PROFORMA FOR REGISTRATION

OF SUBJECT FOR DISSERTATION

Submitted by,
Ms.A.Shobana
1st year M.Sc Nursing
Medical Surgical Nursing.
2008-2010
Sarvodaya College of Nursing
Bangalore – 79.
 RAGIV GANDHI UNIVERSITY OF HEALTH SCIENCE,
BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 NAME OF THE CANDIDATE AND ADDRESS A.Shobana
1 st year M.Sc. Nursing
Sarvodaya College of Nursing
11/2, Magadi Road,
Agrahara Dasarahalli
Bangalore – 560 079.

2 NAME OF THE INSTITUTION Sarvodaya College of Nursing

Bangalore – 560 079.

3. COURSE OF THE STUDY AND SUBJECT I st year M.Sc. Nursing

Medical Surgical Nursing
4. DATE OF ADMISSION OF COURSE 01.06.2008

5. TITLE OF THE STUDY

"A Study To Assess The
Knowledge Regarding
Cardiac Emergencies Among
Staff Nurses At Selected
Hospitals, Bangalore, With a
View to Organize A
Hands -On Skill Training
Programme."
6 BRIEF RESUME OF THE INTENDED WORK
Enclosed
6.1 Introduction Enclosed
6.2 Need for the study Enclosed
6.3 Statement of the problem Enclosed
6.4 Objectives of the study Enclosed
6.5 Operational definitions Enclosed
6.6 Inclusion and exclusion criteria Enclosed
6.7 Assumptions Enclosed
6.8 Review of related literature

7 MATERIALS AND METHODS

7.1 Source of data-Data will be collected from staff nurses working at selected
Hospitals, Bangalore. .
7.2 Method of data collection: self administered questionnaire method.
7.3 Does the study require and investigation or interventions to be conducted on
the patients or other human being or animals - NO
7.4 Has ethical clearance been obtained from your institutions?
YES, ethical committee's report is here with enclosed.
 RAGIV GANDHI UNIVERSITY OF HEALTH SCIENCE,
BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. NAME OF THE CANIDATE AND ADDRESS A.Shobana.

I st year M.Sc. Nursing
Sarvodaya College of Nursing
11/2, Magadi Road,
Agrahara Dasarahalli
Bangalore – 560 079.
2. NAME OF THE INSTITUTION Sarvodaya College of Nursing
Bangalore – 560 079.

3. COURSE OF THE STUDY AND SUBJECT I st year M.Sc. Nursing

Medical Surgical Nursing
4. DATE OF ADMISSION 01.06.2008

5. TITLE OF THE STUDY "A Study To Assess The

Knowledge Regarding
Cardiac Emergencies Among
Staff Nurses At Selected
Hospitals, Bangalore, With a
View to Organize A
Hands -On Skill Training
Programme."
6. BRIEF RESUME OF THE INTENDED WORK

6.1 Introduction

"Every heart that has beaten strong and cheerfully has left a hopeful impulse

behind it in the world, and bettered the tradition of mankind."

Robert Louis Stevenson

Cardiovascular diseases exert a huge burden on

individuals and society, with coronary heart disease the single most common cause of

death in the United Kingdom and other developed countries. Improved clinical care

has been responsible for around two fifths of the decline in mortality from coronary

heart disease in England and Wales over the past decade. Developments in cardiac

care, most of which have closely engaged nurses, have contributed to improvements

in care for patients with acute myocardial infarction and other acute coronary

syndromes.1

Death rates from coronary heart disease have been falling over recent

decades, mostly because of reductions in important risk factors, especially smoking.

