KNOWLEDGE ASSESMENT OF INTENCIVE CARE UNIT (ICU) NURSING STAFF

ABOUT MANAGEMENT OF PATIENTS RECEIVING INOTROPIC DRUGS ·

PROJECT REPORT

SUBMITTED BY

TIMY SANTHIPALAN

SREE CHITRA TIRUNAL INSTITUTE FOR MEDICAL SCIENCE AND TECHNOLOGY

' ~·

MEDICAL COLLEGE, THIRUV ANANTHAPURAM. NOVEMBER 2006

-7 c----------------------- --~ ------------------------------------ ------ __ __. __________ - -------------------------- --------------------------~-----J~

CERTIFICATE

Certified that this is the bonofied work of MrsTimy Santhipalan at

Sree Chitra Tirunal Institute For Medical Science And Technology.

Submitted in partial fulfillment of the requirement for the

Diploma in Cardiovascular and Thoracic Nursing from Sree Chitra Tirunal

Institute ofMedical Science and Technology.

Date: "\ 12-l 'l. oo.C

Place:

Mrs.Saramma.P.P .M.N Lecturer in nursing SCTIMST Trivandrum

ACKNOWLEDGEMENT

All the glory and honour is to god who guided the investigator from the very

beginning till the end for the successful completion of the work.

The investigator would like to express heartful thanks to ow:: advisor and guide

Mrs.Saramma.P.P ,M.N Lecturer in Nursing, SCTIMST who put their valuable efforts .

to correct our study materials and guided us through out the study.

Then the investigator also takes this opportunity to express the sincere thanks to

Dr.A.V.Gorge (MA, BA, PHD) Registrar SCTIMST, TVM.

The investigator expresses her heartful thanks to Mrs.Sudhamaniamma (MSc (N),

PGHRM, Deputy Nursing Superintendent · who gave her valuable suggestions in

conducting the study.

The investigator takes this opportunity to express the special thanks to Mrs. Valsala

(Ward sister, <;SICU) and Mrs.Aiiamma John ( Ward sister ,CCU) SCTIMST,

THIRUV ANANTHAPURAM. The investigator is also thankful to all staff of ICU at

SCTIMST ..

The investigator report special thanks to the library staffs of Achutha Menon Centre

SCTIMST for their co-operation and help.

The investigator likes to express thanks to all friends who helped directly or indirectly

through out the project.

The investigator wish to express heartful thanks to parents and near one for their prayer,

encouragement and help by all means through out the procedure.

The investigator also takes this opportunity to express the sincere gratitude to all nursing

staff who co-operated during the time of data collection.

INVESTIGATOR

TABLE OF CONTENTS

Chapter Titles Page. No

1 INTRODUCTION

Background of the study 10

Need for study 11

Statement of the problem 11

Operational Defenitions 11

Objectives 12

Delimitations 12

Summary 12

2 REVIEW OF LITERATURE

Introduction 13

Studies conducted on knowledge assessment 13-19

3 RESEARCH METHODOLOGY

Introduction 20

Statement of the problem 20

Research approach 20

Research design. 21

Settings of the study. 21

Populations .21 Samples and sampling techniques. 21

Development of Data collection tool. 22

Description of tools 22

4

5

6

7

Pilot study

Data collection procedure

Plan of Data Analysis

Summary.

22

22

23

23

ANALYSIS AND INTERPRETATION OF DATA

SUMMARY, CONCLUTION, IMPLPICATIONS AND

RECOMMENDATIONS.

Summary.

Conclusion.

Findings ofthe study

Limitations.

Recommendations.

BIBILIOGRAPHY

APPENDICES.

34

35

35

35

35

36-37

38-42

LIST OF TABLES

Sl.no Titles Page. No

1 Distribution of sample according to age group 25

2 Distribution of sample according to experience 27

3 Distribution of sample according to Speaciality in nursing. 29

4 Distribution of sample according to knowledge level 31

LIST OF FIGURES

Fig.No. Title of figures Page.No

1 Bar Diagram showing distribution of sample according to age group 26

~ Pie diagram showing distribution of sample according to experience 28

3 Pie diagram showing distribution of sample according to Speaciality in nursing.30

4 Bar Diagram showing dstribution of sample according to knowledge level 32

~--~~~~-----~--~~----~- ~-------------~- -~- -----~-,----------~

Appendix No.

