Effectiveness : It is the extent to which the knowledge of staff nurses improved with regard to care of a client
with mechanical ventilator after the implementation of planned teaching programme as evidenced by the
differences in the pre test and post test scores.

Planned teaching programme: It refers to systematically developed integration designed for a group of staff
nurses to provide information regarding care of client with mechanical ventilator.

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Clients: It refers to the persons who are weaned by the mechanical ventilator in ICU by staff nurses.

Mechanical ventilation: Respiratory support provided by means of a device that can maintain ventilation and
oxygen delivery for prolonged period of time for the clients who cannot breathe by themselves.

Staff nurses: It refers to the nurse who has obtained diploma or bachelor degree in nursing, and working in
intensive care units with facility of mechanical ventilator device and having atleast one year of experience.

7. MATERIAL AND METHODS

7.1. Source of data:

 Design: The research design adapted for this study is one group pre and post test design.
 Setting of the study: Study will be conducted in, selected hospitals, at Gulbarga.
 Population: The population include in the study are those who are working as a staff nurses in selected
Hospitals at Gulbarga.
 Sample: Sample for the study consists of 40 staff nurses.
 Sampling Technique: Purposive sampling technique will be used to select the Hospital and complete
enumeration method will be used to select the sample.
 Inclusion Criteria: the study includes staff nurse who are:
o Working as staff nurses in ICU
o Both Male and Female staff nurses
o Willing to participate in the study
 Exclusion Criteria: The study excludes the staff nurses who are:
o Not working as a staff nurse in ICU
o Not willing to participate in the study
o Not available at the time of data collection
 Selected Variables:

Dependent Variables: Knowledge of the staff nurses regarding care of a client with mechanical ventilator in
selected aspects such as:

o Physiology of ventilation
o Normal parameters of ventilation
o Various modes of mechanical ventilation
o Airway maintenance by suctioning and chest physiotherapy
o Fluid and electrolyte balance

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 o Nutrition and elimination
o Prevention of infection
o Comfort and coping of the client
o Complications of continuous mechanical ventilation

Independent variables: Planned teaching programme on care of a client with mechanical ventilator.

Extraneous variables:
Age: Age of the sample is categorized as:
a. 21-25 years
b. 26-30 years
c. 30 and above
Gender:
a. Male
b. Female
Educational background: It refers to previous education of the subjects. It is categorized as:
a. GNM
b. B.Sc Nursing
Clinical experience: Refers to experience of the sample in critical care units with the facility of
mechanical ventilator.

7.2. Methods of Collection Data

 Data Collection Instruments: A structured questionnaire will be developed and used for collecting the
data. It consists of 2 parts namely Part-I and Part-II. Part-I deals with socio demographic data. Part-II
represents the knowledge related items on care of a client with mechanical ventilator.

 Data Collection Method : After obtaining the prior permission and consent from the significant
authorities and the subjects, the Investigator will assess the knowledge of staff nurses regarding care of a
client with mechanical ventilator by using a staff self administered questionnaire and then intervenes
planned teaching programme. Again the investigator will assess the effectiveness of planned teaching
programme by post test after a gap of 7 days depending on time convenience of the sample.

 Plan of Data Analysis: Data will be obtained from the samples will be organized and summarized with
the help of both descriptive and inferential statistics.
(Mean, median, SD and Chi-square etc..)
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7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE
CONDUCTED ONPATIENTS OR OTHER HUMAN OR ANIMALS? IF SO, PLEASE DESCRIBE
BRIEFLY.

Yes

Since, it is one group pre test and post test experimental design, the study requires intervention. The
investigator will assess the knowledge of staff nurses on care of a client with mechanical ventilator and
administers planned teaching programme and again tests the knowledge of staff nurses to assess the effectiveness
of planned teaching programme.

7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR HOSPITAL IN CASE OF 7.3?

Yes

 H.K.E.S College of Nursing ethical committee

 Permission will be obtained from the concerned authority in selected Hospitals, at Gulbarga.
 Consent will be obtained from all the participants.

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8. BIBLIOGRAPHY

1) Brunner and suddarths , “text book of Medical surgical Nursing” Suzanne c. smeltzer Brenda bare 10th
Edition page no. 463,466,467,610.

2) Phyllis Turner, Connie Glass , Mary Jo Grap. “Care of the patient requiring mechanical ventilation”. Med surg
nursing, April, 1997.

3) Ann Howard, Bs , Timothy S Carey MD MPH. “society of ciritical care medicine mechanical ventilation”.
Endorsed by American Association of Critical – Care Nurses.

4) Donna D . Ignatavicus, M.LindaWorkman. Mary A .Mishler. Text book of medical surgical nursing . 2nd
Edition Volume 1. Pg no 758.

5) Irwin R, Rippe J. “Intensive Care medicine” 5th Edition, 2003

Lippin Cott Willianms and Wilkins available at http://en.wikipedia.org.wiki/mechanical ventilation.

6) Jacob anthikad. “Psychology for Graduate Nurses” Jaypee puplication 3rd Edition pg no 32.

7) Macnaughton et al . 1993: “Management of Adult Respiratory Distress syndrome” post graduate medical
journal, medknown publishers .69(8111): page no. 351.352.

8) Brunner and suddarth 1996: “Text book of medical surgical nursing” . Philadelphia. Lipincott Company 8th
edition page no 555.

9) Diane masalipante . Rn, Cs, Ms, CCRN “Developing a multidisciplinary weaning unit through collaboration”
critical care nurse 2002, 22:30.39.

10) luchmann and Sorenson. 1993: medical surgical nursing Philadelphia w b. saunders publishers 4th edition
page no 984.

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11) Catherine joseph et al. 2004:”Nursing care of patients on mechanical ventilation” the nursing journal of
India. New Delhi TNAI XCV (10): page no .231-232.

12) Mukhopadhay C., Bhargava A. Ayyagari A. “Role of mechanical ventilators and development of multidrug
resistant organisms in hospital acquired pneumonia” Indian J Med Res 2003 Dec: 118: 229-35.

13) Aggar wall AN, Gupta ad, lal V “ventilatory management of respiratory failure in patients with severe
Guillain – Barre syndrome” Neurol Ubdua 2003 jun: 51 (7): 203-5.

14) Ponbo CM, Almeida pc, Rodrigues JL “Health professionals’ knowledge about the prevention of pneumonia
associated to mechanical ventilation at Intensive care Unit”. Ceien saude colet 210 Jun: 15 supply 1: 1061.72
15) Guttormson. J L , Chlan L , Weinert C. Mechanically ventilated patients commonly Receive sedative
medications” ( C 2009 Elesv : er ltd. USA gw ioo25@umi.edu.

16) Sumitra.P.S 1998: Study to assess the knowledge and proclices of nursing personel on immediate post
operative care of cardiac surgery patient on ventilator page no 1- 2 .

17) Debra M Melson. 1993: “Interventions related to respiratory care” the nursing clinics of north America
Medline. 18. Page no 36-38.

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9 SIGNATURE OF CANDIDATE :

10 REMARKS OF GUIDE :

11 11.1 NAME AND

:
DESIGNATION OF THE
GUIDE

11.2 SIGNATURE :

11.3 CO-GUIDE (IF ANY) :

11.4 SIGNATURE :

11.5 HEAD OF THE :

DEPARTMENT

11.6 SIGNATURE :

12 12.1 REMARKS OF THE

CHAIRMAN AND :
PRINCIPAL

12.2 SIGNATURE :

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