Effectiveness of Planned Teaching Programme on Knowledge and Practice regarding Arterial Blood Gas analysis and its Interpretation among Staff Nurses working in Critical Care Quantitative Research Approach

 

Divya Upreti¹, Rakhi Mishra²

¹M.Sc Nightingale Institute of Nursing, Noida, India

²Associate Professor, Nightingale Institute of Nursing, Noida

 

ABSTRACT:

Aim: The aim of the study was to assess the effectiveness of planned teaching programme on Knowledge and Practice regarding arterial blood gas analysis and its interpretation among staff nurses working in critical care units at selected hospital of Delhi/ NCR. Material and method: A Quantitative Research approach and Pre experimental research design was employed with Non –probability convenient sampling technique was used to collect the sample. A Structured knowledge questionnaire was developed to identify the knowledge of staff nurses and Observational practice checklist regarding arterial blood gas analysis and its interpretation was used to assess the practice of staff nurses working in critical care units. The conceptual framework used to guide this study was based on Stufflebeam’s context input process product (CIPP) which was used to assess the effectiveness of planned teaching programme on Knowledge and Practice regarding arterial blood gas analysis and its interpretation. Analysis of data was done in accordance with the objectives. A total of 30 Staff nurses working in critical care units i.e., Medical and Surgical intensive care units (MICU and SICU), Cardiovascular and vascular surgery (CTVS) unit were selected using Non probability convenient sampling technique. Data obtained were analyzed and interpreted in the light of the objectives using both descriptive statistic and Inferential statistics. The level of significance was 0.05. Fisher’s Exact Test was used to find the association between post knowledge score with selected demographic variables and post-test practice score of staff nurses working in critical care units with selected demographic variables. Results: Results collected from the study showed knowledge score of Arterial blood gas analysis and its interpretation in pre-test was assessed and maximum numbers of staff nurses i.e. 13 (43.4%) of staff nurses were having average knowledge ,11(36.6%) good,2 (6.6%) excellent and 4(13.4%) poor knowledge. The knowledge score of staff nurses in post-test was assessed 24(80%) of staff nurses were having very good knowledge, 6 (20%) good knowledge whereas in pretest, practice score of staff nurses was assessed and 17(56.66%) of nurses had average practice, 7(23.34%) of nurses were having poor knowledge and 6(20%) good average practice. The practice score of nursing students in posttest was assessed and 19(63.33%) had very good practice, 11(36.67%) good practice. Hence, the teaching programme was effective in improving the practice of staff nurses working in critical care units after administration of planned teaching programme regarding arterial blood gas analysis and its interpretation. The Pre-test and post-test mean knowledge scores about arterial blood gas analysis was 17.8 and post-test 26.4 with standard deviation 4.25 therefore mean difference (8.6) was found to be statistically significant. Data further shows that mean pre-test practice score is 10.7 and post-test practice score is 17.3 with standard deviation 2.88. The obtained mean difference 6.6 was found to be statistically significant as evident from the t value of 12.60 at 0.05 level of significance. Hence, the teaching programme was effective in improving the knowledge and practice of staff nurses working in critical care units regarding Arterial blood gas analysis and its interpretation. Conclusion:  Planned teaching programme were effective in improving the knowledge and practice regarding arterial blood gas analysis and its interpretation among staff nurses working in critical care units.

 

 

INTRODUCTION:

Nurses are integral part to health care delivery and it is important that they have a clear understanding of the nature of the procedures that they would have to perform for the patients. The critical care nurse serves as a catalyst in the healing process, making complex and timely judgments and decisions and taking actions for which the nurse remains accountable. The rationale of such decision is based upon the thorough knowledge of the health and life saving procedures. The knowledge base is upgraded continuously by new clinical and educational experiences that reinforce the critical care nurses’ professional practice and autonomy.

 

Blood is a connective tissue. The primary function of blood is to transport oxygen from the lungs to the body tissues and carbon dioxide from the tissues to the lungs. This function is essential in order to prevent the death of the tissues due to hypoxia. If body tissues are not getting adequate supply of oxygen, acid-base imbalance occurs. Arterial blood gas studies are concerned with respiration the exchange of gases between the lungs and blood and between blood and tissues. The normal function of all body cells depends on the regulation of acid base balance. The kidneys, lungs and blood buffers can usually balance acids and bases. Disorders of the lungs, kidneys and metabolism can impair the balance, leading to respiratory or metabolic acidosis or alkalosis.