A

B

List of Appendices

Titles

Consent form

Structured questionnaire

Page.No

38

39-42

CHAPTER 1

INTRODUCTION

Baeground of the study

Ino~opic drugs start the failing heart by increasing cardiac output, relieving

pulmo~ congestion and improving blood pressure and tissue perfusion. It affects the

strength of cardiac muscle contraction. Negative inotropic action decreases the forc.e of

contraction, positive inotropic action increases it. Common intropes used in ICU are

Dopamine, Dobutamine, Adrenaline, Noradrenaline, Isoprenaline and Milirinone.

Congestive Heart Failure is a common condition that occurs when the heart cannot

pump enough blood to meet tissue needs for oxygen and nutrients. Cardiogenic shock

following Conjestive Heart Failure, Myocardial Infarction and Cardiovascular surgical

procedures is also common. Inotropes play an important role in avoiding cardiogenic

shock. The compensative mechanism itself increases the workload of the heart and they

are limited tQ extend and. duration. In this condition drug therapy is aimed to improve

cardiac output by using inotropes and other supportive measures.

Nursing staff providing care to patitmts receiving inotropic drugs on a medical or a

surgical unit must have an adequate knowledge about its administration All inotropes can

cause a marked increase in heart rate and encourage tachy arrhythmias They should

preferably be given through a central venous line than peripheral infusion Infusion of

some drug cause extravasations and can cause severe local tissue damage The drugs m~y

be diluted in saline or dextrose before administration All drugs must be la~led

accurately with name concentration diluent's and rate

Nursing expertise for drug administration can vary according to experience

educational level and the knowledge, ·regarding evidence based practice. Lack of

knowledge regarding current practice guideline and care may result in poor patient out

JO

Continuing education for nursing must be made a priority for nurses to provide safe

and high quality care Education provided must be current and based on positive outcome

through research based nursing practice

Need and importants of the study

An incident of dopamine administration in a peripheral vem, occurred in

CoronaryCareUnit(CCU) that caused tissue necrosis in the fore arm of a child Accidental

purging of inotropic drug can causes adverse effect in patients. Nursing staff providing

care to patients receiving inotropes in a CCU must have an adequate knowledge about its

administration. Hence the investigator conduct a study to assess the knowledge of ICU

nursing staff .

Statment of the problem

Knowledge assessment of the ICU nursing staff regarding the administration of

inotropic drugs

Defenitions of terms

Ionotropes

Ionotropes are drugs used to increase the force of myocardial contraction and

cardiac output common inotropes used in ICU are Dopamine Dobutamine, Adrenaline,

Nor adrenaline, Isoprenaline etc

Knowledge assesment

Written responses of nursing staf.f to the knowledge test on inotropes

11

l.To asses the knowledge of nursing staff of different category, qualification, age and

ICU experience regarding inotropes.

2.To find out association between knowledge ofiCUnursing staff and providing

better nursing care to patients and selected variables.

Delimitations

l.Knowledge test on inotropes done only in CCU and Cardiac Surgical Intensive

Care Unit (CSICU). Medical and surgical wards are not involved.

2.Assesment done only among the staff nurses of SCTIMST and other institutions

are not involved.

Summary

This chapter has included the background of the study, need for the study,

statement of the problems, objective of the study, definition of terms and limitations .

