RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS

FOR DISSERTATION

1. Name of the candidate and address

Mr. T. SATHISH BABU

I Year M. Sc. Nursing,

Florence College of Nursing

Bangalore – 560 043.

2. Name of the institution Florence College Of Nursing

3. Course of study and subjectM. Sc NURSING

Paediatric Nursing

4. Date of admission to course 15 – 05 – 2008

5. Title of the topic

“A study to assess knowledge and practice

regarding oxygen therapy among paediatric

staff nurses working in selected paediatric

hospitals in Bangalore, with a view to

develop an information booklet”.

0

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

Oxygen is a non-metallic gas chemical element symbolized by <<O>>. It is the

fifth constitutive element of the atmosphere and totally bonded to all life forms. The

ancient Greeks and Chinese, believed that the atmosphere contains a substance necessary

for life, and noticed the existence of oxygen. Leonardo da Vinci in 1500 AC. propounded

the theory that the animal kingdom needs an element of the atmosphere to sustain life. In

1600 Robert Boyle propounded the theory that both respiratory function and fire use

some common element that exists in the atmosphere.1

The element of oxygen was officially discovered by Joseph Pristley in 1774 and

took the name it carries today by Lavoisier who believed that this element is the

necessary component of all acids, and so he named it oxygen or creator of acids. It

constitutes an important therapeutic means to treat acute or chronic diseases. Two

indicators determine the need to an immediate oxygen therapy: hypoxemia, that is, the

low partial pressure of oxygen in the arterial blood, or hypoxia, that is, the necessity of

oxygen in the cells. All the above prove that oxygen is a great medicine for many

pathological cases.1

Oxygen is delivered by various methods. Mask – delivers higher oxygen

concentration than cannula, Nasal cannula – provides low moderate oxygen concentration

(22% - 40%). Oxygen tent helps in achievement of lower oxygen concentration (Fi O2 up

to 0.3 – 0.5). Oxygen hood helps in achieving high oxygen concentration (Fi O2 up to

1.00). The mode of delivery is selected on the basis of the concentration needed and the

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child’s ability to cooperate in its use. The concentration of oxygen delivered should be

regulated according to the individual child’s needs. There are hazards related to its uses,

therefore oxygen should be continued only as long as needed. Humidification of the gas

before administration to the patient is essential to prevent irritation of respiratory mucosa.

Oxygen therapy is administered frequently in the hospital. It is the responsibility of the

nurse or respiratory care practitioner to ensure uninterrupted delivery of the appropriate

oxygen concentration and to monitor the child’s response to the therapy.2

Oxygen therapy is a commonly used intervention in the treatment of hospitalized

patients. The administration of oxygen in the United States began in the 1920’s. WHO

recommends oxygen administration in a child having acute respiratory infection with

cyanosis and inability to drink. Oxygen should also be given in a child with grunting and

tachypnea. The appearance of cyanosis is a late indicator of hypoxemia and therapy

should be started before its appearance.3

6.1. NEED FOR THE STUDY

Oxygen therapy is the most important aspect of supportive care in the

management of a critically ill child. Knowledge of the technique of oxygenation is a key

to the proper oxygen therapy. High flow systems are more dependable devices for

oxygenation and their use needs to be stressed. Patients on oxygen therapy needs close

monitoring. Five million babies die every year in the world. Of them 98% deaths occur in

the developing countries. Of those, one million or 24% are contributed by India. This

high rate of neonatal death is due to asphyxia or lack of oxygen to fetus and new born

baby (20%).4

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Oxygen is an indispensable element of life; its deficiency has deleterious

consequences to all organs of the human body leading eventually to cell dysfunction and

death. Oxygen supplementation is used on a daily basis in clinical practice. Also oxygen

therapy is highly specialized and its prescription must be tailored on an individual basis.