 

An arterial blood gas analysis can be safely and easily obtained and furnishes rapid and accurate information on how well the lungs and kidneys are working, it is the single most useful laboratory test in man-aging patients with respiratory and metabolic disorders. One should not rely on oximetry alone to evaluate arterial oxygen saturation (SaO2) fully. Thus, the arterial blood gas analysis provides the most important way and severity of a respiratory or metabolic disturbance

 

MATERIAL AND METHOD:

For Quantitative Part:

A pre-experimental one group pre-test post-test research design was employed. The conceptual framework used to guide this study was based on Modified Stufflebeam’s, (1973) Context-Context-Input-Process-Product (CIPP) model. Observational checklist used to assess the skills of staff nurses regarding arterial blood gas analysis and interpretation Checklist was developed and Structured knowledge questionnaire is used to assess the knowledge of staff nurses regarding arterial blood gas analysis and its interpretation consisting of 30 multiple choice questions.

 

A total 30 staff nurses working in critical care units i.e., medical and surgical intensive care units, cardiothoracic and vascular surgery unit (MICU, CTVS and SICU) were selected using Non-probability convenient technique was implemented. Content

 

Reliability was checked in terms of structured knowledge questionnaire was calculated by KR-20 formula and was found to be 0.76, thus the tool was found reliable and Reliability coefficient of practice checklist was calculated by inter- rater reliability formula, the reliability was found to be 0.80, thus the tool was found reliable. Pilot study was conducted on 10 staff nurses working in critical care units i.e., medical and surgical intensive care units, cardiothoracic and vascular surgery unit (MICU, CTVS and SICU) in Fortis hospital, Noida (UP) to find out the feasibility of the study. Confidentiality was assured for all the information provided. The data has been collected from 30 staff nurses working in critical care units of Jaypee Hospital, Noida (UP). Quantitative data was analyzed using descriptive and inferential statistics.

 

RESULT:

Objective 1: To assess the frequency and percentage distribution of staff nurses working in critical care units in terms of demographic characteristics:

This section describes the demographic characteristics of the samples under study. The samples consist of thirty (30) staff nurses. The data obtained describe the characteristics pertaining to their Age, Gender, Educational Qualification, Total years of experience and Source of information regarding arterial blood gas analysis and its interpretation.

·       Majority 19 (63.34%) staff nurses were in the age group of less than 25 years, 9 (30%) were in age group 25 - 30 years and 2(6.67%) were of Age group more than 30 years.

·       Majority of the staff nurses were female i.e., 25(83.33%) and 5 (16.67%) were Males.

·       Majority of staff nurse’s educational qualification was Bachelor of Science in Nursing i.e., 15(50%) whereas 13 (43.34%) was General Nursing and Midwifery and 2(6.67%) have done Post Basic B.Sc. Nursing.

·       Majority of staff nurses were having total years of working experience of less than 5 years i.e., 26 (86.67%) whereas 4(13.34%) were having 5-10 years of working experience.

·       Most of the staff nurses i.e., 20(66.67%) had attended Workshops, Conferences and In-Service Education regarding Arterial blood gas analysis and its interpretation whereas 6(20%) from Mass media and only 4 (13.34%) by Printed materials.

 

Table 1: Frequency and percentage distribution of staff nurses working in critical care units in terms of demographic variables

S. No.	DEMOGRAPHIC VARIABLES	FREQUENCY (f)	PERCENTAGE (%)
1.	Age  .    Less than 25 years a.   25 - 30 years b.  More than 30 years	19 9 2	63.4 30 6.6
2.	Gender a.   Male b.  Female	5 25	16.7 83.3
3.	Educationalqualification a.   General Nurse Midwifery b.  B Sc. Nursing c.   Post Basic Nursing d.  Post graduate	13 15 2 0	43.4 50 6.6 0
4.	Total Years of Working Experience a.   Less than 5 years b.  5-10 years c.   More than 10 years	26 4 0	86.7 13.3 0
5.	Source of Information Regarding Arterial Blood Gas Analysis and Its Interpretation a.   Workshops/ Conferences/ In-Service Education b.  Mass media c.   Printed materials	20 6 4	66.7 20 13.3

 

Objective 2: To assess the knowledge regarding arterial blood gas analysis and its interpretation among staff nurses working in critical care units before and after administration of planned teaching programme.