About two fifths of the reduction in deaths resulted from improvements in medical

care. In the case of acute myocardial infarction, emergency treatment, particularly

early defibrillation, prompt administration of aspirin, and to a lesser extent hospital-

based thrombolytic treatment, has made important contributions to improved

outcomes.2

Arrhythmias are abnormal rhythms of the heart. Arrhythmias cause the

heart to pump blood less effectively. Most cardiac arrhythmias are temporary and
benign. Most temporary and benign arrhythmias are those where heart skips a beat or

has an extra beat. The occasional skip or extra beat is often caused by strong emotions

or exercise. Nonetheless, some arrhythmias may be life-threatening and require

treatment.3

Angina pectoris is a severe chest pain due to ischemia of the heart

muscle, generally due to obstruction or spasm of the coronary arteries. In coronary

artery disease, the main cause of angina is atherosclerosis of the cardiac arteries. The

term derives from the Greek ankhon ("strangling") and the Latin pectus ("chest"), and

can therefore be translated as "a strangling feeling in the chest". It is not common to

equate severity of angina with risk of fatal cardiac events. There is a weak relationship

between severity of pain and degree of oxygen deprivation in the heart muscle i.e.

there can be severe pain with little or no risk of a heart attack, and a heart attack can

occur without pain.4

Worsening angina attacks, sudden-onset angina at rest, and angina

lasting more than 15 minutes are symptoms of unstable angina, usually grouped with

similar conditions as the acute coronary syndrome. As these may herald myocardial

infarction, they require urgent medical attention and are generally treated as a

presumed heart attack.4

Myocardial infarction is the rapid development of myocardial necrosis

caused by a critical imbalance between oxygen supply and demand of the

myocardium. This usually results from plaque rupture with thrombus formation in a

coronary vessel, resulting in an acute reduction of blood supply to a portion of the

myocardium. Although the clinical presentation of a patient is a key component in the

overall evaluation of the patient with myocardial infarction, many events are either
"silent" or are clinically unrecognized, evidencing that patients, families, and health

care providers often do not recognize symptoms of a myocardial infarction.5

Coronary care units were developed in the 1960s to

reduce deaths following acute myocardial infarction. They provided a specialized

hospital facility staffed and equipped to monitor patients with suspected acute

myocardial infarction and facilitate rapid defibrillation of patients in cardiac arrest.

Nurses trained in resuscitation were crucial in providing 24-hour expertise in rhythm

recognition and early defibrillation to patients at the bedside.6

The success of the coronary care unit concept was, and remains, highly

reliant on the expertise of nurses working in close collaboration with medical

colleagues. From the early days of the coronary care unit, there has been recognition

of the value of nurses developing specialist knowledge and skill in, for example, ECG

interpretation, the understanding of treatment of acute myocardial infarction

complications and expertise in cardiopulmonary resuscitation. The formative years of

the coronary care unit provide the earliest examples of nurses taking on 'advanced'

roles, usually the preserve of physicians.7, 8

The advent of thrombolytic therapy, intravenous medication used to

break down or lyse blood clots occluding coronary arteries which lead to acute

myocardial infarction, brought new opportunities for nurses to develop and use their

expertise in patient assessment and ECG interpretation to benefit patients by

expediting treatment.
 Nurse-initiated thrombolysis refers to a situation where a nurse

assesses a patient with suspected AMI for eligibility to receive thrombolysis and

administers the treatment under a Patient Group Direction.

It is generally accepted that it is not the job title or profession of the

individual initiating thrombolytic treatment that is the key consideration. It is the

competence of that individual to safely undertake the intervention. Generic

competencies for the assessment and treatment of patients with suspected acute

coronary syndrome have therefore been proposed. An influential report from the

British Cardiac Society and Royal College of Physicians recommends that, all patients

with an indication for thrombolysis, and where there is no contraindication, should

receive this treatment from the first available qualified person able to provide

coronary care, whether this is a primary care physician, paramedic or hospital based

clinician.9

There is growing consensus that further reductions in delay will only

be achieved through the widespread introduction of pre- hospital thrombolysis,

delivered mostly by paramedics. Pre-hospital thrombolysis has been the subject of a

meta-analysis which demonstrated a 17 percent reduction in mortality. More recent

UK studies have assessed the feasibility of paramedic thrombolysis and concluded

that autonomous paramedic pre-hospital thrombolysis seemed feasible and safe and

was associated with improved call-to-needle times.10, 11, 12

Cardiovascular disease alone will kill 5 times as many people as

HIV/AIDS in middle and low income countries. This is over 29% of all deaths

globally. It's been projected that 71% of deaths due to ischemic heart disease. Cardio
vascular disease is more prevalent in India and china than in all economically

developed countries.13, 14

Projected global coronary heart disease deaths by sex, in all ages, 2005

shows that 53% are in men and 47% are in women. 15 According to WHO estimates in

2003, around the globe16.7 million death due to cardio vascular diseases each year.16

