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A Study to Assess the Knowledge and Practices for Endo-Tracheal Care among Staff Nurses Working in Selected Hospitals of Pune.
Mrs. Leeja Bonny Thomas
1*, Mr.Basavant Dhudum
21Assistant Professor, Symbiosis College of Nursing (SCON), Symbiosis International (Deemed University), Pune, Maharashtra, India
2Bharati Vidyapeeth Deemed University, College of Nursing, Wanlesswadi, Sangli, Pune, Maharashtra, India
ABSTRACT
Nurses all over the world are occupied in pioneering performance ensuring an important development in the physical conditions of patients, populations, and health systemson an everyday basis.1
Endo- tracheal care is majorly done on prolonged mechanical ventilation patients. A retrospective study was conducted on the timing and technique of tracheostomy on mortality and morbidity in cardiovascular surgery patients. The duration of the study was Jan 2000 to October 2007. During this period 205 cases underwent the tracheostomy surgery out of 19559 cardiac operations. 134 (65.4%) cases were undergone the surgical tracheostomy and 71(34.6%) were percutaneous tracheostomy.
Infection rate was significantly low after the surgery of tracheostomy. Mobilization, cooperation and oral feeding rates were higher. 71.4% was the early multifactorial mortality rate of tracheostomiesand late tracheostomies were 88.1% (p=0.037).
The research method was exploratory descriptive approach which was adopted for the study because the study was aimed at assessing their knowledge and practice regarding Endo- tracheal care among Nursing staff working in selected hospital of Pune and determining it statistically.2
Keywords: Knowledge; practice, Endo-tracheal care, Nursing staff
Introduction
“Constant attention by a good nurse may be justimportant as a major operation by a surgeon.”
This definition of health given by WHO includes a clear objective which has to be pursued in an ongoing process.
Tracheostomy is a surgical opening in the trachea to make breathing easier and that forms a temporary or permanent opening. 3
From ancient time itself attempts to save man’s life from suffocation have been made. It’s said that around 1000 BC Alexander the great saved the life of his soldier from suffocation in his trachea using tip of his sword.4
"Semi slaughter” was the name given tothis technique of slashing the throat to save the life,previously. And later, Lorenz Heister coined the term tracheostomy in the year in 1718& in 1921 the indications and techniques for modern tracheostomy was described by Chevalier Jackson. He also emphasized the importance of post-operative care, which dramatically reduced death rate.4
Caring for a patient with tracheostomy requires the nurses to have a thorough understanding of airway management and maintenance ongoing assessment of the patients respiration function. In critical situation would require immediate intervention to ensure that respiration arrest is avoided.
Endo- tracheal care is a basic nursing skill, while it is matter of routine procedure in the practice of otolaryngology and critical care nurses’ general nurses in other areas may perform infrequently.5
Need for the Study
Tracheostomy is a common surgical procedure. Complication rates varying from 6 to 66% reported in India of considerable associated morbidity and mortality associated with tracheostomy range from 0 to 5% was also reported.6
A retrospective study was conducted on the timing and technique of tracheostomy on mortality and morbidity in cardiovascular surgery patients. The duration of the study was Jan 2000 to October 2007. During this period 205 cases underwent the tracheostomy surgery out of 19559 cardiac operations. 134 (65.4%) cases were undergone
the surgical tracheostomy and 71(34.6%) were percutaneous tracheostomy. Infection rate was significantly low after the surgery of tracheostomy. Mobilization, cooperation and oral feeding rates were higher. 71.4% was the early multifactorial mortality rate of tracheostomiesand late tracheostomies were 88.1% (p=0.037).
As per conclusion mortality and morbidity due to tracheostomy is common in the cardiovascular surgery patients. Early imitation of the procedure would have been greater effect on expected mortality and infection of critical patietns.6
Due to improper Endo-tracheal care and negligence complication on greater extent arisessuch as aspiration of secretion into the airway, oedema at site on incision, discharge from site of incision. Other problems which arise during endo- tracheal care are dislocation of Tracheostomy tube, bleeding from stoma, blockage of Tracheostomy tube, aspiration, swallowing problem, speech problems, secretionsand many more. These complications can usually be prevented with if the caregiver has proper knowledge of how to care for the tracheostomy site using aseptic technique. Endo-tracheal cares greater importance is precaution and measures adopted to reduce infection, morbidity and mortality plays important role.7
Good endo-tracheal management has a significant impact on patient’s general wellbeing and quality of life. It is therefore important that nurses are equipped with appropriate skills and knowledge and practice to take care of patient safely and completely and to very possible suctioning.7
Problem Statement
A Study to assess the knowledge and practices for endo-tracheal care among staff nurses working in selected hospitals of Pune.
