final res pres jas

8/14/2019 Final Res Pres Jas

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STATEMENT OF PROBLEM

An Evaluative Study of the

Performance of Critical CareNurses in Selected Nursing

Procedures,Christian Medical

College & Hospital, Ludhiana,Punjab.


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OBJECTIVES:-

To assess the performance of critical

care nurses in endotracheal

suctioning and positioningprocedures.

To identify the deficit areas in the

performance of endotrachealsuctioning and positioning

procedures.


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OBJECTIVES CONTT.

To assess the relationship of performance

of critical care nurses with selected

variables i.e age, gender, professional

qualification, experience in present

working area, area of work and type of

training institute.

To develop protocols for the endotrachealsuctioning and positioning procedures.


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Criterion Measure for ENDOTRACHEAL SUCTIONING

A. Structure standard= Max score =24

Expected standard met= >90 %(> 21.6)

Need improvement < 90% (


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STRUCTURE PROCESS OUTCOMES1 The nurse exhibits

knowledge

related to endotracheal

suctioning

S1=9

S2 The nurse reports

availability

of articles

S2 = 13

S3 Nursing/ Unit/ Practice

setting

S3= 2

P1Assessment

P1= 2

P2Nursing diagnosis

P2= 1

P3 Implementation

P3 20

P4After care of articles and

patients

P4 4

P5 Documentation and

Recording

P5 =1

P6 Evaluation

P6 = 2

01 Effectiveness

01 = 1

02 = 1

03 = 1

24 30 3


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CRITERIA MEASURES FOR POSITIONING

A. Structure standard= Max score =12

Expected standard met= >90 %(10.8)

Need improvement < 90% (


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STRUCTURE PROCESS OUTCOMES1 The nurse exhibits

knowledge

related to positioning

S1=4

S2 The nurse reports

availability

of articles for

positioning for

client available in the

ward/unit

S2 = 6

S3 Nursing/ Unit/ Practice

setting

S3= 2

P1 Assessment

P1= 2

P2 Nursing diagnosis

P2= 1

P3 Interventions

P3 14

P4 After care

P4 3

P5 Recording and

Reporting

P5 =3

P6 Evaluation

P6 = 1

01 Effectiveness

01

= 1

O2 = 1

12 24 2


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DATA COLLECTION PROCEDURE

The data was collected from critical care areas

i.e. intensive care unit (1 & 2),neurosurgery ICU

,neurosciences ward.

Prior to data collection ,a written formalpermission was obtained from the nursing

superintendent,CMC & hospital through proper

channel.

Investigator also obtained permission from the

ward in -charges of the concerned wards.

Sample consisted of 40 nurses.


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DATA COLLECTION PROCEDURE

Data collection was carried out from the second

week of september,2008.

Investigator went to concerned wards and units

after duty hours, during different duty shifts &weekends.

The investigator first introduced self to the

subjects and explained the purpose of gathering

information. They were assured that their responses would

be kept confidential and used only for research

purpose.


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DATA COLLECTION

PROCEDURE

The investigator spent 40 minutes for

endotracheal suctioning and 35

minutes for positioning. A good rapport was build with the

ward incharges and staff nurses.

PURPOSIVE SAMPLING techniquewas used for data collection


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STRUCTURE STANDARD

CRITERIA

S1 knowledge related performance related to

Endotracheal Suctioning & positioning was

filled by asking question directly to the subjects.

S2 criteria related to availability of articleswere filled asking subjects and observing there

availability in the ward/unit.

S3- nurses to patient ratio & in-service

education criteria were filled by asking directly

to subjects and observing the ward/unit.


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PROCESS STANDARD

CRITERIA

P1 assessment and P3 intervention, P4 after

care of the articles,P6 evaluation were filled

by observing the subjects by observer.( 2

observations for each sample.) Criteria P5 recording and reporting was filled by

checking the documentation in the patients bed

side chart.

Criteria related with nursing diagnosis were filled

by asking subjects and by assessing nursing

process sheet.


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OUTCOME STANDARD

CRITERIA

O.1, O2 achievement of desired

effect was filled by auditing the

bed side chart (vital signs) andgeneral condition of patients.


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DIFFICULTIES FACED BY THE

INVESTIGATOR

This study consisted of evaluation of 2

procedures and moreover it was observational

study so it took lot of time. Investigator has to

collect sample during different shifts. As it was observatory study, investigator has to

wait for each procedure to take place. For each

procedure 2 observations were done .hence

investigator has to follow same nurse for 2nd

observation.


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Difficulties Faced by the Investigator

Same sample was taken for both procedures,

hence investigator has to wait for time when a

nurse who has done suctioning, to do

positioning. . The investigator had to face lot of

inconvenience. Many times investigator had to

wait for long time in order to get information from

staff nurses related to structure standard as theywere too busy in stabilizing the condition of the

patient.


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The conceptual framework is based

on AMERICAN NURSESASSOCIATION QUALITYIMPROVEMENT MODEL on the

standards of care & quality indicatorswithin the Donabedians framework of

structure,process,outcome (1975).