According to WHO, in 2002 there were 7.22 million deaths from

coronary heart disease globally. By 2020 heart disease will become the leading cause

of both death and disability worldwide. With number of fatalities projected to increase

to more than 20 million a year and to more than 24 million a year by 2030.16

Compared to year 2000, the number of years of productive life lost to

cardio vascular disease will have increased in 2030 by only 20% in USA, by 30% in

Portugal. For Brazil the figure is 64%, for china 57% and for India 95 %.Women will

continue to experience disproportionately high mortality from cardio vascular disease.

By 2040, women in the study countries like Russia, Brazil, India, China, and South

Africa will represent higher proportion of cardio vascular diseases deaths than men.17

In both developed and developing countries 40-75% of all heart attacks

victims die before reaching the hospital. 18 Projections suggest that for coronary heart

disease, mortality for all developing countries will increase by 120% for women and

137% for men. The WHO predicts 11.1 million deaths from coronary heart disease in

2020.19

'India to have 100 million heart patients by 2020', Going by the trends

in the incidence of cardiovascular diseases in India, the country is likely to have 100

million heart patients, i.e. nearly 60 per cent of the world's heart patients by the year
2020, according to an observation made by president of the Cardio logical Society of

India .20

Cardiovascular diseases are major causes of mortality and disease in

the Indian subcontinent, causing more than 25% of deaths. It has been predicted that

these diseases will increase rapidly in India and this country will be host to more than

half the cases of heart disease in the world within the next 15 years.21

6.2 Need for the study

Recent data on the global burden of disease have shown that

cardiovascular diseases will soon become the leading cause of death worldwide,

killing close to 15 million people in the world each year. The emergence of

cardiovascular diseases as the major cause of death in the world's most populated

regions, such as India and China, along with falling death rates from infectious

communicable diseases in these countries, are clearly the major reasons for the

elevation of cardiovascular diseases to their position as the leading cause of death

globally. Projections of mortality, taking into account the expected increases in

population and increased life expectancy, suggest that cardiovascular diseases will be

the leading cause of mortality, measured as "lost years of life," and the leading cause

of "years lived with disability" in all parts of the world by the year 2020.22

Cardiac diseases have nearly doubled in India, an alarming fact,

considering that it has almost halved in Europe and the USA.Latest data culled from

the World Health Organization and reports published in medical journals like Lancet

and Indian Heart Journal, suggest that by 2010 there would be close to 100 million

cardiac patients in India. It is 30 million now. These rather frightening facts were

revealed at a press conference on cardiac prevention, held by a top team of

cardiologists at the Apollo Gleneagles Hospital in Kolkata on Friday. Prevalence of

heart problems among US and European citizens under 40 years of age accounts for

just 25% and is declining. This patient population in India accounts for 60% and is

growing, said, senior cardio-thoracic surgeon at the city's Apollo Gleneagles

Hospitals. 23

Going by the trend, WHO has estimated that by 2010, India will have

60% of world's cardiac patients, and in another five years it is likely to become the

world capital for heart ailment. 23

Integrated Management of Cardiovascular Risk, WHO, 2002 shows,

12.5 million of the estimated 32 million worldwide heart attacks are fatal. 40-75% of

all victims die before reaching hospital.24

A study conducted in queen Elizabeth hospital, London, highlights the

need to identify and fast-track patients with an acute coronary syndrome so that

thrombolysis or appropriate interventional care can take place as soon as possible, to

optimize myocardial salvage and reduce door-to-needle time It is therefore extremely

important that nurses in acute clinical areas are able to record and interpret 12-lead

electrocardiograms so that the treatment modality can be initiated as soon as possible,

leading to better clinical outcomes for this patient group. Although nurses work within

a healthcare team, it is often the nurse who initially assesses, implements and

coordinates care for patients with chest pain, be it in the emergency department,