Health care professionals and nurses use oxygen therapy empirically without sufficient

knowledge of its indications, dosage, side effects and toxicity. Oxygen therapy is a

nursing procedure where specific medical orders should be given in order to minimize

side effects for hospitalized children.5

An article cited that, oxygen therapy aims to increase the partial pressure of

oxygen in arterial blood by increasing the oxygen concentration of inspired air. In

addition to its therapeutic effects, the adverse effects and drawbacks of oxygen should be

known. Several methods and devices for the administration of supplementary oxygen are

available. Selection of the method should be individualized according to the patient’s age

and disease.6

A study was conducted on omissions and errors during oxygen therapy in Greece.

The sample consisted of 105 head nurses working in 7 hospitals. Data were collected

after interview using an interview schedule. Data are expressed as percentages and

analyzed using Chi-square test. The study findings revealed that 41% of head nurses

believed that oxygen is a gas which improves patients’ dyspnea. Majority of the nurses

(88.6%) stated that there was no protocol for oxygen therapy in the department in which

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they worked. It was found that oxygen therapy was commonly started, modified,

discontinued by nurses in the absence of a medical order. The study results indicate that

educational programmes, nursing protocols and guidelines are mandatory in order to

ensure the proper use of oxygen therapy.7

A study was conducted on hypoxaemia in children with severe pneumonia in New

Guinea. Objective of the study was to investigate the severity and duration of

hypoxaemia in 703 children with severe or very severe pneumonia. A prospective

evaluation of children with severe or very severe pneumonia was done by comparing

with a retrospective control group for whom oxygen administration was guided by

clinical signs. The researcher evaluated whether there was a survival advantage from

using a protocol for the administration of oxygen based on pulse oximetry. The results

showed that in 151 well, normal children, the mean SpO2 was 95.7% (SD 2.7%). The

median SpO2 among children with severe or very severe pneumonia was 70% (56 – 77);

376 (53.5%) had moderate hypoxaemia (SpO2 70-84%) ; 202 (28.7%) had severe

hypoxaemia (SpO2 50-69%); and 125 (17.8%) had very severe hypoxaemia (SpO2

<50%). After 10, 20 and 30 days from the beginning of treatment, respectively 102

(14.5%), 38 (5.4%) and 19 (2.7%) of children had persistent hypoxaemia; 46 children

(6.5%) died. The researcher concluded that there is a need to increase the availability of

supplemental oxygen in developing countries, and to train health workers to recognize

the clinical signs and risk factors of hypoxaemia. In moderate sized hospitals a protocol

for the administration of oxygen based on pulse oximetry may improve survival.8

4

A study was conducted on oxygen therapy for children. A need-based preparation

and evaluation of a self-instructional module for staff nurses on care of a child receiving

oxygen therapy. The study was conducted in two phases. A survey approach was used for

Phase –I and one group pre-test, post-test design was adopted for Phase-II. The total

sample of the study was 30 staff nurses, with 6 months experience in Paediatric Ward.

The findings of the study showed high learning need status in most of the areas and the

staff nurses also expressed the desirable need for learning in detail. It was found that age,

total years of experience, experience in paediatric ward and married with or without

children were independent of their learning need. SIM was effective in terms of gain in

knowledge score as well as acceptability and utility scores of staff nurses.9

Oxygen administration is one of the most important modalities of therapy for

patients with hypoxaemia to prevent death. Health care professionals especially nurses

seem to use oxygen therapy without sufficient knowledge of its indications, dosage, side

effects and toxicity. However oxygen therapy is a fundamental part of the nursing care

and is a commonly used nursing procedure. From the available literature reviewed it is

evident that, there is little information for health professionals regarding indications for

initiating and discontinuing oxygen therapy, selecting appropriate methods of oxygen

administration and deciding on the source for oxygen. So the researcher felt it relevant to

assess the knowledge and practice of paediatric staff nurses regarding oxygen therapy,

and to develop an information booklet with appropriate guidelines on oxygen therapy for

the paediatric nursing professionals. This will help to provide efficient and safe methods

of administration of oxygen where by mortality can be further reduced.

