A Study to Assess the Effectiveness of Planned Teaching Program on Knowledge regarding Glasgow Coma Scale among the Staff Nurses in Nootan General Hospital, Visnagar

 

MS. Ankita Chaudhari

Assistant Professor, Nootan College of Nursing, Vinagar, Dist; Mehsana.

 

ABSTRACT:

Introduction: The Glasgow Coma Scale (GCS) was developed in 1974 to provide a practical method for the assessment of impaired consciousness (Teasdale and Jennett, 1974). Nursing, medical and other staff welcomed its straightforward approach and use of simple terms to record and communicate their findings; the scale became an integral part of the care of patients with acute brain injury from head trauma, intracranial haemorrhage and many other causes. Objective: To assess the knowledge regarding Glasgow coma scale among the staff nurses in selected hospital. To evaluate the effectiveness of planned teaching program on knowledge of GCS among staff nurses. To find the association between the knowledge regarding GCS with their selected demographic variable. Hypothesis: H0: There will be no significant difference between pre-test and post-test knowledge regarding GCS at 0.05 level of significant H1: There will be significant difference between pre-test and post-test knowledge scores on knowledge about GCS at level of significance. Design: Quasi experimental one group pre-test post-test design was used. Participation: 60 samples of staff nurses of Nootan general hospital, visnagar selected using non – probability convenient sampling techniques. Tool: Questionnarie was used to assess the level of knowledge among. staff nurses of Nootan general hospital, visnagar Results: ‘T’ test value is 14.10. This value is significant at p < 0.05 level. Conclusion: Staff Nurses had increase level of knowledge.

 

 

 

INTRODUCTION:

“Biology Gives You A Brain…Life Turns It Into A Mind…”

Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Yearly, about 1.5 million people die from TBI and those several millions that survive receive emergency treatment.

 

In Malaysia, the statistics for the year 2009-2010 reveal that the causes of death from motor vehicle accidents are head injury (56.5%) followed by brain injury (38.1%), both head and brain injury (34%) and skull/craniofacial fractures (27.9%). The common presentation to the ED is with an acutely altered level of consciousness that requires quick assessment, which is the crucial action of all health providers.⁽¹⁾

 

Appropriate use of the GCS is Essential because these assessments may be the foundation for changes in treatment, as intended by Teasdale And Jennett. Although the GCS has achieved international acceptance and continues to be widely used. The GSC evaluates three parameters of behavior that most closely reflect activity in the higher centers of the brain: eye opening, verbal response and motor response. It uses numeric system to minimize variation and subjectivity in clinical assessment. The total score of GCS ranges from 3(indicating deep unconsciousness) to 15(indicating fully awareness). It is important note that the scale is intended to assess level of consciousness and is not designed for following neurological deficits. So the scoring will detect early deterioration in such patients.⁽²⁾

 

An international study that evaluated knowledge of nurses about GCS and associated results with demographic variables, reported area of working and time of experience are associated with high or low knowledge. Nurses of neonatal intensive care unit had the highest score (12.7) whereas nurses of internal medicine had lowest score (9.7). In knowledge scale, nurses working at neurologic unit over or equal to 6 years had the highest scores (11.9), and those working for less or equal to 1 year had the lowest scores (10.0). The same study reported the need of educational interventions and design of manuals for maintenance and improvement of assessment of consciousness using the GCS.⁽³⁾

 

GCS is a neurological scale which gives a reliable, objective way of recording the conscious state of a person, for initial as well as subsequent assessment (Batool et al. 2013). GCS consists of three components (eye opening, best verbal response, and best motor response) (table 1). The scale uses the numeric system with a total score ranging from 3 to 15. Patient is considered in a coma if he/she has GCS score of ≤ 8 (Juliet and Claranne 2001, Urdan (2014). The GCS reflects the initial severity of brain dysfunction, while serial assessments demonstrate the evolution of the injury. Each is crucial for decision making. The GCS is also a guide to prognosis and an essential tool for research studies.⁽⁴⁾

 

NEED FOR STUDY:

The patients who need a GCS assessment have generally suffered a traumatic brain injury and are either in the ER or ICU. An initial GCS should be done at time of admission and then every four hours unless otherwise indicated by the medical team. Documentation of the GCS is crucial since the medical team, which generally includes neurology, will use this to determine improvement or decompensation of the patient.⁽⁵⁾

 