.12

CHAPTER II

Review of literature

Review of literature is the key step in the research process it refers to a

broad,comprehensive,indepth,systematic and critical review of scholarly publications,

unpublished scholarly print materials and audio visual materials

(B.Y.BASAVATHAPPA,2001)

A review of literature is an essential activity of scientific research projects,which

provides a basis for future investigation, justifice feasibility of the study,

indigate,constraits of data collection and helps to relate findings from one study to

another with a view to establish a comprehensive body of scientific knowledge in a

professional discipline from which valid and pertinent theories may be developed

(ABDULLA FAY, 1979)

Wash burn ( 2005) conducted a study to describe nurses' knowledge of heart

failure (HF) self-management education principles. Fifty.;.one nurses working in a small

midwestern community hospital completed a 20-item true or false written survey to

assess their knowledge of 5 areas of HF self-management The sample included 14 nurses

working in an intensive care unit (ICU) and 41 nurses wm:king on a general medical unit,

all routinely providing care to patients with HF. There was no statistical difference in

mean score between intensive care unit (14.7 +/- 1.6) and floor (14.5 +/- 2.1) nurses.

Correct responses to individual survey items ranged from 20% to 1 00%; 6 questions

resulted in mean scores >90% correct, 9 questions had mean scores between 70% and

90% correct, and 5 questions had mean scores <70% correct. Most respondents (90%)

answered 6 questions correctly, but on 9 questions, 70% and 90% answered correctly. On

13

questions, less than 70% answered them correctly. Two questions were answered

correctly by all participants. Subject areas of frequently missed questions were the use of

nonsteroidal anti-inflammatory drugs, use of potassium-based salt substitutes, assessment

of weight results, and physician notification of a symptomatic low blood pressure and

momentary dizziness when rising. These results suggest that nurses working in a small

community hospital may not be sufficiently knowledgeable in HF management

principles. Additional emphasis on HF educational principles may improve the quality of

patient education. One suggested intervention is to provide ongoing education for nurses

regarding HF management.

Bird (2002) conducted a study to describe nurses' assessment skills and

knowledge related to the management of a patient with an epidural infusion and to

explore relationships between these variables and the levels of education/clinical

experience of the nurses. This descriptive correlation study used a convenience sample of

surgical and obstetric unit registered nurses to explore relationships between the

knowledge and skill in epidural management and the educational preparation of the

nurse. Data were collected via survey and observation, using instruments developed by

the research team. The researchers found that the nurses had a good knowledge base for

the performance of sensory blockade assessment but scored less well in motor blockade

assessment and clinical decision-making. Nurses who had clinical experience, had

completed a self- directed learning package and who worked in surgical areas scored

higher on the survey than other nurses. Observation scores revealed a range of

performance outcomes. There was only a weak correlation between knowledge and skill

performance. There were no differences in scores for the observation exercise for

different groups of nurses: The results of this study indicated that the nurses' theoretical

knowledge outweighed their clinical skill performance and clinical decision-making.

Education for nurses regarding the management of epidural infusions needs to be

comprehensive, context specific and have the capacity to develop the nurse's autonomous

critical thinking and clinical decision-making skills. Strategies for this include self­

directed learning

14

Walsh (2005) examined the influence of level of practice, additional pediatric

education and length of pediatric and current experience of nurses knowledge and

believes about fever and fever management A self-report questionnaire was used. An

instrument was developed, piloted by test-retest and revised prior to data collection.

Fifty-one paediatric nurses working in medical wards of a metropolitan paediatric

hospital in Australia participated. Nurses' mean knowledge score about the physiology of

fever, general fever management and antipyretics was 62%, which was not as high as

expected. Participants reported positive attitudes toward the benefits of fever, the

necessity for its reduction in children with pre-existing cardiac or respiratory conditions

and towards regular antipyretic administration masking the infective process. Negative

attitudes included disbelief that temperature is often unrelated to illness severity.

Conflicting attitudes toward febrile convulsions were highlighted by beliefs that

antipyretic therapy prevents these and that antipyretics do not prevent initial febrile

convulsions. Predictors of intentions to administer paracetamol were beliefs about the

effectiveness of paracetamol and nurses' beliefs about the expectations of others in

relation to paracetamol administration. Nurses reported strong intentions to administer

paracetamol to the next febrile child they cared for. Limitations of the study include the

use of a nurse manager for recruitment and collecting the data at only one site. C Fever

management is an integral aspect of paediatric nursing. For its consistent rational

management, nurses must have appropriate knowledge and positive attitudes. This

highlights the need for continuing education in fever management.