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6.2. REVIEW OF LITERATURE

Literature reviews can serve a number of important functions in the research

process. A literature review helps to lay the foundation for a study, and can also inspire

new research ideas. A literature review also plays a role at the end of the study when

researchers are trying to make sense of findings.10

A study was conducted on the effect of education on hypothetical and actual

oxygen administration decisions. This study aimed to examine the effect of an education

intervention on emergency nurses’ decisions related to oxygen administration. A pre-

test/post-test quasi-experimental design was used. The intervention was a written self

directed learning package. Outcome measures were (i) factual knowledge measured using

parallel form multiple choice questions and (ii) clinical decisions measured using parallel

form MCQs, parallel form patient scenarios and clinical practice observation. The study

sample consisted of 88 nurses, 37 nurses were in control group and 51 were there in

experimental group. Sub-groups of nurses from the experimental group participated in

patients scenario (n=20) and clinical practice observation (n=10). The study findings

showed that emergency nurses knowledge increased as a function of education, both

patients scenario data and clinical practice observation showed decreased selection of

nasal cannula, increased selection of masks and trend towards selection of higher oxygen

flow rates following education. The researcher concluded that evaluation of educational

interventions in nursing should focus on identifying strategies that enhance learning in a

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clinical environment, which are valid in terms of the clinical context and culture in which

they are being used.11

A study was conducted on comparison of nasal prongs with nasal catheters in the

delivery of oxygen to children with hypoxia. The objective of the study was to estimate

the frequency of complications when nasal catheters or nasal prongs are used to deliver

oxygen. Ninety – nine children between 2 weeks and 5 years of age with hypoxia were

randomized to receive oxygen via nasal catheter (49 children) or nasal prongs (50

children). There was no difference in the incidence of hypoxemic episodes or in the

oxygen flow rates between the two groups. Mucus production was more of a problem in

the catheter group. Nasal blockage, intolerance to the method of administration, and

nursing effort were generally higher amongst the catheter group, but these differences

were not significant, except for nursing effort, when all age groups were analysed

together.12

A study was conducted to examine the current oxygen prescribing practice and

methods of oxygen delivery in a respiratory ward. A prospective audit was conducted on

patients receiving oxygen therapy over a four week period, during pre and post education

sessions. Education was on oxygen prescribing and oxygen therapy. The study findings

showed that oxygen was often poorly prescribed by doctors and at times poorly

administered by nurses. Among the 55 patients audited during pre education, only 5%

had a prescription. This increased to 20% during post education (p=0.042). The initial

audit uncovered 14 issues regarding oxygen delivery. This fall to one post education

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(p<0.001) reassuringly all patients had arterial oxygen saturation recorded. The study

findings concluded that current rates of oxygen prescribing remain unsatisfactory despite

doctors being made aware of the audit findings but education on oxygen therapy

improved the practice of oxygen delivery among nurses to patients in respiratory ward.13

A study was conducted on to evaluate whether the practice of oxygen

administration is evidence based. The aim of the audit was to review oxygen

administration practices against the guidelines but also to gather information concerning

patients, diagnoses, prescription practices and delivery devices. The notes of 36 infants

and children admitted during a two week (winter) period who received oxygen were

retrospectively reviewed for the audit. The standards for monitoring the amount of

oxygen delivered and oxygenation were found to be high but the prescribing of oxygen

was varied. The most common diagnosis of children receiving oxygen was broncholitis,

and the device used to deliver oxygen most frequently was nasal cannula. Few head

boxes were used and experienced team members noted this as a marked change in

practice. A further examination of the evidence on the use of nasal cannulae for oxygen

delivery in the younger age group led to new practice recommendations.14

A study was conducted on oxygen delivery to children with hypoxaemia based

on the following criteria: cost and availability, efficiency/oxygen concentration achieved,

tolerability/comfort of the method, requirement of humidification, demand for nursing

care, and safety of the method and complications. In summary, it is concluded that all

low-flow methods, i.e., nasopharyngeal catheters, nasal catheters and prongs, are

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effective in the oxygenation of sick children with severe pneumonia or bronchiolitis.