cardiac unit, general ward setting or general practice.25

A study conducted in St.Thomas hospital, London questioned 112

qualified nurses working on general medical wards about their resuscitation

experience and knowledge of ECG interpretation and defibrillation. Among 112

nurses 75% of nurses were involved in CPR as first responders but only 18% had used

a defibrillator during a cardiac arrest. The responses to this inquiry suggest that nurses

on medical wards are enthusiastic about advanced cardiac life support but have

limited basic practical knowledge. Therefore they suggest appropriate training and

retraining of staff will help to improve the outcome of resuscitation efforts on medical

wards.26

A study conduced in Bristol Royal Infirmary, UK, among nurses to

explore nurses' confidence and competence in preparing patients for having an

implantable cardioverter defibrillator. 152 nurses were assessed who are working in

cardiology areas of four large teaching hospitals. The study result shows nurses are

having poor knowledge of the device and its effects irrespective of additional

qualifications, length of time since qualifying or area of work. Many participants were

aware of the poor knowledge level of nurses and identified it as a weakness in current

care practices. Lack of understanding may impair preparation of patients for

implantation irrespective of additional qualifications, length of time since qualifying

or area of work.27

A study was conducted in BourneMouth University, poole hospital,

UK to assess the need for continued learning and professional development among

nurses working within the intensive care unit. To explore nurses' experiences, a

qualitative approach using a semi-structured questionnaire comprising open questions

was used. The questionnaires were then analyzed using line by line coding. The

findings revealed that intensive care nurses learn knowledge and skills continually

through a lifelong learning process in order to become a competent practitioner. The

ultimate outcome of learning for the intensive care nurses was to practice competently

in order to deliver high quality patient care.28

A study conducted to evaluate new instructional methods for teaching

high school students cardiopulmonary resuscitation and automated external

defibrillator knowledge, actions and skills by a cluster- cardiopulmonary resuscitation

controlled trial of 3 instructional interventions among Seattle area high school

students, with random allocation based on classrooms, during 2003-04. Study

examined two new instructional methods: interactive-computer training and

interactive-computer training plus instructor-led hands-on practice, and compared

them with traditional classroom instruction that included video, teacher d automated

external defibrillator demonstration and instructor-led hands-on practice, and with a

control group. Study assessed and knowledge, performance of key automated external

defibrillator and cardio pulmonary resuscitation actions, and essential cardio

pulmonary resuscitation ventilation and compressions skills 2 days and 2 months after

training. Students who received hands-on practice more successfully performed

cardio pulmonary resuscitation actions than those in the computer program only

group. Mean cardio pulmonary resuscitation skill scores were low in all groups. The

highest mean score for successful ventilations was 15% and for compressions, 29%.

The pattern of results was similar after 2 months.29

During 53 cardio pulmonary resuscitation (CPR) refresher courses

offered to nursing staff members, their individual skills and competence in CPR

procedures were examined according to the standards and guidelines of the German

Medical Association. The efficacy of cardiac massage and artificial ventilation

performed by each nurse was recorded. Result shows only 6.6% of the nursing staff
were found to have good skills in artificial ventilation. The main faults observed were

insufficient tilting of the head (24%) and failure to prevent leakage from the

insufflation airway (35%). Study concludes that, cardiopulmonary resuscitation skills

of hospital nurses are inadequate, mainly because of lack of manual dexterity. Study

result suggests that, refresher courses in specific CPR techniques must be demanded,

which should be made obligatory for nursing staff every 2 years. 30

The investigator had a felt need to do study among nurses on

cardiac emergencies when she came across an incident in her clinical practice. One

day when she was taking care of a client with multiple myeloma and severe acute

asthma in intensive care unit suddenly the patient developed acute myocardial

infarction, where the nurses could not take decision on immediate management.Thus

made her to think on educating nurses on cardiac emergencies by taking up this

research study.

6.3 Statement of the problem

"A Study To Assess The Knowledge Regarding Cardiac Emergencies Among

Staff Nurses at Selected Hospitals, Bangalore, With a View to Organize a

Hands -on Skill Training Programme."

6.4 Objectives of the study:

1. To assess the knowledge regarding cardiac emergencies among staff nurses.

2. To find out the association between knowledge on cardiac emergencies and

selected demographic variables among staff nurses.