We identified 15 820 patients with TBI presenting to neurosurgical centres directly (6258), transferred from a district hospital to a neurosurgical centre (3682) and remaining in a district general hospital (5880). The commonest mechanisms of injury were falls in the elderly and road traffic collisions in the young, which were more likely to present in coma. In severe TBI (Glasgow Coma Score (GCS) ≤ 8), the median time from admission to imaging with CT scan is 0.5 hours. Median time to craniotomy from admission is 2.6 hours and median time to intracranial pressure monitoring is 3 hours. The most frequently documented complication of severe TBI is bronchopneumonia in 5% of patients.⁽⁶⁾

 

United States, 2001–2010 Overall, rates of TBI-related ED visits, hospitalizations, and deaths climbed slowly from 2001 through 2007, then spiked sharply in 2008, and continued to climb through 2010. In 2007, overall rates of TBI-related ED visits, hospitalizations, and deaths were 26% higher in men compared to women. The increase in TBI-related ED visits, hospitalizations, and deaths rates in 2008 was much sharper for men (nearly a 40% increase) than for women (20% increase). In 2008, that gap began to widen, reaching 61% in 2009 before narrowing to 29% in 2010. Rates of overall TBI are largely driven by rates of TBI-related ED visits. Rates of TBI-related ED visits increased for all age groups from the period of 2001–2002 through 2009–2010. The rates of TBI-related ED visits increased the most for youth four years of age and younger. From 2007–2008 to 2009–2010, the rates of TBI-related ED visits in this group increased by more than 50% from 1374.0 to 2193.8 per 100,000. Children 0 to 4 years of age had the highest rates of any age group, typically with almost twice the rate of those in the next highest age group (15–24year-olds). Rates of TBI-related deaths decreased for both men and women between the years 2001–2010. During these ten years, rates in men decreased from 27.8 to 25.4 per 100,000 and rates in women decreased from 9.6 to 9.0 per 100,000. In each year, men had more than twice the rate of TBI-related deaths compared to women. Rates of TBI-related deaths varied depending on age. For persons 44 years of age and younger, TBI-related deaths decreased between the periods of 2001–2002 and 2009–2010. Rates for those aged 45–64 years remained stable for this same ten-year period. For persons 65 years and older, rates of TBI-related deaths increased during this time period.⁽⁷⁾

 

STATEMENT OF THE PROBLEM:

^“A study to assess the effectiveness of planned teaching program on knowledge regarding glasgow coma scale among the staff nurses in nootan general hospital, visnagar”

 

OBJECTIVES OF STUDY:

·       To assess the knowledge regarding Glasgow coma scale among the staff nurses in selected hospital.

·       To evaluate the effectiveness of planned teaching program on knowledge of GCS among staff nurses.

·       To find the association between the knowledge regarding GCS with their selected demographic variable.

HYPOTHESIS:

H0: There will be no significant difference between pre-test and post-test knowledge regarding GCS at 0.05 level of significant

H1:  There will be significant difference between pre-test and post-test knowledge scores on knowledge about GCS at level of significance.

 

METHODOLOGY:

An Quantitative approach was adopted for this study. The Research design selected was Quasi experimental one group pretest post-test design. The study was conducted on Staff Nurse of Nootan General Hospital Visnagar and the sample size for the present study will be 60. Non probability convenient sampling technique will be used for the present study collection done after obtaining permission from authority. Self structured knowledge questionnaire was used to collect data regarding regarding Glasgow Coma Scale Among The Staff Nurses In Nootan General Hospital, Visnagar.

 

RESULTS:

Demographic data was analyzed using frequency and percentage. Frequencies, percentage, mean, median, mean percentage and standard deviation was used to determine the knowledge score.

 

Section A:

Table I: Data on demographic variables of staff nurses of Nootan General Hospital Visnagar.                                                  N=60

Frequency and percentage distribution of Demographic variables of Staff nurses of Nootan General Hospital

 

The data presented in the table 1 indicate result as follows:

1. Age in Year:

Regarding age, categories of the respondents has been divided into four different categories among Staff Nurse, 86.7% of respondents belongs to age 21 -30 years, 8.3% of respondents belongs to age group of 31-40, 5% of respondents belongs to age41 - 50 years.

 

2. Gender:

Regarding Gender, the sample belong to the Male category (50%).

And the sample belong to the female category (50%)

 

3.Professional Qualification:

Regarding Professional qualification 13 sample (8.3%) have G.N.M qualification, 5 sample (21.5%) have post basic Nursing qualification, and 42sample (70%) have Basic BSc Nursing qualification.

 

4.Work Expirience:

Regarding work experience 43(71.7%) sample have <1 year experience, 13 (21.7%) sample have 1-4 year experience, 3 (5%) sample have 5-8 year experience, 1 (1.75%) sample have >8 year experience.