Nasal prongs are the safest method of oxygen delivery, but nasopharyngeal catheters and

nasal catheters are more easily available and less expensive. However, if they are used,

they need close supervision to avoid serious complications. Nasal prongs are the method

of choice for oxygen delivery in hospitals in developing countries.15

A prospective study was carried out to assess the knowledge level of nurses

working in hospitals concerning the oxygen supply to patients and the safety regulations

that rule it. The study sample consists of 672 nurses. Data was collected by means of a

questionnaire, which contained 35 closed ended questions. The study findings revealed

that nurses have adequate knowledge in matters of oxygen therapy and the nurses who

worked in ICU were found to be more informed by a significant difference of P = 0.005.

The study findings concluded that the results while not disappointing, prove the constant

need to renew knowledge with systematically organized programmes and the need to

realize the responsibility one must show and have while exercising the profession as a

nurse.16

A study was conducted on hypoxaemia among children. The aim of the study was

to support a national approach to oxygen systems and to document the incidence of

hypoxaemia. The researcher also established baseline mortality rate data for all children

admitted to five hospitals with a diagnosis of pneumonia. Data were collected

retrospectively over 3 years. A total of 1313 admissions were studied prospectively in the

five hospitals. Altogether, 384 (29.25%, CI 26.8-31.8) had hypoxaemia, defined as SpO2

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<90%. The incidence of hypoxaemia was much greater in highland hospitals (40% of all

admissions) than on the coast (10% of all admissions). Clinical signs proposed by WHO

as indicators for oxygen would have missed 29% of children with hypoxaemia and, if

these clinical signs were used, 30% of children without hypoxaemia would have been

considered in need of supplemental oxygen. The researcher concluded as an approach to

improve the detection of hypoxaemia and the availability of oxygen has been trailed in

these five hospitals and a programme of clinical and technical training in the use and

maintenance of pulse oximetry and oxygen concentrators has been introduced.17

A study was done on efficacy and acceptability of different modes of oxygen

administration in children. The study sample consisted of eighty under-five children.

Oxygen was administered to all the children by head box, face mask, nasopharyngeal

catheter, and twin-holed prenasal catheter in predetermined sequence. Oxygen was

delivered at a flow rate of 4 l/min in the head box and by face mask and at a rate of 1

l/min for nasopharyngeal catheter and twin-holed prenasal catheter. The study findings

revealed that, there was a significant rise in PaO2 and SaO2 values with all the oxygen

delivery methods. The number of children who achieved PaO2 of > 90 mmHg with

oxygen delivered by head box was 53 (69 %), with face mask 37 (57 %), with

nasopharyngeal catheter 13 (26 %), and with twin-holed prenasal catheter 18 (25 %). A

further pilot study involving 10 children was carried out to compare the efficacy of head

box and twin-holed prenasal catheter at an identical oxygen flow rate of 4 l/min. The

number of children achieving PaO2 of > 90 mmHg were comparable, i.e. seven (70 %)

and eight (80 %) when the oxygen was delivered by head box and twin-holed prenasal

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catheter, respectively. The study findings conclude that both head box and twin-holed

prenasal catheter are equally effective, acceptable and safe methods for administration of

oxygen to children with acute respiratory disorders.18

A randomized controlled study was conducted, comparing complications in the

use of nasal prongs with nasopharyngeal catheters among hypoxic children. One hundred

and twenty-one children between the ages of 2 weeks and 5 years with hypoxia due to

ALRI were randomized to receive oxygen via a catheter (61 children) and via nasal

prongs (60 children). The two groups were similar in terms of diagnoses, clinical

severity, oxygen saturation on admission, case fatality rates and incidence of hypoxemic

episodes. The oxygen flow rates required on the day of admission for adequate

oxygenation (SaO2 > 90%) ranged from 0.8 liters per minute to 1.2 liters per

minute. The required oxygen flow rate decreased during the course of treatment. The

study findings revealed that ulceration or bleeding of the nose was significantly more

common in the catheter group (19.7% Vs 6.7%, p < 0.05). Abdominal distension and

nasal perforation were not seen in either group. This study suggests that nasal prongs are

safer, more comfortable and require less nursing expertise than nasopharyngeal catheters

for administration of oxygen to children.19

A study was conducted on nasopharyngeal oxygen (NPO) as a safe and

comfortable alternative to face mask oxygen therapy. Nasopharyngeal oxygen therapy is

an emerging alternative to conventional face mask oxygen administration. It warrants

consideration for treating hypoxaemia when face mask therapy is impractical or when