Figure 1 depict the knowledge score of Arterial blood gas analysis and its interpretation in Pre- test was assessed and maximum  numbers of staff nurses i,e.13(43.4%) was having average knowledge ,11(36.6%) was having good knowledge, 2(6.6%) was having excellent knowledge and 4(13.4%) was having poor knowledge whereas in  post-test 24(80%) was having excellent knowledge, 6(20%) was having good knowledge which indicates an increase in knowledge score after administration of planned teaching programme. Hence, the teaching programme was effective in improving the knowledge of staff nurses working in critical care units

 

 

Figure 1: Frequency and percentage distribution of pre test and post test knowledge scores of staff nurses

 

Objective 3: To assess the practice regarding arterial blood gas analysis and its interpretation among staff nurses working in critical care units before and after administration of planned teaching programme:

Table 2  describes the practice score of staff nurses in Pre-test maximum numbers of staff nurses i.e. 17(56.6%) of nurses had average practice, 7(23.4%) of nurses was having poor knowledge and 6(20%) was having good average practice whereas in  post-test 19(63.3%) was having excellent  practice, 11(36.7%) was having good practice which indicates an increase in practice scores Hence, the teaching programme was effective in improving the practice of staff nurses working in critical care units after administration of planned teaching programme regarding arterial blood gas analysis and its interpretation among staff nurses working in critical care unit.

 

 

Figure-2 Column diagram showing the Percentage of Pre Test and Post Test Practice Score of Staff Nurses Working In Critical Care Units

 

Objective 4: To evaluate the effectiveness of planned teaching programme regarding arterial blood gas analysis and its interpretation in terms of knowledge and practice among staff nurses working in critical care units

 

Mean Pre-test knowledge score and Mean Post-test knowledge score was (17.8) and (26.4) respectively. The calculated ‘t’ value was 11.1 which is higher than the table value 2.05 for degree of freedom (29) at 0.05 level of significance.

Table 2: (N=30)

Test	Range	Mean	Mean Difference	Median	Standard Deviation	‘t’ Value
Pre test	10-22	17.8	8.6	17	4.3	11.1
Post test	19-30	26.4		26	2.4

df (29) =2.05 at 0.05 level of significance

 

Thus the above Table 2 depicts finding revealed that there was a significant difference between mean pre-test and mean post-test knowledge score. Hence, null hypothesis H₀₁ is rejected and Research hypothesis H₁ is accepted indicating that the Planned Teaching Programme was effective in increasing the knowledge of staff nurses regarding Arterial blood gas analysis and its interpretation among staff nurses working in critical care units.

 

The Mean Pre-test practice score and Mean Post-test practice score was (10.7) and (17.3) respectively. The calculated ‘t’ value was 12.6 which is higher than the table value 2.05 for degree of freedom (29) at 0.05 level of significance .Thus the above finding revealed that there was a significant difference between Mean Pre-Test and Mean Post-Test Practice score. Hence, null hypothesis H₀₂ is rejected and Research hypothesis H₂ is accepted indicating that the Planned Teaching Programme was effective in improving the practice of staff nurses regarding Arterial blood gas analysis and its interpretation among staff nurses working in critical care units.

 

Table 3 depicts mean, median, standard deviation, mean difference and ‘t’ value of pre-test practice score and post-test practice score among staff nurses working in critical care units (N=30)

Test	Range	Mean	Mean difference	Median	Standard Deviation	‘t’ Value
Pre test	7-16	10.7	6.6	10.5	2.4	12.6
Post test	14-19	17.3		17.5	1.4

df (29) =2.05 at 0.05 level of significance

 

Objective 5: To find out the correlation between the post test knowledge and practice scores regarding arterial blood gas analysis and its interpretation among staff nurses working in critical care units.

 

The correlation coefficient between post test knowledge score and post-test practice scores was calculated using Karl Pearson formula and the calculated value was r = 0.75. This implies that there exist a positive correlation between knowledge and practice regarding Arterial blood gas analysis and its interpretation among staff nurses working in critical care units.

 

Objective 6: To determine the association between the post test knowledge score regarding arterial blood gas interpretation among staff nurses working in critical care units with selected demographic variables.