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MAJOR FINDINGS

Sample of forty nurses from selected critical

care areas comprised of maximum number of

nurses (80%) was with GNM qualification and

majority of nurses (82.5%) were trained fromCMC & Hospital. Majority of nurses (100%) were

working in special units where as none worked

in general wards.


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FINDINGS OF PERFORMANCE RELATED

TO STRUCTURE STANDARD

Overall mean percentage score of nursing

performance during endotracheal

suctioning related to structure standard

was 66.45 which was lower than theexpected standard of 90%.


performance during positioning related to

structure standard was 58.9 % which waslower than the expected standard of 90%.


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TO STRUCTURE STANDARD

Expected standard of knowledge related to

endotracheal suctioning was met by 48.8 % of

nurses; where as 51.2% did not meet the expected

standard of 90%. Availability of articles for

endotracheal suctioning was reported by nurses(78.6%) and 66% nurses reported nursing unit

practice setting, 34 % did not.

Expected standard of knowledge related to

positioning was met by 63.75 % of nurses; where as36.25% did not meet the expected standard of 90%.

Availability of articles for endotracheal suctioning

was reported by nurses (57.8 %) and 52.5% nurses

reported nursing unit practice setting, 47.5 % didnot.


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In meeting the structured standard, during endotracheal

suctioning maximum deficits were identified structure

standard in S1 i.e. knowledge (51.2%)ranked 1, followed

by S3 related to nursing unit (34%) ranked 2 & S2

related to availability of articles (21.4 %) ranked 3. For positioning, the maximum deficit was found in S3

criteria i.e. related to nursing service unit (47.5%) ranked

1 followed by availability of article (42.2%) ranked 2,

followed by S1 related to knowledge (36.25 %) ranked 3.


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TO PROCESS STANDARD


performance during endotracheal suctioning related

to process standard was 83 % which was lower than

the expected standard of 100%.


performance during positioning related to process

standard was 75.8 % which was lower than the

expected standard of 100%.


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TO PROCESS STANDARD

For endotracheal suctioning, maximum deficits was

found in meeting of process standard in P4 criteria i.e.

after care of articles (25%), followed by interventions

ranked 2, (20%), assessment (13.4) ranked 3, nursing

diagnosis, recording & reporting and evaluation criteriamet the expected standard showing no deficits.

For positioning maximum deficits was found in meeting

of process standard in P2 criteria i.e. nursing diagnosis

(25%), followed by interventions ranked 2, (19.65%),after care of articles & recording and reporting ranked 3,

(28%).assessment and evaluation criteria met the

expected standard showing no deficits.


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Maximum deficit in availability of articles during

endotracheal suctioning was in stethoscope (100%)

ranked 1,followed by pulse oximetry & EKG Monitor

(47.5% ) ranked 2, Ambu (35 %) ranked 3, sterile

Normal Saline (27.5 %) ranked 4, mask (17.5%)ranked 5 , Sterile Water And Bowl (2.5 %) ranked

6.Orther articles meet the expected outcome.

Maximum deficits during positioning in availability of

articles was in hand rolls (100%) ranked 1, sand bags(87.5 %) ranked 2, water filled gloves (47.5%) ranked

3,restraints (15%) ranked 4,followed by draw

sheets/towels (7.5%) ranked 5.


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TO PROCESS STANDARD

Maximum deficits during endotracheal suctioning in

areas of after care of articles and patient by nurses was

in providing mouth care to patient (92.5 %,) ranked 1,

followed by Clear the connecting tubes with hand (20 %)

ranked 2. Other areas of after care of articles metexpected standard.

Maximum deficits during positioning, in areas of after

care of articles by nurses was in Lower Bed (37.5 %)

ranked 1 , followed by observe body alignment (25%)ranked 2 & Wash Hands (2.5 %) ranked 3.


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TO PROCESS STANDARD

2.5 % deficit was found in P5.1 i.e.

documentation during endotracheal

suctioning.

50% deficit was found in P5.3 i.e. SkinCondition rank order 1, followed by

frequency of turning & Records Procedure In

Nurses Notes ranked 2. during positioning.

37.5% deficits were found in evaluation

during endotracheal suctioning and 25%

deficit in positioning.

FINDINGS OF PERFORMANCE RELATED TO


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FINDINGS OF PERFORMANCE RELATED TO

OUTCOME STANDARD

Over all mean percentage score of performance related

to outcome standard was 65.6% which is lower than the

expected standard of 100%.

100% nurses lacks in outcome Standard during

suctioning O1 i.e. improved breathe sounds, followed by

removal of pulmonary secretions (32.5 %) rank 2,

improvement in saturation (25%) rank 3.

35 % Nurses lack in meeting outcome standard related

to both O 1 & O2 i.e. Comfortable Position Is ProvidedTo Client & Appropriate Alignment Of Patient Body

respectively


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For Endotracheal suctioning

mean % score of performance related to

structure standard was 66.45%, whereas

mean% score of performance related to process

standard was 83%. Similarly mean% score ofpractices related to outcome standard was

45.8%. Mean % score of performance of nurses

related to suctioning lower than the expected

levels as per the criterion measure 90% forstructure, 100% for process standard & 100%

for outcome criterion.

final res pres jas

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