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patient intolerance or non-compliance regularly interrupt treatment. The effectiveness of

the NPO route has been validated in post anesthetic care and paediatric intensive care

units, but use in the ICU remains minimal. Recent research in an ICU setting has shown

that nasopharyngeal route is as effective as face mask oxygen administration in

alleviating mild to moderate hypoxaemia, and is significantly more comfortable for

patients. The study findings conclude that, NPO administered via a fine catheter

advanced into the nasopharynx, should be considered when face masks or nasal prongs

are impractical or poorly tolerated and, because of its effectiveness and improved

comfort, in patients for whom traditional non- invasive oxygen therapy is indicated.20

A randomized study was conducted on comparison of nasal prongs and

nasopharyngeal catheter for the delivery of oxygen in children with hypoxemia.

About118 children between 7 days and 5 years of age with oxygen saturation (SaO2) less

than 90% were randomly selected to receive oxygen by nasopharyngeal catheter (n=56)

and nasal prongs (n=62). A crossover study to determine the flow rate necessary to

achieve SaO2 of 95% was performed in 60 children. This study results shows that among

112 children oxygenated by the allocated method, in six, oxygenation was poor with

either method. In the crossover study the prongs needed, on average, 26% higher oxygen

flow rates than the nasopharyngeal catheter to obtain a SaO2 of 95% (p=0.003). Complete

nasal obstruction was observed in 24 children (44%) in the nasopharyngeal catheter

group and in 8 (13%) in the prongs group (p<0.001). The researcher concluded that nasal

prongs are less prone to complications, and oxygenation in children is equally effective,

and they are more appropriate method than the nasopharyngeal catheter for oxygen

delivery to children.21

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6.3. STATEMENT OF THE PROBLEM:

“A study to assess knowledge and practice regarding oxygen therapy among

paediatric staff nurses working in selected paediatric hospitals in Bangalore, with a

view to develop an information booklet”.

6.4. OBJECTIVES OF THE STUDY:

The objectives of the study are to:

1. assess the paediatric staff nurses knowledge regarding oxygen therapy in children.

2. assess the practice of oxygen therapy for children among paediatric staff nurses.

3. determine relationship between knowledge and practice of oxygen therapy among

staff nurses working in paediatric hospitals.

4. associate the mean knowledge scores with the selected demographic variables.

5. association the mean practice scores with selected demographic variables.

6. develop an information booklet on oxygen therapy for paediatric staff nurses.

6.5 HYPOTHESIS:

H1: There is a significant positive correlation between the mean knowledge and

practice scores of paediatric staff nurses regarding oxygen therapy.

H2: There is a significant association between the mean pre-test knowledge scores and

the selected demographic variables.

H3: There is a significant association between the mean practice scores and selected

demographic variables.

6.6. OPERATIONAL DEFINITIONS:

1. Assess:

13

It refers to the process used to identify the level of knowledge and practice of

paediatric staff nurses regarding oxygen therapy.

2. Knowledge:

It refers to information gained through experience or education of paediatric staff

nurses regarding oxygen therapy as evident through their knowledge scores which is

measured as adequate knowledge, moderately adequate knowledge and inadequate

knowledge.

3. Practice:

It refers to the action of application of scientific principles in oxygen administration

measured by items in the observation checklist and is evaluated as adequate practice,

moderately adequate practice and inadequate practice.

4. Oxygen therapy:

This is the treatment with oxygen, a colour less, odour less gas intended to relieve

hypoxia which is used for a therapeutic purpose.

5. Paediatric staff nurses:

It refers to the registered nurses working in the branch of nursing concerned with

children and their diseases in the selected paediatric settings.

6. Information Booklet:

It refers to a bulletin booklet prepared by the investigator and valid by experts, which

contains information regarding various aspects of oxygen therapy for paediatric staff

nurses.

7. Selected demographic variables:

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In this study it refers to age, education and years of experience of paediatric staff

nurses.

6.7. ASSUMPTIONS:

1. Paediatric nurses administer oxygen to children with hypoxaemia.

2. Increased knowledge about the procedure of oxygen administration improves the

skill in performance.