Dawson D ( 2006) conducted a study to: explore the experience of nurses'

new to critical care and to identify what factors influence the nurses' experiences during

this time. Evaluate methods used to facilitate nurses' development such as education and

preceptorship. This longitudinal qualitative study was undertaken using hermeneutic

phenomenology and involved all nurses (n=14) recruited to the unit during two cohort

intakes in 2002. Data collection was by means of semi-structured interviews at one, three

and six months. All interviews were tape recorded, transcribed, and analyzed for

emerging themes and concepts. Participants described a variety of unique experiences

throughout the interviews, many of these related to four key themes: support, knowledge

and skills, socialisation and moving on. There were also a number of key factors

15

influencing these experiences. including foundation programme, support, preceptors, staff

and pre-requisites. Although strategies such as education and preceptorship were

positively evaluated, areas for improvement were also identified. This study capturesthe

unique experiences of nurses new to critical care and demonstrates the complexity of

socialisation to the critical care milieu.

Cooper. (2003)conducted a study to explore the approach taken by nurses

in an adult acute-care hospital to the assessment and management of people with urinary

incontinence. Thirty-three registered nurses from medical and surgical areas of an adult

acute-care hospital in Melbourne, Australia, were recruited to participate in the study.

A questionnaire was developed using a series of 5· scenarios, each representing typical

stories relating to different types of urinary incontinence. The participants' responses

were analyzed for themes. The findings were presented in a focus group of participants to

check validity of the findings and to discuss the implications for practice. The researchers

found that the participants in this study were limit~d in their assessment and management

of people with urinary incontinence. The results of this study suggest that acute care

nurses have limited ability to assess and manage varying types of urinary incontinence.

There are many possible reasons for this limited ability, primarily lack of knowledge, but

contributing factors are lack of time, lack of support, and a culture that fails to promote

independent. practice and holistic care. Specific continence education in undergraduate

nursing programs and following graduation is indicated, and acute-care hospitals need to

develop systems, processes, policies, documentation, and role models to enhanc.e the care

of clients with urinary incontinence.

Kaira ( 2004) conducted a study for comparison of nurses competent of

different hospital environment. examines nurses' perceptions of competence in different

university hospital work environments. The study examined ~urses perceptions of

competents in different university. They analysed self-assessments of competence. of 593

Registered Nurses working in wards, emergency/outpatient or intensive .. care units or in

ope-ration rooms. The instrument used was a pretested 73-item questionnaire consisting of

seven competence categones. The je.vel of competence was assessed on a Visual

Analo~~ Sc~e (VAS) Sy~le pf 0-100 and the frequencY, Q~;~ilg items of competencies ,.

16

in clinical practice was assessed on a four-point scale. Nurses reported their overall level

of competence as good. They felt most competent in the categories of Managing

situations, Diagnostic functions and Helping role (VAS-means 68-69), and least

competent in Ensuring quality category (VAS-mean 56). Operation room nurses

compared with other nurses reported lower level of competence and lower frequency of

using items of competencies in several competence categories. In general, the self­

assessed level of competence was greater the higher the frequency of using of

competencies. Correlations between both age and length of work experience and the self­

-assessed overall level of competence were positive. Nurse competence profiles differed in

both the level of and in frequency of using competencies between work environments.

Context-specific knowledge of nurse competence from real work life situations provides

direction on how to structure work environments and staff development interventions to

provide qualified care.

