RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA
SYNOPSIS PERFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATIONS

Ms. Puja devi

MEDICAL SURGICAL NURSING
1ST YEAR MSC NURSING
YEAR 2018-2019

SJB COLLEGE OF NURSING

BANGALORE -560060
 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA.
ANNEXURE 1
PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 NAME OF THE Ms. Puja Devi

CANDIDATE AND SJB COLLEGE OF NURSING
ADDRESS BGS HEALTH &EDUCATION CITY
KENGERI,
BANGALORE – 60
2 NAME OF THE SJB COLLEGE OF NURSING
INSTITUTE BGS HEALTH &EDUCATION CITY
KENGERI,
BANGALORE – 60

3 COURSE OF THE MSC NURSING 1ST YEAR

STUDY AND SUBJECT MEDICAL SURGICAL NURSING
4 DATE OF ADMISSION
TO THE COURSE
5 TITLE OF THE TOPIC “A study to assess the
effectiveness of the structured
teaching
program on advanced cardiac life support
among nurses in selected hospital of
Bangalore.”
6 BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION:
The goal of the advanced cardiac life support [ACLS] is to achieve the best
possible outcome for individuals who are experiencing a life threatening
event. ACLS is a series of evidence based responses simple enough to be
committed to memory and recalled under moments of stress. These ACLS
protocols have been developed through research, patient case studies, clinical
studies and opinions of experts in the field. The goal standard in the USA and
other countries is the course curriculum published by the American Heart
Association [AHA].Previously, the AHA released periodic updates to their
CPR and emergency cardiovascular care [ECC] guidelines on a five year
cycle, with the most recent update published in 2015.Moving forward, the
AHA no longer wait five years between updates; instead, it will maintain the
most up-to-date recommendations online at ECC guidelines.heart.org.

While ACLS providers should always be mindful of timelines, it is

important to provide the interventions that most appropriately fits the needs of
the individuals. Proper utilization of ACLS requires rapid and accurate
assessment of an individual in distress, but also to the assessment throughout the
course of treatment with ACLS.

ACLS protocols assume that the provider may not have all of the
information needed from the individual or all of the resources needed to
properly use ACLS in all cases. For example, if a provider is utilizing ACLS
on roadside, they will not have access to sophisticated devices to measure
breathing or arterial blood pressure. Nevertheless, in such situations, ACLS
providers have the framework to provide the best possible care in the given
circumstances. ACLS algorithms are based on past performances and result
in similar life threatening cases and are intended to achieve the best possible
outcome for the individual during emergencies. The foundation of all
algorithms involves the systematic approach of the BLS survey and the
ACLS survey [using steps ABCD].
NEED FOR STUDY:
Heart is the hollow muscular vital organ behind the sternum and between the
lungs ; its rhythmic contractions move the blood through the body nourish it.
Any variations in the heart will affect the precious life of human. So saving the
heart is very essential part of life.

Heart disease statistics describe the status are every 34 seconds a person in
the united states dies from heart diseases, more than 2500 Americans die
from heart diseases each day, every 20 seconds, a person in the United States has
a heart attack and about 250,000 people die of heart attack each year
before they reach a hospital and studies show that under-educated people are
more likely to suffer from heart attacks.

Cardiovascular diseases are the world's leading killer, accounting for 16.7
million or 29.2 percent of total global deaths 2003.The World Health
Organization [WHO] estimates that 60 to 70 percent of the world cardiac patients
will be Indians. In India in the past five decades, rate of coronary disease among
urban population have risen from 5 to 15 percent. Nearly 50 percent of CVD-
relates deaths in India occur below the age of 70, compared with 22 percent in
the west. This trend is particularly alarming because of its potential impact on
one of Asia's fastest growing economies.
To discuss the latest developments in the field of cardiac care, the seventh
three-day conference of the Asian Society of Cardiothoracic anesthesia is
being held at India Habitat Center here.