3. The skill of paediatric staff nurses on oxygen administration is dependent on the

cognitive information they receive.

6.8. DELIMITATIONS:

The study is delimited to:

- assessment of knowledge only as correct responses made to the items in the

knowledge questionnaire.

- practice will be assessed on the basis of one observation as observed with the

observation checklist.

7. MATERIALS & METHODS:

7.1. SOURCE OF DATA:

Registered nursing professionals, who are working in the branch of nursing,

concerned with children and their diseases.

7.2 METHODS OF DATA COLLECTION:

Research method : Survey method

Research Design : Descriptive design

Sampling technique : Purposive sampling

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Sample size : 100 Paediatric staff nurses

Setting of the study : Colombo Asia Hospital, Indira Gandhi Institute of Child

health, Lake side Hospital, Philomina Hospital and

Vanivilas Hospital, Bangalore.

7.2.1. CRITERIA FOR SELECTION OF SAMPLE

INCLUSION CRITERIA

The sample consists of ‘Staff Nurses’

- working in paediatric medical ward, paediatric surgical ward, paediatric

emergency unit, PICU and NICU.

- willing to participate in the study.

- available at the time of data collection.

- working at the selected settings.

EXCLUSION CRITERIA

The study excludes ‘Staff Nurses’

- with ANM certificate working in paediatric wards.

- who have attended seminars or workshops on oxygen therapy among children.

7.2.2. DATA COLLECTION TOOL

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A structured knowledge questionnaire will be prepared to assess the knowledge of

paediatric staff nurses regarding oxygen therapy in children. An observation checklist

will be prepared to assess the practice of oxygen administration. An information booklet

will also be prepared for paediatric staff nurses regarding oxygen therapy. Content

validity of the tools will be ascertained in consultation with guide and experts from

various fields like paediatric medicine and nursing.

Reliability of the structured knowledge questionnaire will be established by split

half method. An inter rater reliability will be done for the observation checklist which is

used to assess the practice of oxygen therapy.

Prior to the study, written permission will be obtained from the concerned

authority. Further consent will be taken from the participants regarding their willingness

to participate in the study. The proposed period of data collection will be in August 2009.

7.2.3. DATA ANALYSIS METHOD

Data analysis will be done by descriptive and inferential statistics.

The descriptive statistics used will be frequency and percentage distribution,

mean and standard deviation.

In the inferential statistics, coefficient of correlation will be used to find out

relationship between knowledge and practice regarding oxygen therapy among staff

nurses.

A Chi-square will be done to find out association between knowledge and practice

with selected demographic variables.

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7.3. DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR

INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR

OTHER HUMAN OR ANIMALS?

YES.

Only a structured knowledge questionnaire regarding oxygen therapy and an

information booklet will be used. No other invasive, physical or laboratory

procedures will be done on the samples.

7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED?

YES.

a) A written permission from institutional authority will be obtained.

b) Confidentiality and anonymity of the subjects will be maintained.

c) Consent will be obtained from the paediatric staff nurses before conducting the

study.

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8. LIST OF REFERENCES

1. Chr. Marvaki, Z. Roupa, N. Rilalis, M. Polikandrioti, Chr. Melissa, B. Demertzis,

M.Gourni. Saftey during oxygen therapy. Indian Paediatric journal 2004 Oct –

Dec; (20) P. No. 1.

2. Wong’s. A text book of Nursing Care of Infants and Children. 8 th ed. Missouri;

Mosby Publication; 2007; P.No.1287-1288.

3. Dutta AK, Aggarwal A, Singh A. A text book of Recent Trend in Paediatric. 3rd ed,

Blunmer JE; Mosby Publication; 1992; P.No. 352-353.

4. Deopujari. S. Oxygen therapy in paediatrics. Indian Journal Pediatrics. 2000 Dec;

67(12):885-91.

5. J.D. Fulmer and G.L. Sinder. American College of Chest Physicians (ACCP).

National Heart Lung and Blood Institute Conference on oxygen therapy. Chest:

86 (1984) (2), PP. 234-247.