Timmins (2005) conducted a study aimed to identify the nurses' levels of

knowledge with regard to chest drain management. The research objective of this study

was to describe the nurses' levels of knowledge regarding the care of the patient with

chest drains. The data were collected using survey method. The results of the study

revealed deficits in knowledge in a select group of nurses. Several service-led options

exist with regard to improving knowledge in this area, such as service study days as well

as ward-based tutorials. However, in an era of increasing accountability together with the

impetus for each nurse to provide evidence-based care, it is crucial for individual nurse

responsibility in the pursuit of knowledge it! this area. Nurses must be supported by local

practice development and through personal portfolio use to identify gaps in knowledge

and seek appropt1.ate training and resources.

Walsh (2005) conducted a study that describes nurses' knowledge of and

attitudes toward fever and its management and the predictors of their intentions to

administer paracetamol to a febrile child. Despite evidence-based support for the

beneficial effects of fever over the past three decades, health professionals' negative

attitudes toward fever and their relianc~. on antipyretics to reduce it have persisted and

continue to be reported in the literature. A self-report questionnaire was used. Ari

instrument was developed, piloted by test-retest and revised prior to data collection.

17

Fifty-one paediatric nurses working in medical wards of a metropolitan paediatric

hospital in Australia participated. Nurses' mean knowledge score about the physiology of

fever, general fever management and antipyretics was 62%, which was not as high as

expected. Participants reported positive attitudes toward the benefits of fever, the

necessity for its reduction in children with pre-existing cardiac or respiratory conditions

and towards regular antipyretic administration masking the infective process. Negative

attitudes included disbelief that temperature is often unrelated to illness severity.

Conflicting attitudes toward febrile convulsions were highlighted by beliefs that

antipyretic therapy prevents these and that antipyretics do not prevent initial febrile

convulsions. Predictors of intentions to administer paracetamol were beliefs about the

effectiveness of paracetamol and nurses' beliefs about the expectations of others in

relation to paracetamol administration. Nurses reported strong intentions to administer

paracetamol to the next febrile child they cared for. Limitations of the study include the

use of a nurse manager for recruitment and collecting the data at only one site. Fever

management is an integral aspect of paediatric nursing. For its consistent rational

management, nurses must have appropriate knowledge and positive attitudes. This

highlights the need for continuing education in fever management.

Pierson. (2005) conducted a study to exploring a critical care nurses'

perceptions and understanding of the discharge planning process in the health care system

in the state of Victoria, Australia. As part of the survey participants were asked to define

discharge planning as it related to the critical care environment in which they worked.

Utilising an exploratory descriptive approach, 502 Victorian critical care nurses were

approached to take part in the study. The resultant net total of 218 participants completed

the survey, which represented a net response rate of 43.4%. The data were analysed using

quantitative and qualitative methodologies. Three common themes emerged. A

significant number of participants did not believe that discharge planning occurred in

critical care, and therefore, thought that they could not provide a definition. There was

uncertainty as to what the discharge planning process actually referred to in terms of

discharge from critical care to the general ward or discharge from the hospital. There was

an emphasis on movement of the patient to the general ward, which was considered in

18

three meun ways by first, getting the patient ready for transfer; second, ensuring a smooth

transition to the ward and third, transfer of the patient to the ward often occurred because

the critical care bed was needed for another patient. The fmdings presented here suggest

at a nursing level, the discharge planning process is not well understood and some degree

of mutual exclusivity still remains. There is a need for further education of critical care

nurses with regard to the underlying principles of the discharge planning process.

Mattern (1997) conducted a study to ascertain critical care nurses' knowledge

of pressure ulcer prevention, staging, and description in reference to the AHCPR

guideline on pressure ulcer prediction and prevention. A cross-sectional survey design

was used to collect data from 75 critical care nurses. The Pressure Ulcer Knowledge Test,

used to assess nurses' knowledge, consisted of 4 7 true/false items and had a: total alpha

reliability of.91. Items were sorted into subscores of Prevention (33 items), Staging (7

items), and Wound (7 items). The percentage of items answered correctly on the test by

critical care nurses ranged from 15 percent to 83 percent. Test scores were not affected by

years of nursing experience, type of nursing education, or when the nurses had last read

an article about pressure ulcers. Only the Wound subscore was significantly affected by

the time since listening to a pressure ulcer lecture. Few critical care nurses had read the

AHCPR guideline on pressure ulcer prevention. This study revealed a knowledge. deficit

about pressure ulcer prevention among critical care nurses. Since pressure ulcers have

been identified as· a national health concern, .information about their prevention must be

shared and implemented in patient care.