Talking about the scenario of cardiac problems in India and the factors that
have contributed to increasing the cardiac problems, Dr. Mehta added; ''The
prevalence rate of coronary heart diseases in the urban population is more
than three times than in the rural population. The incidence rate of stroke is
200 per 100,000 people. Every year approximately 25000 coronary bypass
surgery and 12,000 Angioplasties are carried out. About 12.5 percent of adult
urban males suffer from coronary artery disease. Each year between 48,000
and 1,2,8000 children are born with congenital heart diseases.''

The America Heart Association [AHA] developed basic and advanced

cardiac life support [ACLS] courses that expose participants to realistic
learning situations to increase cardiopulmonary arrest survival. This study
compared results of two ACLS classes on measure knowledge [content exam]
and resuscitation skills
[performance exam].Both the control and experimental groups consisted of
physicians, students, nurses, emergency medical technicians, respiratory
therapists, and advanced health care providers. The control group used low-
fidelity simulation [LFS]; the experimental group was exposed to enhanced
realism via high-fidelity simulation[HFS].The findings showed a positive
correlation between enhanced practice and learning but no significant
correlation between posttest and skill test scores for the LFS and HFS. The
HFS group did score higher on both cognitive and behavioural tests, but the
difference was not statistically significant. Participants from both groups
indicated satisfaction with their forms of simulation experience and course
design .The largest difference noted was verbal responses to course
satisfaction. The experimental group stated that learning using HFS was
enjoyable and recommended that ACLS should only be taught using HFS.
Further study is required to assess if practicing beyond the course enhances
short and long term retention of ACLS technique.

This study was conducted in selected teaching hospital of Bangalore during

the period which we started our own program of cardiac and trauma life
support. Team of doctors who attended this program until the end of the study
were involved in the assessment. A questionnaire and three part questions
were given to them, the questionnaire assessed knowledge about important
emergency procedures, while the first
, second and third part of questions assessed knowledge about ACLS and
BLS respectively. The same questions were given before giving the lectures
and repeated afterwards. The results were evaluated by computer and the
Chi-squared test was applied. This low percentage of correct answers
indicates more education and training are an urgent and important need in our
country.

This study examines need for ACLS training in selected rural,

community hospitals in Bangalore. The objectives of study is to define the
relative needs of the staffs of rural, community hospitals for training in
ACLS, identify weakness, and modify a standard ACLS course to meet these
needs; A well validated, multiple option, pre course test for life support
knowledge and clinical-judgement was administered to the staff nurses,
respiratory therapists, and practicing physician of selected rural and
 community hospitals. This study concluded that there is a need for ACLS
training in community hospitals. Educational programs for physicians and
staff should be designed to meet that needs.

Patients with heart failure are prone to arrhythmias, symptomatic and

asymptomatic; those are prognostically significant and have an important
bearing on the management of these patients. However, there are some
inherent problems in assessing the frequency of these arrhythmias within a
large patient population, due to a lack of uniformity in defining heart failure
transient nature of these rhythms. Patients with heart failure commonly die
suddenly. The causes of these deaths are difficult to ascertain accurately and
are often presumed arrhythmic. With the advent of effective interventions to
prevent sudden death, accurately defining the casual relationship between the
arrhythmias and sudden death has assumed great importance to appropriately
target therapy. Several attempts have been made to predict such deaths on the
basis of non-invasive and invasive diagnostic investigations with variables
success.

All the study shows that ACLS is essential in emergency care and
nurses have inadequate knowledge regarding advanced cardiac life support.

Dearth of study in India regarding nurses knowledge on advanced

cardiac life support and lack of knowledge among nurses motivated the
researcher to do this study and it anticipated that the study will help the
nurses to acquire knowledge regarding advanced cardiac life support.
REVIEW OF LITERATURE:

Review of literature provides basis for future investigations, justifies the

need for replication, throw light up on feasibility of the study, and indicates
constant of data collection and help to relate findings of one another.

1. Studies related to importance of education regarding cardiac life

support.
2. Studies related to importance of advanced cardiac life support.