 

 

Table 4 shows that Fisher’s exact test value obtained to find out the association between Post- test knowledge score of staff nurses with demographic variables. (N=30)

Demographic Variable	Knowledge Score (Median-26)		P value	Inference S/NS
	Below Median	Above Median
1.Age a.       Less than 25 years b.       25 - 30 years c.       More than 30 years	6 5 1	13 4 1	0.2	NS
2. Gender a.       Male b.       Female	1 11	4 14	0.2	NS
3. Educational Qualification a.       General Nurse Midwifery b.       B Sc. Nursing c.       Post Basic B Sc. Nursing d.       Post graduate	0 1 0 0	9 6 0 0	0.1	NS
4. Total Years of Working Experience a.       Less than 5 years b.       5-10 years c.       More than 10 years	10 2 0	16 2 2	0.3	NS
5. Source of Information Regarding Arterial Blood Gas Analysis and its Interpretation a.       Workshops/ Conferences/ In-Service Education b.       Mass media c.       Printed material	8 1 3	12 5 1	0.3	NS

Significant at P < 0.05 level of significance

 

The Fisher’s Exact Test value obtained to find out the association between Post test knowledge scores of staff nurses working in critical care units with selected demographic variables .There was no significant association between post test knowledge score of staff nurses with the selected demographic variables such as Age, Gender, Educational qualification, Total years of working experience and Source of information regarding arterial blood gas analysis and its interpretation at 0.05 level of significance. This indicates that the demographic variables and post test knowledge score of staff nurses does not have significant association and were independent of each other. Hence the null hypothesis was accepted and research hypothesis was rejected for the demographic variable Age, Gender, Educational qualification, Total years of working experience and Source of information regarding Arterial blood gas analysis and its interpretation in terms of practice

 

 

Objective 7: To determine the association between the post test practice scores regarding arterial blood gas interpretation among staff nurses working in critical care units with selected demographic variables.

Table-5 Fisher’s exact test showing association of post-test practice scores of staff nurses working in critical care units with selected demographic variables (N=30)

Demographic Variable	Practice Score (Median-17.5)		P value	Inference S/NS
	Below Median	Above Median
1.AGE a.  Less than 25 years b.  25 - 30 years c.  More than 30 years	7 8 0	12 1 2	0.1	NS
2. GENDER a.  Male b.  Female	2 13	3 12	0.03	S
3. Educational Qualification a.  General Nurse Midwifery b.  B Sc. Nursing c.  Post Basic B Sc. Nursing d.  Post graduate	6 7 2 0	7 8 0 0	0.02	S
4. Total Years of Working Experience a.  Less than 5 years b.  5-10 years c.  More than 10 years	12 3 0	14 1 1	0.2	NS
5. Source of Information Regarding Arterial Blood Gas Analysis and Its Interpretation a.  Workshops/ Conferences/ In-Service Education b.  Mass media c.  Printed material	9 3 3	11 3 1	2.7	NS

Significant at P < 0.05 level of significance

 

Table 5 Table depict the Fisher’s Exact Test value obtained to find out the association between Post test practice score of staff nurses working in critical care units with selected demographic variables. There is a significant association between post test practice score of staff nurses with the selected demographic variables such as Gender and Educational level at 0.05 level of significance. Hence H₄ is accepted for Gender and Educational level variable and thus research hypothesis was accepted and null hypothesis was rejected whereas variables such as Age, Total years of working experience and Source of information regarding arterial blood gas analysis and its interpretation indicates that the demographic variables and Post test practice score of staff nurses does not have significant association and was independent of each other. Hence the null hypothesis was accepted and research hypothesis was rejected for the demographic variable Age, Total years of working experience and Source of information regarding arterial blood gas analysis and its interpretation in terms of practice.

 

DISCUSSION:

The current study focused on to assess the effectiveness of planned teaching programme on Knowledge and Practice regarding Arterial blood gas analysis and its interpretation among staff nurses working in critical care units at Jaypee hospital Greater Noida. A number of studies have been included in the chapter dealing with review of literature.

·       The knowledge score of Arterial blood gas analysis and its interpretation in pre test was assessed and maximum numbers of staff nurses i,e. 13 (43.4%) of staff nurses were having average knowledge, 11(36.6%) of staff nurses were having good knowledge whereas  2 (6.6%) were having excellent knowledge and 4(13.4%) were having poor knowledge. The knowledge score of staff nurses in post test was assessed and the table reveals that 24(80%) of staff nurses were having very good knowledge, 6(20%) of staff nurses were having good knowledge which indicates an increase in knowledge score after administration of Planned teaching programme. Hence, the teaching programme was effective in improving the knowledge of staff nurses working in critical care units regarding Arterial blood gas analysis and its interpretation.

·       The practice score of staff nurses in pre test was assessed and 17(56.6%) staff nurses were having average practice, 7(23.4%) of staff nurses were having poor knowledge and 6(20%) were having good average practice whereas in  post-test 19(63.3%) were having excellent  practice, 11(36.7%) were having good practice which indicates an increase in practice scores Hence, the teaching programme was effective in improving the practice of staff nurses working in critical care units after administration of planned teaching programme regarding  arterial blood gas analysis and its interpretation.