19

CHAPTER III

RESEARCH METHODOLOGY

Introduction

Research Methodology is the way to systematically solve the research problem. It studies

the steps that researcher adopts to study his problem with the logic behind.

(C.R Kothari,1990)

This chapter provides brief description of different steps taken to conduct the study. It

includes research approach, research design, setting of the study, sample and sampling

technique, criteria for sample collection, data collection, description of tools, pilot study

plan of analysis.

Statement of the problem

A study to assess the knowledge of nursing staff regarding the administration of inotropes

Research Approach

To accomplish the objectives of the study, the investigator used descriptive

approach. The approach is made quantitative by using self-prepared multiple choice

questionnaire including ten questions. The aim of the study is to asses the knowledge of

nursing staff of different category, qualification, age, and ICU experience regarding

administration of inotropes and to find out the association between knowledge of -~

ICUnursing staff and providing better nursing care to patients and selected variables.

20

Research Design

Research design is the conceptual structure with in which the research is conducted. It

facilitates the smooth sailing of the various research operation, and there by making

research as efficient as possible yielding, maximum information with minimal

expenditure of time, effort and money. It is concerned with a researcher plan for

obtaining answers to the research questions. The research design selected for the present

study was descriptive approach.

Settings of the study

The study was conducted in "Sree Chitra Tirunal Institute for Medical Science And

Technology, Trivandrum.

The rationale for selecting this institute(SCTIMST) for this study

was that the investigator was most familiar with the institution. In addition to that

SCTIMST were one of the famous hospital all over India

Population

Staff nurses working in CCU and CSICU.

Samples and Sampling Techniques

Random sampling technique was used to select the samples for the study. Two stage

sampling was used for the present study. In the first stage ,5 samples were selected for the

pilot study .In the second stage twenty samples were selected for study purpose.

21

Development of Data Collection Tool

Data collection tool refers to the instrument which was constructed by the investigators to

obtain relevant data .In this study the researcher assessed the nurses knowledge by using

written responses of multiple choice questioner. The experts of SCTIMST test the tools

examined and content validity. A multiple choice questionnaire of 20 questions were

prepared based on the literature.

Description of the tools

The tool used in the present study consis of mainly 2 sections. Section A and B.

Section A

Deals with the demographic data.

Secttion B

Consist often questions regarding the management of administration of inotropes

The total score is 13 marks and each correct answer carries ' 1 ' mark and each wrong

answer carry' 0' mark.

Pilot study.

The pilot study was conducted on September 2006. The aim of the pilot study was to find

out the practicability and feasibility of the tool. The study was conducted among 5

samples. The sampling technique used was convenient sampling technique. Pilot study

findings revealed that the study was feasible and practicable.

Data collection procedure

Since no problem was faced during pilot study same method of data collection

was used for final study. The final study took around one and half month from Octobner

to November of 2006.Researcher first introduced herself and explained the need and

purpose of study to the subjects .Self prepared questionnaire given to subjects and

22

answers are written in a paper including their bio data and qualifications. Total time

taken for entire procedure was 5 to 1 0 minutes. The samples were co-operative and no

problem was encountered.

Plan of Data Analysis

The researcher decided to analyze the data in terms of frequency and percentages

and to present them in forms of tables, pie diagrams and bar diagrams.

Summary.

This chapter deals with introduction, statement of the problem, research approach,

research design, settings of the study, population samples and sampling techniques,

crieteria for sample selection, development of data collection tool, description of tools,

pilot study, data collection procedure and plan of data analysis.

23

CHAPTER IV

ANALYSIS AND INTERPRETATION OF DATA

Introduction

This chapter presents the analysis and interpretation of data collected from 20

staff nurses working in CCU and CSICU.