Studies related to importance of education regarding cardiac life

support

This study conducted on knowledge level of residents in selected hospital

on ACLS. The aim of the study was to determine the ACLS knowledge level
of residents and related factors in the departments of anesthesiology,
emergency medicine, internal medicine, and cardiology in a selected hospital.
For this cross-sectional study, a total of 20 multiple-choice questions were
prepared concerning several different topics, including; fatal dysrhythmias,
oxygenation, ventilation and airway control, systole, and pulseless electrical
activity .Questions were given to residents before their periodic training
meetings and collected in 30 min. The present study emphasizes the necessity
for a standardized systematic postgraduates ACLS training program for the
resident of related medical disciplines. Further studies with larger groups are
needed to investigate theoretical knowledge, resuscitation skill competency,
and related factors.

This is a case-control study based education improves quality of care

during cardiac arrest among team responses at an academic teaching hospital
simulation technology is widely used in medical education. Linking
educational outcomes achieved in a controlled environment to patient care
improvement is a constant challenge. During the study period, both simulator
trained and traditionally trained residents responded to ACLS events. We
evaluated the effects of simulation training on the quality of the ACLS care
provided. This study highlights that simulation based educational program
significantly improved the quality of care provided by residents during actual
ACLS events. There is a growing body of evidence indicating that simulation
can be a useful adjunct to traditional methods of procedural training.

This study conducted on teaching advanced cardiac support on stroke.

The objective of study is to determine whether a case-based educational
module would increase pre hospital care providers, short term and long term
knowledge about stroke and to compare the educational impact when the
module was moderated by a physician versus an ACLS. Identical 25 question
tests were administered before and after the module. This case based
approach to emergency medical services stroke education is effective and can
achieve equal benefit when administered by a physician or an ACLS
instructor.

A study conducted on the assessment of the general knowledge of

emergency physician from selected hospitals on the care of cardiac arrest
patients. The objective of the study was to identify the proportion of
emergency physicians certified in immersion courses of ACLS, professional
profile, participation or not in ACLS, FCCS and ATLS immersion courses,
and cognitive assessment with 22 objective questions on CPR. In the sample
studied, theoretical knowledge of CPR was higher among physicians who
had attended the ATLS course. Cardiologists who had attended the ACLS
demonstrated a higher theoretical knowledge of the care of CA patients when
compared with physicians from other specialities taken as whole-internal
medicine, surgery, and orthopedics. Physicians who had attended the ACLS
and FCCS courses demonstrated a higher theoretical knowledge of the care
of CA patients when compared with physicians who had attended only one of
those courses; continued education is therefore essential.

This study investigates the Mastery learning of ACLS skills by

internal medicine residents using simulation technology and deliberate
practice. The aim of the study was to use a medical simulator to assess
postgraduate year 2 resident baseline proficiency in ACLS scenario and
evaluate the impact of an educational intervention grounded in deliberate
practice on skill development to mastery standards. After baseline evaluation,
residents were then retested. Performance improved significantly after
simulator training. All residents met or exceeded the mastery competency
standards.

A study conducted on knowledge and skill after brief ACLS training.

An objective was to determine the knowledge level and skill base in nurses
before and after brief ACLS training and again three month later. Thirty
nurses were tested for knowledge and skill before ACLS training comprising
1 hour lecture and handouts, and 1 hour simulation training. Skill practice
comprised airway management, chest compressions and practice with
equipment. After the training, the nurses anesthetist were immediately tested
and again three months later. Conclusion of the study was after the brief ACLS
training knowledge and skills were significantly improved, but
knowledge was not retained at the post training test levels until the three month
check. More frequent ACLS education is necessary.

A study conducted on the retention of ACLS knowledge among

registered nurses. In an investigation into the retention of ACLS knowledge over
time, the author found that ACLS scores significantly decreased for a
subgroup of a sample of 40 RNs employed in critical care areas in the first
year after certifications. Several variables that influenced scores were
identified. Recommendations for inservices educators include reconstructing the
ways in which ACLS courses are taught, conducting mock mega code
scenario every 6 months, constructing mega code scenarios that reflect the
reality of practice, and routinely conducting refresher courses based on
problems identified in a particular group.