 

NURSING IMPLICATIONS:

The present study has implications for nursing practice, nursing education, nursing administration and nursing research.

 

Clinical Nursing Practice:

Nurses play an important role in providing standardized optimal patient care by adopting good Knowledge and Practice skills regarding Arterial blood gas analysis and interpretation.

 

Nurses has great responsibility to protect patient rights and safety, so they should be aware about the assessment on Arterial blood gas analysis, acid – base disorders and proper handling of arterial line patients as there is difficulty in recognizing and reporting events that routinely occur in complex and dynamic environments such as critical care units.

 

Nurses can organize mass educational training programmes on basic analysis of Arterial blood gas interpretation and documentation in hospital.           

 

Senior Nurses can educate and supervise staff in all aspects of Arterial blood sampling procedure and its interpretation.

 

Nursing Education:

Staff nurses should be prepared to impart knowledge and practice on arterial blood gas analysis and interpretation.

 

Training workshops should be organized for staff nurses to perform analysis of arterial blood gas on analyzer and acts on abnormalities within sample.

 

The nurse educator should teach and provide learning experience to nurses through demonstration of Arterial blood gas (ABG) sampling and analysis in relation to acid base balance.

 

Nursing Administration:

Nurse Administrator should take initiative and provide necessary facilities for the nursing staff to furnish themselves with the knowledge and practice regarding arterial blood gas analysis.

 

Nurse administrator must make sure that educational and informational materials are available and should have consistent information which can be displayed during educational programme.

 

Nursing Research:

The health care environment today is more dynamic and demanding. There is a need to promote research practice as nursing moves towards as an independent professional practice mode.

 

Nurses must take up researches in this area, so that quality care can be given to the patients.

 

Extensive research studies can be undertaken in different fields to quantify the magnitude of deficiency of knowledge and practice on arterial blood gas analysis and interpretation.

 

LIMITATION:

·       The small sample size

·       There was no control group

·       Restricted set-up

·       The staff nurses working in critical care units i.e., medical and surgical intensive care units, cardiothoracic and vascular surgery unit (MICU, CTVS and SICU) in single hospital only.

 

RECOMMENDATIONS:

On the basis of the findings of the study, the following recommendations were made;

·       A similar study can be repeated by using a large sample for the generalization.

·       A similar study could be conducted with a control group.

·       In-service education to be conducted to increase the knowledge and practice of nursing personnel.

·       A comparative study can be conducted to assess the nurses knowledge and practice between Government and Private hospital nursing personnel.

·       An experimental study can be conducted between direct puncture and arterial line sampling.

 

CONCLUSION:

The present study was done to assess the effectiveness of planned teaching programme on knowledge and practice regarding arterial blood gas analysis and its interpretation and from them majority of the staff nurses had Excellent knowledge, few of them had Good knowledge Regarding Arterial blood gas analysis and its interpretation and the majority of staff nurses were having Excellent practice, and rest is having Good practice Regarding Arterial blood gas analysis and its interpretation

 

ACKNOWLEDGEMENT:

I would like to acknowledge the study participants for providing me their responses. My sincere thanks to all those who assisted me directly or indirectly in the successful completion of this study.

 

CONFLICT OF INTEREST:

The study entitled “to assess the effectiveness of planned teaching programme on knowledge and practice regarding arterial blood gas analysis and its interpretation among staff nurses working in critical care units” is self-funded research work of Ms. Divya Upreti. So there is no conflict of interest.

 

REFERENCES:

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4.      Dona D Ignatavicius. Medical and Surgical Nursing; 5th edition; Saunder Publication; Hyderabad; 2009, pg.no . 928-37.

5.      Black M Joyce, Jacobs Matassarin Esther. Medical Surgical Nursing clinical management for continuity of care .3^rd Edition: New Delhi.W.B. Saunders Company; 1997.

6.      Raffin T. Indications for arterial blood gas analysis. An International Medicine 1986;105: pg.no .390-8.

7.      Moamary Al Mohamed, Daniel Diane. Appropriateness of Arterial blood gas measurements in acute general wards. Annals of Saudi Medicine 1999;19(2): pg.no.153.

8.      Mohan Alladi, Premanand Raya, Reddy Narayana, Kamity Ranjit, clinical presentation and predictors of outcome in patients with severe acute exacerbation of COPD requiring admission to ICU.BMC Pulmonary medicine 2006;6:27.

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Received on 22.10.2019         Modified on 16.11.2019

Accepted on 06.12.2019       ©A&V Publications All right reserved