Objectives
To assess the knowledge about endo-tracheal care among Nursing staff
To assess the practices aboutendo-trachealcare among Nursing staff
To find out the association between knowledge and practice with selected demographic variables
Operational Definitions Knowledge
According to Oxford Dictionary
Knowledge means information of awareness gained through experience or education.
In this Study
Knowledge means data collected through structured Questionnaire.
Practice
According to Oxford Dictionary
When you repeat an activity to improve your ability to do repeatedly in order to learn to become proficient.
In this Study
Practice means data collection through observation checklist.
Methodology Research Approach
The research method adopted for the study was quantitative research approach.
Research Design
The research design used was exploratory- descriptive research design
In the present study, the investigator tries to assess the knowledge and practice skills regarding tracheostomy care in an attempt to develop self-structured modules.
Setting of the Study
The setting of the study was selected hospital of Pune.
Sample and Sampling Technique
In this study, the investigator used the non-probability sampling approach. Using convenient sampling technique, 60 sample were selected who fit the inclusion criteria.
Inclusion Criteria
The Following criteria were to select the sample.
Nurses with working experience of 1year & above.
Nurses who are ready totake part in the study.
Exclusion Criteria
Nurses working in OPD.
Nurses who are not ready to take part in this study.
Nurses who are below one year of experience.
Development and Description of Tool
In this study, astructured questionnaire was developed by the investigator
Description of the Tool
The tool used self-reported structured questionnaire, which include two sections:
Section I consisted items on demographic data, such as age, sex, professional education, experience in years.
Section II was for the assessment of knowledge regarding tracheostomy care.
Total 20 items were selected for questionnaire. A blue print was prepared.
Scoring
There were totally 20 items in the questionnaire.Every correct answer was given a score of one.
01-05Poor
06-10 Average
11-15 Good
16-20 Excellent.
Another tool was used for observational checklist, which included total 27 items observational checklist was prepared. Correct step is given as one mark and wrong step is given zero. The total observational checklist was plotted on the scale of four.
01-07 Poor
08-14 Average
15-21 Good
22-27 Excellent
Interpretation
Inadequate knowledge & practices<50%
Moderate knowledge&practices 51- 75%
Adequate knowledge & practices>75%
Result
Table 1. Distribution of demographic variables
Demographic Variables
Experimental Group Frequency Percentage
Age:- 20-30years 30-40years 40-50years
38 18 04
63.33 30 6.67
Sex:- Male Female
35 25
58.34 41.66 Professional Education:-
ANM NURSING GNM NURSING B.Sc NURSING
26 22 12
43.34 36.66 20 Years in experience:-
1-5years.
6-10years 11-15years.
39 17 04
65 28.34
6.66
Table no.1 shows that most of the majority of sample 63.33 belongs to the age group of 20-30 years. 58.34%
were Males.43.34% were the ANM nurses and 65% were 1-5 years of experience.
Section II
This section presents findings on the relationship between knowledge and practice scores with selected demographic variable
Table 2. Association between knowledge score and Age
Age in years
0-25%
Poor
25-50%
Average
50-75%
Good
75-100%
Excellent Total
20-30 00 03 27 08 38
0.00% 7.90% 71.05% 21.05% 100%
30-40 00 02 16 00 18
0.00% 11.12% 88.88% 0.00% 100%
40-50 00 00 04 00 04
0.00% 0.00% 100% 0.00% 100%
Total 0 05 47 08 60
0.00 8.34% 78.33% 13.33% 100%
Figure 1. Association between Knowledge Score and Age
Fig.1. The above bar diagram shows that majority of samples i.e. the age group between 20-30 years had good knowledge 88.88 %( 16) regarding tracheostomy care in selected condition. Chi square test was 9.49 which is
>0.05. This shows that there is no significant association between knowledge and age.