 

5.work shop attaining:

25 (41.7%) sample attain the work shop on neurological assessment, 35(58. 3%) sample not attain any work shop on neurological assessment.

 

Section B:

Table II: Data on level of knowledge on GCS among staff nurses in Nootan General Hospital, Visnagar.                   N=60

 

Frequency and percentage distribution of level of knowledge on GCS among staff nurses in Nootan General Hospital Visnagar According to pre test and post test.

 

Objective-1: To assess the knowledge regarding GCS among the Staff nurses at Nootan General Hospital Visnagar.

 

 

 

 

Section C:

Table III: Data on effectiveness of planned teaching programme on GCS among staff nurses.                                   N = 60

Mean, Mean Difference, Standard Deviation, And ‘t’ test value of level of knowledge on GCS among Staff nurses.

 

Objective: 2 To evaluate the effectiveness of Planned teaching programme on GCS among Staff nurses.

 

Table III Reveals that, during pre-test, the mean score of level of knowledge was 13.46 and the standard deviation was 5.79 During post-test, the mean score of level of knowledge was 21.91 and the standard deviation was 2.30. The obtained ‘t’ value for level of knowledge was 13.066 which is significant at p<0.05 level. Thus it rejects the null hypothesis (H₀₁) and accepts the research hypothesis (H₁). This indicates that the Planned teaching programme Above table II reveals that, during Pre-test, only 22 (36.6%) of staff nurses had Poor level (0-10 score) of knowledge on GCS, 28 (46.6%) of staff nurses had average (11-20 score) level of knowledge on GCS and 10 (16.66%) had good knowledge (21-30) on GCS.

 

During Post-test, No one of staff nurses had Poor level(0-10score) of knowledge on GCS, 16(26.66%) of staff nurses had average (9-16 score) level of knowledge on GCS and 44(73.33%) had good knowledge (20-30) on GCS.

 

It was inferred from the above table that the Planned teaching programme was Effective in Improving Knowledge on GCS among Staff Nurses.

 

Section D:

The association between the Pre test level of Knowledge and socio demographic Variable. Based on the Third objectives used to chi –square test to associate the level of knowledge of GCS and selected demographic variable. The chi square value show that there is significant in Marital status. The calculated Chi-square was less than the table value at the 0.05 level of significance.

 

CONCLUSION:

The following conclusions can be drawn from the present study findings: The findings concludes that planned teaching programme was an effective in improving knowledge and practice of Staff Nurses in Nootan General Hospital Visnagar, Staff Nurses gained significant increase in knowledge and practice shows that the planned teaching programme was effective. The Planned teaching programme on Glasgow coma scale was acceptable and useful method of teaching for Staff nurses.

REFERENCES:

1.      Nursing Research and Practice Volume 2016, Article ID 8056350, 5 pages http://dx.doi.org/10.1155/2016/8056350

2.      Annamma Jacob (2011), ― Clinical Nursing Procedures: The Art of Nursing Practice‖, 2^nd edition, Published by Jaypee brothers,  Unit - 11,  Pp. 478-480

3.      Glasgow Coma Scale Technique: Effect of Theoretical and Practical Educational Program on Nurses’ Compliance

4.      Soheir Tawfeek Ahamed1, Mona Nader Ebraheim2 1(Assist. Prof. Medical Surgical Nursing Department, Faculty of Nursing / Ain-Shams University, Egypt 2 (Lecture in Medical Surgical Nursing Department, Faculty of Nursing / Ain-Shams University, Egypt Assessment of nurse’s knowledge about Glasgow coma scale at a university hospital Wesley Cajaíba Santos, Cássia Regina Vancini-Campanharo, Maria Carolina Barbosa Teixeira Lopes, Meiry Fernanda Pinto Okuno¹ and Ruth Ester Assayag Batista

5.      International Journal of Advanced Nursing Studies Journal home page: www.sciencepubco.com/index.php/IJANSdoi:10.14419/ijans.v4i2.4639Simplifying Glasgow Coma Scale Use for Nurses

6.      Basavanthappa  B. T  (2007),  " Nursing  Research",  2^nd  edition, Jaypee   Brothers ,  Bangalore,  Pp. 145 - 155

7.      Hamza AL-Quraan BSN 1, Mohannad Eid AbuRuz PhD RN 2* 1 Critical Care Nurse, Clinical Nursing Master students, Applied Science Private University, Amman, Jordan 2Assistant Professor, Applied Science Private University, Amman, Jordan.

 

Received on 27.10.2020         Modified on 21.11.2020

Accepted on 19.12.2020       ©A&V Publications All right reserved