3. To organize a hands-on skill training programme on cardiac emergencies.

6.5 Operational definitions

1. Knowledge: Refers to the information regarding cardiac emergencies

possessed by the staff nurse as assessed by the response to structured questionnaire.

2. Cardiac emergencies: Refers to debilitating cardiac conditions, such as

angina, acute coronary syndrome, myocardial infarction and dysrhythmias,

recognition of such emergencies, and the immediate management like,

cardiopulmonary resuscitation, defibrillation, thrombolysis and other measures like

oxygen administration, oral and sublingual nitroglycerin administration and morphine

administration.

3. Hands-on skill training programme: It refers to structured simulation

activity on CPR, defibrillator operation and cardiac monitoring organized by the

researcher for the samples.

6.6 Inclusion and Exclusion Criteria:

Inclusion criteria

1. Staff nurses with Diploma and BSc (Nursing) qualification who are registered

and licensed as RN.

2. Staff nurses who are willing to participate in the study.

3. Staff nurses who are available at the time of data collection.

Exclusion criteria

1. Staff nurses with ANM and Certification programme.

2. Staff nurses who have attended any kind of training programme on Cardiac

emergencies such as CPR training, ECG monitoring, defibrillator operation and

cardiac monitoring etc.

6.7 Assumption

1. It is assumed that nurses may have inadequate knowledge regarding various

cardiac illnesses, its causes, identification of emergency and its management within

the scope of nursing practice.

6.8. Review of related literature

1. Review related to incidence of cardiac death

A news was published in The Times Of India Bangalore,aug 21st 2008

on "Foot baller faints on field and dies". Albert Auguste was playing an intercollege

foot ball match on Wednesday when the incident took place. In the 18th minutes of

the second half, Auguste collapsed; still he was breathing in the ambulance, but

declared dead on arrival at the hospital.

Cardio vascular physician Dr.Ganesh Iyer says most

common cause of sudden death in sports persons could be due to obstruction of blood

flow from the heart. While exercising the requirement of blood to the body increases

suddenly. The heart is not able to cope. The person collapse and dies.31

2. Review related to nurses knowledge on cardiac emergencies

A study was conducted in Christine E Lynn College of Nursing to

identify and describe critical care nurses perception of arrhythmia knowledge. A

qualitative research design was used. The subjects were critical care nurses who work

in acute care settings where they read electrocardiographic data and make treatment
decisions. Study identified, basic, intermediate, and advanced levels of arrhythmia

knowledge among nurses. This study revealed a deficit in nurses' ability to recognize

and identify specific arrhythmias including heart block, aberrant conduction, and

tachyarrhythmia. Understanding of lead placement concepts varied greatly among

participants. Study conclusion, suggested that, the critical care nurses need to have

knowledge on level of arrhythmia for the development of competency measures and

evidence-based practice.32

50 qualified nurses were surveyed regarding their perception of their

competence in resuscitation and cardiology-related skills. This included the ability to

place a patient on a cardiac monitor, the identification of 7 basic arrhythmias and the

ability to offer correctly to the anesthetist the equipment for airway intubations and

central venous cannulation during the cardiac arrest situation. Generally, there was not

a satisfactory level of knowledge, with only 10 nurses feeling competent in

identifying all 7 basic arrhythmias. 33 nurses believed that they were competent in

handling the anesthetist the correct equipment for intubations, but only 22 nurses

stated competence in offering the correct equipment for central venous cannulation. A

review of the literature reveals that there is a considerable disparity between perceived

competence and the actual ability to carry out the resuscitation skills. This survey

once again reinforces the urgent need for regular assessment and updating of

resuscitation skills, knowledge and practice amongst nurses, particularly those

working in the ward areas.33

A descriptive study conducted on nursing judgment in the assessment

and the management among nurses in Rogue College, Oregon. Unrelieved cardiac

pain in patients admitted to a coronary care unit with a diagnosis of coronary artery

disease was examined from the perspective of nursing judgment. The purpose of this
study was to reveal expert clinical knowledge and judgment in this specific area of

critical care practice. Using a naturalistic approach, nurses were observed and

interviewed as they made judgments about cardiac pain. Findings indicated that

clinical knowledge of the titration of drugs was used in the treatment of cardiac pain

is also important in pain assessment.34

A study conducted in Queen Elizabeth II Health

Sciences Centre, Halifax, NS regarding administration of sublingual nitroglycerin

sublingual nitroglycerin for the treatment of episodic stable angina discomfort.