Table 3. Association between Knowledge Score and Sex
n=60
Gender 0-25%
Poor
25-50%
Average
50-75%
Good
75-100%
Excellent Total
Male 00 03 25 07 35
0.00% 8.57% 71.43% 20% 100%
Female 00 02 23 00 25
0.00% 08% 92% 00 100%
Total 00 05 48 07 60
0.00% 8.33 80% 11.67 100%
Figure 2. Association between Knowledge Score and Sex
Fig.2. The above bar diagram shows that majority of samples are in males (35) but females had good knowledge regarding endo-tracheal care in selected condition. The calculated chi square test was 2.86, p value =5.99.which is > 0.05. This shows that there is no significant association between knowledge and sex.
Table 4. Association between Knowledge and Education
n=60
0-25%
Poor
25-50%
Average
50-75%
Good
75-100%
Excellent Total
ANM 00 02 21 03 26
0.00% 7.70% 80.77% 11.53 100%
GNM 00 02 20 00 22
0.00% 9.09 90.91 00 100%
B.Sc.N 00 01 08 03 12
0.00% 8.34 66.66 25 100%
Total 0 05 49 06 60
0.00 8.34 81.66 10 100%
Figure 3. Association between Knowledge Score and Education
Fig.3. The bar diagram shows majority of samples are from ANM (26) but GNM staff had good knowledge 90.91% regarding endo-tracheal care in selected condition. The calculated chi square test was 3.350 P = 9.49 which is > 0.05. Thus it shows there is no significant association between knowledge and education.
Table 5. Association between Knowledge and Experience
n=60
Experience 0-25%
Poor
25-50%
Average
50-75%
Good
75-100%
Excellent Total
1-5 years 00 03 33 03 39
0.00% 7.70% 84.61% 07.69% 100%
6-10 years 00 01 14 02 17
0.00% 5.88% 82.35% 11.77% 100%
11-15 year 00 01 01 02 04
0.00% 25% 25% 50% 100%
Total 0 5 48 07 60
0.00 8.33% 80% 11.66% 100%
ASSOCIATION BETWEEN KNOWLEDGE AND EXPERIENCE
Fig.4.The above bar diagram shows that majority of sample from 1-5 years’ experience (39) they had good knowledge 84.61% regarding endo-tracheal care. The calculated chi square test value was 8.725 P=9.49 which is
> 0.05. It shows that there is no significant association between knowledge and experience.
Figure 4. Association between Practice Scores with Selected Demographic Variables
Table 6. Association between Practice Scores and Age
n=60
Age in Years 0-25%
Poor
25-50%
Average
50-75%
Good
75-100%
Excellent Total
20-30 00 00 25 13 38
0.00% 0.00% 65.79 34.21 100%
30-40 00 00 09 09 18
0.00% 0.00% 50 50 100%
40-50 00 00 04 00 04
0.00% 0.00% 100% 0.00% 100%
Total 0 0 38 22 60
0.00 0.00% 63.35 36.65 100%
The above table shows that majority of samples in age group between 20-30 years (38) but age group of 40-50 had good practice skills (100%) regarding tracheostomy care. The calculated chi square test value was 3.80 P=
5.99 which is greater than 0.05.
Table 7. Association between Practice Skills and Sex
n=60
Sex 0-25%
Poor
25-50%
Average
50-75%
Good
75-100%
Excellent Total
Male 00 00 25 10 35
0.00% 0.00% 71.43% 28.57% 100%
Female 00 00 14 11 25
Total 00 00 39 21 60
0.00% 0.00% 65% 35% 100%
The above table shows that majority of samples are males and they had good knowledge (71.43) regarding tracheostomy care. The calculated chi square test value was 1.53 P= 3.84 which is greater than 0.05. This shows that there is no significant association between practice and sex.