6. Rodriguez Nunez A, Martinon Sanchez JM, Martinon Torres F. Medical gases:

oxygen and heliox. 2003 July; 59(1):74-81.

7. Hero Brokalaki, Vssiliki Matziou, Sophia Zyga, Maria Kapella, Konstantions

Tsaras, Eirene Brokalaki and Pavlos Myrianthefs. Omissions and errors during

oxygen therapy of hospitalized patients in a large city of Greece 2004 July;

13(2): 37-48.

8. Duke T, Mgone J, Frank D. Hypoxaemia in children with severe pneumonia in

Papua New Guinea. International Journal of Tuberculosis Lung Diseases. 2001

Jun; 5(6): 511-9.

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9. Machado A, Bhaduri A, George A. Oxygen therapy for children Need- based

preparation and evaluation of a self-instructional module for staff nurses on care

of a child receiving oxygen therapy. Nursing Journal of India. 1998 Jun; 89(6):

125-7.

10. Polit F Denise. A text book of Nursing research Principles and Methods 7th ed.

Philadelphia. Lippincott Publications. 2004. P. No:88,89,722.

11. Considine J, BottiM, Thomas S. The effects of education on hypothetical and actual

oxygen administration decisions. Nurse Education Today 2007 Aug; 27(6): 651-

60.

12. Muhe L, Degefu H, Worku B, Oljira B, Mulholland EK. Comparison of nasal

prongs with nasal catheters in the delivery of oxygen to children with hypoxia.

Journal Tropical Pediatrics. 1998 Dec; 44(6): 365-8.

13. Hickey S. An audit of oxygen therapy on a respiratory ward. British Journal of

Nursing. 2007 Oct; 11-24; 16(18): 1132-6.

14. Pease P. Oxygen administration: is practice based on evidence. Pediatrics Nursing.

2006 Oct; 18(8): 14-8.

15. Muhe L, Webert M. Oxygen delivery to children with hypoxaemia in small

hospitals in developing countries. International Journal Tuberculosis Lung

Diseases. 2001 Jun; 5(6): 527-32.

16. Chr. Marvaki, Z. Roupa, N. Rilalis, M. Polikandrioti, Chr. Melissa, B. Demertzis,

M.Gourni. Saftey during oxygen therapy; 2004 Oct – Dec; 69(20).

17. Wandi F, Peel D, Duke T. Hypoxaemia among children in rural hospitals in Papua

New Guinea: epidemiology and resource availability—a study to support a

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national oxygen programme. Annual Tropical Paediatrics. 2006 Dec; 26(4):

277-84.

18. Kumar RM, Kabra SK, Singh M. Efficacy and acceptability of different modes of

oxygen administration in children. Journal Tropical Pediatrics. 1997 Feb; 43(1):

47-9.

19. Degefu H, Worku B, Oljira B, Mulholland EK. Oxygen administration to hypoxic

children in Ethiopia: a randomized controlled study comparing complications in

the use of nasal prongs with nasopharyngeal catheters. Annuals of Tropical

Pediatrics. 1997 Sep; 17(3): 273-81.

20. East wood GM, Dennis MJ. Nasopharyngeal oxygen as a safe and comfortable

alternative to face mask oxygen therapy. Australia Critical Care. 2006 Feb;

19(1): 22-4.

21. Weber MW, Palmer A, Oparaugo A, Mulholland EK. Comparison of nasal prongs

and nasopharyngeal catheter for the delivery of oxygen in children with

hypoxemia because of a lower respiratory tract infection. Journal of Pediatrics.

1995 Sep; 127(3): 378-83.

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9. SIGNATURE OF CANDIDATE

10. REMARKS OF THE GUIDE

11.NAME AND DESIGNATION

11.1 GUIDE

Mrs. ASHA ANDREWS

Professor in Paediatric Nursing

11.2 SIGNATURE

11.3 HEAD OF THE DEPARTMENT Mrs. ASHA ANDREWS

11.4 SIGNATURE

12.

12.1 REMARKS OF THE CHAIRMAN AND PRINCIPAL

12.2 SIGNATURE

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