Analysis is a process of organizing and synthesizing data in such a way that

research questions can be answered. The over all aim of analysis is to organize, provide

structure to and elicit meaning from research data.

Interpretation refers to the process to making sense of the results and to

examining the implications of the fmdings with in a broader content.

The fmdings of the study were arranged analyzed under the following section.

Section A

Distribution of sample according to the demographic variables.

Section B

Distribution of subjects according to the knowledge score.

24

SECTION A

Distribution of sample according to demographic variables

Table 1

Distribution of sample according to age group

Age Group (years) Frequency Persentage (0/o)

20-25 5 25

26-30 9 45

31-35 1 5

36-40 3 15

41-45 2 10

Total 20 100

Data presented on table 1 shows that 25% of subjects belonged to the age group of ~

20-25,45% of subjects belonged to the age group of 26-30,5% of subjects belonged to

the age group of 31-35,15% of subjects belonged to the age group of36-40 and 10% of

subjects belonged to the age group of 41-45

25

Fig.No.-1

Bar graph showing distribution of sample according to age group

50 45 /1 40 v;, 35 '/;

Q) 30 01)

~ 25 Q)

/; V/ /I

0 20 1-1 Q)

p... 15

I/ I lj l'l /1/ /

10 'lj_ '/; '/; /; 5 I/; /; /; I/; I/; 0 I I I I /

20-25 26-30 31-35 36-40 40-45

Age in years

26

Table2

Distribution of sample according to experience

Experience Frequency Percentage (%) Above 1 Year 15 75 Below 1 Year 5 25 Total 20 100

Data presented in table 2 shows that 75% of subjects had an experience above 1 year

and 25% of subjects had an experience below 1 year.

27

Fig.No.2

Distribution of sample according to experience.

28

Table3

Distribution of sample according to Speciality

Specialty Frequency Percentage (0/o) Specialisation training 5 25 No Specialisation training 15 75 Total 20 100

Data presented on table 3 shows that 25% of subjects belonged to specialization

(CVT Nursing.).And 75% of subjects belonged to no specialisation

29

Fig.No3

Distribution of sample according to specialty

30

Table4

Distribution of sample according to level of Knowledge Score

5 35 60 100

Data presented on table4 shows that 12 (60%) of subjects had 100% knowledge, 7(35%)

of subjects had 92% knowledge, ~d 1 (5% )had 77% knowledge.

31

Fig.No. -4

Distribution of sample according to level of knowledge score

60 n=13 55 . .

/; II) 50 rf 45 "Ei II) 40 Q 1-< II) 35 p,..

30

llj / 1/ //, I// n=12 //, 1/

25 Vj /j 20 1/j lj 15 1// I// 10 1// /j 5 I// I/ I n=10 0 1/ / 1//1

Very good Good Fair

32

SUMMARY

This chapter dealt with the objectives in which the data were analyzed,

distribution of samples according to the demographic variables such as age, experience,

speciality in nursing, and distribution of sample according to the knowledge level.

33

CHAPTERV

SUMMARY, CONCLUSION, LIMITATIONS AND

RECOMMENDATIONS

This study was conducted with the objective to assess the knowledge of staff

nurses regarding the administration of inotropes .A multiple-choice questionnaire was

used for collecting data from twenty samples.

A review of related research literature helped the investigator to get a clear

concept about the research topic undertaken, as well as to develop tools, methodology of

study and decide the plan for data analysis.

The research approach adopted for the study was descriptive approach. This

study was conducted at CCU and CSICU. Random sampling technique was used to

obtain samples.

Tools used for data collection comprising of two sections. Section A deals with

demographic data. Section B consists of 10 questions regarding the administration of

inotropes.

The prepared tool was given to experts for content validity. The pilot study was

conducted among 5 samples and the pilot study findings revealed that the tool was

feasible and practicable. The data collection was done on the month of September and

October 2006 and was analyzed and interpreted by using descriptive statistics.

Findings of the study.