Studies related to importance of ACLS:

This study examines ACLS in out of hospitals cardiac arrest in 17 cities

before and after ACLS programs were instituted and enrolled 5638 patients
who had cardiac arrest outside the hospital. The addition of the ACLS
interventions did not improve the rate of survival after out-of-hospital cardiac
arrest in a previously optimized emergency medical services system of rapid
defibrillation. In order to save lives, healthcare planners should make CPR by
citizens and rapid defibrillation responses a priority for the resources of
emergency medical services systems.

A prospective study on withholding advanced cardiac life support in

out of hospital cardiac arrest among 114 patients. This was a descriptive
study in a physician-staffed emergency medical services during a 12 month
period. All patients presenting with a cardiac arrest were included. Patients
were allocated to 2 groups: Characteristics of patients including previous
health status , time intervals, therapies and outcomes, were collected. This
study concluded that decision criteria leading to refrain from starting CPR in
the pre hospital setting are age, previous health status and initial basic life support.

This study was examining treatment of prolonged ventricular

fibrillations. The purpose of this study was to compare cardiac
resuscitation
outcome between immediate counter shock of prolonged
ventricular
fibrillation with high dose epinephrine therapy and conventional
CPR before
counter shock of prolonged ventricular fibrillation in a canine model.
Early
counter shock of ventricular fibrillation has been shown to improve

immediate and long term outcome of cardiac arrest. The findings of

this study
suggest that a brief period of myocardial perfusion before counter
shock
improves cardiac resuscitation outcome from prolonged ventricular
fibrillations
 STATEMENT OF THE PROBLEM:

“ A study to assess the effectiveness of the structured teaching

program on advanced cardiac life support among nurses in selected
hospital of Bangalore.”

OBJECTIVES OF THE STUDY:

1.Assessing the knowledge regarding advanced cardiac life support among

nurses in the terms of pretest.
2.Evaluate the effectiveness of structures teaching program regarding
advanced cardiac life support by comparing pretest score with posttest
knowledge score.
3.Find out the association between knowledge score on posttest knowledge
score and selected demographic variables.

OPERATIONAL DEFINITIONS:
1.EFFECTIVENESS: It refers to the extent to which the structured teaching
program on ACLS has achieved the desired effect in improving the
knowledge of nurses as assessed by structured questionnaire .
2.STRUCTURED TEACHING PROGRAM: It refers to systematically
planned group instructions by lecture cum discussion method designed to
provide information regarding ACLS such as meaning, indications, uses,
equipment setting clinical interventions and management.
3.ADVANCED CARDIAC LIFE SUPPORT: It refers to a set of clinical
interventions for the treatment of cardiac arrest and other life threatening
medical emergencies and also refers to the knowledge and skills necessary to
deploy those interventions.

HYPOTHESIS:

H 1 : There is a significant difference in the knowledge score on ACLS

in the posttest knowledge score than the pretest knowledge score among
nurses .
H 2 : There is a significant association between knowledge score and
demographic variables.

ASSUMPTIONS:

1.The nurses will have inadequate knowledge regarding ACLS.

2.The planned teaching program improves the knowledge of nurses regarding

ACLS.

PROJECTED OUTCOMES:

The structured teaching program will enhance nurses knowledge

regarding advanced cardiac life support.

DELIMITATIONS:

The data collection period is limited to 6 weeks

2.Assessment of knowledge is measured by one observation only.

3.Teaching strategy is delimited to lecture method only.

 VARIABLES:

1.Dependent variables of this study are knowledge of nurses regarding ACLS and
independent variables are STP on ACLS.
2.Demographic variables in this study are age, gender, education, occupation, religion and family
income, type of family and source of information.

MATERIALS AND METHODS:

The study is designed to determine the effectiveness of structured teaching

program on cardiac life support among nurses in selected hospitals of
Bangalore.