Anecdotal evidence gathered by advanced practice nurses in a cardiac pre-assessment

clinic suggested that sublingual nitroglycerin was often overlooked by health care

professionals as an integral part of angina management. The study found that nurses

were having knowledge deficits concerning the proper dosage and administration of

sublingual nitroglycerin, even in patients with a longstanding history of angina. Many

were unaware of sublingual nitroglycerin prophylaxis and the concomitant use of

topical nitrates.35

An article on the introduction of nurse initiated thrombolysis in

coronary care states patients who were assessed, and whose thrombolysis was

initiated by a nurse designated to deliver this treatment, had "door-to-needle" times

consistent with the current targets of the National Service Framework for Coronary

Heart Disease. A cardiologist acting as a "gold standard" reviewed the assessments of

the first 50 patients seen by nurses and he found that nurse delivered thrombolysis

treatment decision was appropriate. This gives support to the notion that appropriately

trained and experienced nurses can assess and make treatment decisions in this acute

care situation.36
 A study was made of the professional profile of nurses working in the

intensive care units of the hospitals of the Castilla-La Mancha, Spain. The study was

based on a questionnaire completed by significant sample of nurses working in these

units. This study result shows though most of the nursing professionals were satisfied

with the care they provide, there is demand for further training of nurses working in

intensive care and coronary units.37

3. Review related to effectiveness of Hands-on skill training programme on

cardiac emergencies.

A study conducted at Newham University hospital on a literature

review examining factors that enhance retention of knowledge and skills during and

after resuscitation training, in order to identify educational strategies that will

optimize survival for victims of cardiopulmonary arrest.

Poor knowledge and skill retention following cardiopulmonary

resuscitation training for nursing and medical staff has been documented over the past

20 years. Cardiopulmonary resuscitation training is mandatory for nursing staff and is

important as nurses often discover the victims of in-hospital cardiac arrest. Many

different methods of improving this retention have been devised and evaluated. One

hundred and five primary and 157 secondary references were identified. Of these, 24

met the criteria and were included in the final literature sample. Four studies were

found pertaining to cardiac arrest simulation, three to peer tuition, four to video self-

instruction, three to the use of different resuscitation guidelines, three to computer-

based learning programmes, two to voice-activated manikins, two to automated

external defibrillators, one to self-instruction, one to gaming and the one to the use of

action cards.
 In conclusion, suggested resuscitation training should be based on in-

hospital scenarios and current evidence-based guidelines, including recognition of

sick patients, and should be taught using simulations of a variety of cardiac arrest

scenarios. This will ensure that the training reflects the potential situations that nurses

may face in practice. Nurses in clinical areas, who rarely see cardiac arrests, should

receive automated external defibrillation training and have access to defibrillators to

prevent delays in resuscitation. Staff should be formally assessed using a manikin

with a feedback mechanism or an expert instructor to ensure that chest compressions

and ventilations are adequate at the time of training. Remedial training must be

provided as often as required. Resuscitation training equipment should be made

available at ward/unit level to allow self-study and practice to prevent deterioration

between updates.38

4. Review related to cardiac emergencies among patients with non-cardiac

medical illness.