Out of 20 subjects 60% of staff nurses had 100% knowledge, 35% of subjects had

92% knowledge and 5% of subjects had 77% knowledge.

34

Out of20 subJects 75% had an experience above 1 year and 25% had an experience

below 1 year, 75% of subjects belonged to specialization training and 75% had no

specialization training.

According to this study, the experience and speciality in nursing influnses

nurses knowledge

Limitations

The sample size was limited to 20.

Subjects were taken only from CCU and CSICU.

The study was conducted only in SCTIMST.Sree Chitra Tirunal Institute for Medical

Science and Technology

Nursing Research

This study was conducted with a minimum sample of 20. So the attention paid on

this aspect is very less. According to this study the experience and specialty in nursing,

influences the nurses knowledge. Nursing expertise for drug administration varied

according to experience and educational level. Lack of knowledge regarding current

practice guide line result in poor patient outcome Confidence in performing safe and

quality nursing care can affected by lack of knowledge

Recommendations

1.A study can be done by using a large sample.

35

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37

APPENDIX-A

CONSENT

Mrs. Timy Santhipalan explained the necessity of answering the 10 selected questions, as

a part of project work," Knowledge assessment of ICU nursing staff "regarding

administration of isotropes, the time taken will be with in 5 to 15 minutes. There is no

objection to participate in the above mentioned study

Date

Place.

38

Name

Signature.

APPENDIX-B

Knowledge assessment of ICU nursing staff regarding the administration of inotropes by

Written responses of multiple-choice questionnaire

Section-A

Demographic Data

1Name of the staff:

2Ed~fonal qualification in Nursing: ' I

4.Experience:

1.20-25

2.26-30

3.31-35

4.'36-40

5.41-45

1.Above 1 year

2.Below 1 year

5. Specialty in Nursing:

1.CVT Nursing: r·

2.No specialty-training programme

39

SECTION-B

Listen the question carefully and answer the most appropriate one.

Each cottect answer carries 1 mark.

Each wrongwswer carries 0 mark.

1 Inotropic drugs are used

a. To increase myocardial contraction and cardiac output

b. For the dialatation of blood vessels

c. As an anti coagulant

d. For the treatment of arrhythmias

2 Among the following drugs which one is not an inotrope

a. Amrinone

b. _ Atenelol

c. Dopamine

d. Milrinone

3 Safest route of continous infusion of inotrop is through an

a. Arterialline

b. Centralline

c. Peripheralline

d. Al1 the above

4 A patience body weight is 80kg, we have to administer dopamine infusion

(400mg/50ml),lO,Mglkg/mt, then how much ml/mt we have to set in an infusion pump.

a. 4mllhr

b. 6mllhr

c. Smllhr

d. 7mllhr

SAwailable form of drug of dobutamine.

a. 200mg/5ml

b. lOmg/Sml

c. 300mg/5ml

40

d. 250mg/5ml

6 An important side effett of inotrope include

a. Dyspnoea

b. Blurred vision

c. Bradycardia

d. V entric\ihrr arrhytJ?mias

7 The usual range of daily maintenance dos of Tab digoxin for an adult patient is

a. 0.125 to 0.25mg

b. 0.12 to 0.3 mg

c. 0.52 to 1 mg

d. 0.75 to 1 mg

' 8 Drug that usually cause tissue necrosis, when given through a peripheral line.

a .. Dopamine

b. Dobutamine

c. Adrenaline

d. Atropine

9 A first line drug for a low cardiac output state, especially when the systemic vascular

resistance is low and bp is marginal

a. Dopamine

b. Dobutamine

c. Isoproterinol

d. Amrinone

10 What would you do, if the ionotropic infusion does not produce a predictable effect?

Tick mark all that apply

a. Check that IV line is patent

b. Check all the calculation

c. Neglect it and wait

d. Ask a colleague to review yottr work

e. Call the doctor for help

41

Answers of selected questions.

1. a

2. b

3. b

4. b

5. d

6. d

7. a \

8. a

9. a

10. a,b,d,e