Table 8. Association between Practice and Education
n=60
Education 0-25%
Poor
25-50%
average
50-75%
Good
75-100%
Excellent Total
ANM 00 00 17 09 26
0.00% 0.00% 65.38% 34.62% 100%
GNM 00 00 12 10 22
0.00% 0.00% 54.55% 45.45% 100%
B.Sc.N 00 00 10 2 12
0.00% 0.00% 83.33% 16.67% 100%
Total 00 00 39 21 60
0.00 0.00% 65% 35% 100%
The above table shows that majority of samples are ANM (26) but B.Sc. N had good knowledge 83.33%
regarding tracheostomy care. The calculated chi square value was 2.83 P value =5.99 which is > 0.05.
Table 9. Association between Practice Score and Experience
n=60
Experience 0-25%
Poor
25-50%
Average
50-75%
Good
75-100%
Excellent Total
1-5 years 00 00 27 12 39
0.00% 0.00% 69.24% 30.76% 100%
6-10 years 00 00 09 08 17
0.00% 0.00% 52.95% 47.05% 100%
10-15 years 00 00 03 01 04
0.00% 0.00% 75% 25% 100%
Total 0 00 39 21 60
0.00 0.00% 65% 35% 100%
The above table shows majority of samples belonging to 1-5years (39) but 10-15 years of experience had good knowledge regarding tracheostomy care. The calculated chi square test value 1.57 P= 5.99 which is >0.05.
Section III
Table 10. Distribution According to their Mean, Median, Standard Deviation of Knowledge and Practice of Nursing Staff Working in ICU
Aspect Knowledge Practice
Mean 13.46 20.73
Median 14 20
S.D 1.62 1.86
Table 11. Association of Knowledge and Practices Scores with Selected Demographical Variables
S.no Selected variables Chi square test P value
0.05 level Association
1 Age 2.62 9.49 No significant
2 Sex 2.86 5.99 No significant
3 Education 3.350 9.49 No significant
4 Experience 8.725 9.49 No significant
Table No.11:The above tables show that there is no association between knowledge score with selected demographics. (Age, Sex, Education, Knowledge)
Table 12. Association between Practice Score with Selected Demographic Variable by Chi square/ Fisher’s Exact Test
S.no Selected variables Chi square test P value
0.05 level Association
1 Age 3.80 5.99 No significant
2 Sex 1.53 3.84 No significant
3 Education 2.83 5.99 No significant
4 Experience 1.57 5.99 No significant
Table No 12: The above table shows that there is no association between practice score with selected demographic variables (Age, sex, Education, experience)
Discussion
Based on the objectives the researcher tried to assess the knowledge and practices of 60 samples regarding endo- tracheal care.
A similar study was conducted on staff nurses working in ICU regarding knowledge and practice regarding tracheostomy care in UK. 280 samples were selected. It was found that, of sampling group 56.69% were males 43.31% were female, it also found the majority of knowledge scored by males than females. In the present study
A similar study was conducted on staff nurses regarding endo-tracheal care among nurses 90 samples were selected. The study found that the samples were high in age group of below 35 years 62.22% were below 35 years. It also found that they achieved high good scores (73.53%). In the present study, of 60 samples 63.33%
were 20-30 years.
The demographic variables of above study were found to be similar. Another similar study was conducted on knowledge about tracheostomy care among nursing staff working in ICU the study found that majority of participants had inadequate knowledge scores 65.66%. In this present study among 60 samples 78.33% had good knowledge scores.13.33% had excellent knowledge. The results of above study were found to be contradictory.
Conclusion
The purpose of study was to assess the existing knowledge and practice regarding endo-tracheal care among staff nurses working in selected hospital and its correlation with selected descriptive research design was good research design for the present study.8
Based on the objective data was analysed by using inferential and descriptive statistics. Chi- square and p value is used to correlate the demographic variables.8
The nurses may malpractice and may don’t have adequate knowledge they need to improve the knowledge and practice skills. 9
The reliability co-efficient was done using test split half method and was found 0.9. The research design was used exploratory descriptive research design. Convenient sampling method was used 60 staff Nurses was selected according to criteria.9
The study was based on the fact which was reviewed the literature shows that nurses have adequate knowledge and practice skills regarding endo-tracheal care. The present study shows that the nurses are having adequate knowledge regarding endo-tracheal care.9