A study was conducted at Mc Master University and Hamilton health

Sciences, Canada to assess the progressive relationship between hemoglobin A(1c)

levels and cardiovascular events in persons with and without diabetes. The study

found that the incidence of cardio vascular death, hospitalization for worsening heart

failure and total mortality rose progressively with higher levels of HbA1c. in

conclusion, in diabetic and non- diabetic patients with symptomatic chronic heart

failure, the HbA1c is an independent cause for cardio vascular death, hospitalization

for heart failure and total mortality.39

A study was conducted among hospitalized patients with serious

medical conditions such as shock, aspiration, pulmonary edema or stroke may

develop acute respiratory compromise requiring rescue treatment by medical

emergency teams at department of emergency medicine, University of Pittsburgh,

USA to assess the risk of cardio pulmonary arrest after acute respiratory compromise

in hospitalized patients. The study result shows out of 4358 acute respiratory

compromise events, cardio pulmonary arrest occurred in 726 one-fourth occurred in

general inpatient units. Media time from acute respiratory compromise recognition to

cardio pulmonary arrest was 7min. cardio pulmonary arrest occurred within 10min in

65.3% of these cases. Factors associated with cardio pulmonary arrest included

pulmonary embolism, hypotension or hypo perfusion, or failed invasive airway

efforts. Survival to discharge was lower for cardio pulmonary arrest patients (14.3%)

than non-cardio pulmonary arrest patients (58.4%).

In conclusion, approximately one in six patients experiencing initial

acute respiratory compromise deteriorates to cardio pulmonary arrest. Improved acute

respiratory compromise recognition, hospital emergency team response and airway

management may potentially enhance care and outcomes for these critically ill

patients.40

7. MATERIALS AND METHODS

7.1 Sources of data:

All Staff nurses who are working at selected Hospitals, Bangalore.

7.2 Methods of data collection

i. Research Approach : Exploratory approach

ii. Research design : Descriptive design

iii. Setting : Vivus West Hospital, Bangalore.

Panacea hospital,Bangalore.

BGS hospital,Bangalore.
iv. Population : All Staff nurses who are working at

Vivus West Hospitals,Panacea

Hospital,BGS Hospital, Bangalore

v. Sample : 60 Staff nurses working at Vivus West

Hospital,Panacea Hospital,BGS

Hospital,Bangalore.

vi. Sample size : 60 Staff nurses.

vii. Sampling technique : Convenient sampling

viii. Method of data collection : Self administered questionnaire

ix. Tool for data collection : Structured questionnaire.

x. Method of data analysis : Appropriate descriptive and inferential

and interpretation statistics will be used and presented

in the form of tables and pie

diagrams.demographic variables will

be analyzed by frequency and

percentage distribution.

Level of knowledge will be analyzed

By mean and standard deviation.

Association between demographic

variables and knowledge on cardiac

emergencies will be analyzed

by chi square test.

xi. Duration of study : 4 weeks

xii. Variables

Research variable : Knowledge of staff nurses regarding

cardiac Emergencies.

Demographic variables : Age, sex, educational qualification,

experience Area of nursing practice like

casualty, intensive care unit, coronary

care unit, out patient department,

operation theatre and postoperative

unit. Any previous source of

information if yes specify.

xiii. Projected outcome : Hands on skill training programme on

cardiac emergencies will prepare the

nurses to be competent enough in

delivering emergency cardiac care in

the potential situations.

7.3 Does the study require any investigation or intervention to be conducted on the

patient or other human beings or animals?

NO

7.4 Has ethical clearance has been obtained from your institution

YES, ethical clearance report is here with enclosed.

8. BIBLIOGRAPHY

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03. Types of arrhythmias. Available from

URL:http://www.mamashealth.com/arrhythmia.asp.

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URL:http://en.wikipedia.org/wiki/angina-pectoris.

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10. Boyle RM (2004) MINAP Third Public Report: Dear Co/league Letter.

www.dli.gov.nk/assetRoot/04/08/40/2 8/04084028.PDF (Last accessed: July 23 2005.)

11. Morrison LJ, Verbeek PR, McDonald AC, Sawadsky BV, Cook DJ (2000)

Mortality and pre-hospital thrombolysis for acute myocardial infarction: a meta-

analysis. Journal of the American Medical Association. 283(20): [P. 2686-2692].

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13. International cardiovascular disease statistics. Available from URL:www.who.int.

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16. Atlas of heart disease and stroke, WHO,Sep 2004.

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economics, 2004, Columbia University, New York

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9. Signature of the candidate :

10. Remarks of the guide :

11. Name and designation (in block letters) :

11.1 Guide :

11.2 Signature :

11.3 Head of the department :

11.4 Signature :

12. Remarks of chairman / principal :

12.1 Signatures