*Source of Data : Data will be collected from nurses in selected hospital.

*Research desgine: Research design adopted for the present study is quasi,
one group pretest design.
*Research approach: The research approach is used in this study is
evaluative approach.
*Setting of the study: It will be in the selected hospital of Bangalore.
*Population: The population of present study comprises the nurses in
selected hospital of Bangalore.
*Sample size: The proposed sample size of the study is 60 nurses.
*Sampling technique: Sampling technique using in this study is simple random sampling.

SAMPLING CRITERIA:

1.Nurses who are working in cardiac ICU.

2.Nurses who are willing to participate.

*Inclusion criteria: Nurses who are available at the time of data collection.

*Exclusion criteria: Nurses who are taking leave/absent at the time of data collection.
 METHODS OF DATA COLLECTION:
*Tools for data collection: Self administered questionnaire.

*Procedure for data collection: The data will be obtained with the
prescribed time period in selected hospital of Bangalore.

-Permission will be obtained from higher authorities.

-Purpose of the study will be explained to the respondents.
-Pretest will be conducted using knowledge questionnaire. Subsequently
planned teaching program will be given on the day.
-On the seventh day posttest will be conducted. Proposed data collection
period will be 30 days.

*Data analysis method: The data analysis through descriptive and

inferential statistics.

a. Descriptive statistics: Frequency, mean, mean percentage and standard

deviation of described demographic variables.
b. Inferential statistics: Paired test to compare pre and posttest knowledge score. Chi-Score test will
be used to find out association between selected demographic variables.

DOES THE STUDY REQUIRE ANY INVESTIGATION TO BE

CONDUCTED ON THE PATIENT OR OTHER HUMAN BEING OR
ANIMALS?

-NO, This study does not have any investigations.

ETHICAL CLEARANCE:

The main study will conducted after approval of the research committee. Permission will
be obtained from the concern head of the institution. The purpose and after details of the
study will be explained to the study subjects and as informed concerned will be obtained
from them. Assurance will be given to the study subject on the confidentiality of the data
selected from them. Information consent will be taken from nurses who are willing to
participate in the study.
 LIST OF REFERENCES:
1.http://www.mamashealth.com/Heart_stat.asp

2.http://www.expresshealthcaremgmt.com/20041215/criticare 06.shtml

3.http://www.americanheart.org/presenter.jhtml?identifier=4478

4.Theresa A. Hoadley . learning advanced cardiac life support. a comparison study of

the effects of low-and-high-fidelity simulation. Nursing education perspective.V.30 [2],
p.91-5

5.Omar S. Khattab. Starting Basic and advanced, cardiac and trauma, life support
program’s will improve the emergency medical services in Iraq. Journal of emergency
medicine. September 2007, V7 [2].

6.Birnbaum ML, Kuska BM, Stone HL, Robinson NE, Need for advanced cardiac life
support training in rural, community hospitals, critical care med. .1994 May:V22 [5]
:P735-40
7.John G. F. Cleland, Timothy Houghton and Gerald C. Kaye. Prevelance and
incidence of arrhythmias and sudden death in heart failure. Medicine. November 02,
200;V7[3],P,229-242
1 SIGNATURE OF THE
CANDIDATE
2 REMARKS OF THE Study is feasible and of genuine interest of the
GUIDE Student. Similar type of study is not conducted in
Bangalore.
3 3.1 NAME AND Mr.Jince Thomas
DESIGNATION OF HOD, Asst. Professor,
GUIDE Medical surgical nursing
SJB College Of Nursing
Bangalore-60
3.2 SIGNATURE
3.3 CO-GUIDE
3.4 SIGNATURE
3.5 HEAD OF THE Mr.Jince Thomas
DEPARTMENT Asst Professor M.Sc.(N)
Obstetric & Gynecological Nursing
SJB College Of Nursing
Bangalore-60
3.6 SIGNATURE
4 4.1 REMARKS OF THE The topic for the study is relevant and forwarded
for needful action
PRINCIPAL
4.2 SIGNATURE