Title : Arterial Blood Gas Analysis and Interpretation

 

Assessing the Effect of Video-Assisted Teaching on Knowledge regarding Arterial Blood Gas Analysis and Interpretation among Staff Nurses of bhopal (MP)

 

Arterial blood gas analysis is a common investigation in emergency departments and inten sive care units for monitoring patients with acute respiratory failure. While non-invasive monitoring of pulmonary function, such as pulse oximetry is simple, effective and increasingly widely used, pulse oximetry is no substitute for arterial blood gas analysis. Pulse oximetry is solely a measure of oxygen saturation and gives no indication about blood pH, carbon dioxide or bicarbonate concentrations. 

 

Hence the researcher felt the need to assess the effect of video-assisted teaching on knowledge regarding arterial blood gas analysis and interpretation among staff nurses working in selected hospitals in Bhopal, MP.

Need and significance of the study

The collection of arterial blood by nurse is not only technically difficult, but can be painful and hazardous for the patient. Therefore, it is essential that individuals performing arterial puncture be familiar with the proper techniques, with the complications of the procedure, and with necessary precautions. Arterial blood is one of the specimens most sensitive to preanalytic effects. Improper patient assessment, test requisition, collection or transport of a specimen of arterial blood intended for pH, and blood gas analysis can alter the gas tensions or pH or both. 

 

Therefore, minute attention to the principles outlined in this standard is mandatory to eliminate a major potential source of erroneous laboratory results. This has traditionally been the role of the doctor, however by using an education and training package along with a competency-based assessment, nurses can now perform this extended role.

Objectives

The study was undertaken with the following objec-tives: 

 

  • To assess the (a) pre-interventional and (b) post-interventional knowledge of staff nurses regarding Arterial Blood Gas analysis and interpretation. 
  • To find out the significant difference between pre-test and post-test knowledge regarding arterial blood gas analysis and interpretation among staff nurses. 
  • To associate the pre-interventional knowledge of staff nurses regarding arterial blood gas analysis and interpretation with selected demographic variables.

Hypothesis

H1: There is a significant difference between pre-test and post-test knowledge score on video-assisted teaching on arterial blood gas analysis and interpretation among staff nurses at 0.05 level of significance.

H2: There is significant association of pre-test knowledge score on arterial blood gas analysis and interpretation with selected demographic variables of staff nurses at 0.05 level of significance.

Theoretical Framework

Theoretical Framework used in this study based on modified Imogene M. King’s goal attainment model (1981).

Review of Literature

Martinez Castillo, Valero Macro AV et al (2013) conducted a survey in Spain regarding nurse’s knowledge and attitude regarding local anaesthesia in arterial puncture. The 131 nurses surveyed were issued a 15-item questionnaire consisting of two parts.

Local anaesthesia was used routinely by 7 (5%) nurses, of whom 3 (27%) belonged to the respiratory medicine department. Local anaesthesia was not used by any of the nursing students. 

 

The main reasons given by nurses for not using local anaesthesia were lack of knowledge (54%), need to perform two punctures when anaesthesia is used (11%), belief that the same amount of pain is caused with anaesthesia (8%), and success on the first attempt at arterial puncture (7%). The main reason given by student nurses for not using local anaesthesia was lack of knowledge (53%), followed by the fact that it was not used by the nurses (24%) and concluded that these data should be taken into consideration when training nurses to perform arterial puncture.

Methodology

In this study, Quantitative Evaluative Approach using one group pre-test post-test design was used. The research setting was Chirayu Hospital Medical Col-lege & Hospital, Bhopal (MP).

Independent variables were video-assisted teach-ing on ABG analysis and interpretation and the dependent variable was knowledge level of staff nurses.

The staff nurses working in hospitals in Bhopal (MP) constituted the study population and the sample was 40 staff nurses working in Chirayu Medical College and Hospital, Bhopal. Simple random sampling using self-structured questionnaire was employed.

Development & description of tool:

The tool was developed through extensive literature review of book and journals. The structured quesionnaire comprised of two parts:

Section A: Demographic profile of the nurses (6 items) i.e., age, sex, professional qualification, previous ex-posure, years of clinical experience, area of current working experience.

Section B: Structured questionnaire consisted of 30 multiple choice questions to assess the knowledge of staff nurses regarding arterial blood gas analysis and interpretation. It was divided into the 4 sub heading, Anatomy and physiology, Procedure for arterial blood gas analysis, Interpretation of arterial blood gas analysis, Nurses’ responsibility regarding arte-rial blood gas analysis.

Scoring criteria: Poor (0006); Average (0712); Good (1318); Very good (1924); and Excellent (2530).

Data collection method

Approval was obtained from the Director, Chirayu Medical College and Hospital, Bhopal to conduct the main study from 19-30 June 2014. The investigator collected 40 samples who fulfilled the inclusive criteria. Pre-test response was assessed and selected teaching module was administered and after 7 days post-test was done to assess the effectiveness of the selected teaching module. 

Results & Discussion

Section A: Description of sample characteristics

  •  Majority of the selected staff nurses i.e. 18 (45%) belonged to the age group of 21-25 years,
  •  Most of the selected staff nurses (n=18, 45%) were males and 22 (55%) were female.
  •  Half of the selected staff nurses (50%) had com-pleted their BSc Nursing Degree (Fig 1).
  •  Majority of the selected staff nurses (n=24, 60%) had 13 years of experience.
  •  Most of the selected staff nurses (n=18, 45%) were working in medical ward.
  •  Majority of selected staff nurses (n=18, 45%) had information regarding arterial blood gas analysis and interpretation from various CNE pro-grammers.

Section B: Frequency & percentage distribution of pre-interventional knowledge score revealed that majority i.e. 15 (45%) of staff nurses had average knowledge i.e. between 7-12, 15 (37.5%) had good knowledge ranging from 13-18, 5 (12.5%) had poor knowledge ranging from 13-18, 2 (5%) had very good knowledge ranging from 25-30 and none had excel-lent knowledge ranging from 25-30. 

Section C: Frequency & percentage distribution of pre-interventional knowledge score shows that 29 (72.5%) gained good knowledge ranging from 13-18, 5 (12.5%) gained very good knowledge ranging from 19-24 and 4 (10%) gained average knowledge rang-ing from 7-12 and 2 (5%) gained excellent knowledge ranging from 25-30. 

 

Session D: Findings related to effect of video-assisted teaching on knowledge of staff nurses regarding arterial blood gas analysis and interpretation.

Fig 1: Professional qualification of staff nursesNursesZone

 

Table 1: Mean scores of staff nurses before and after intervention

 

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The data collected was analysed by using descriptive and inferential statistics. 

With regards of pretest knowledge of staff nurses selected hospital had a total mean score of 11.6 and post-interventional mean score of 16.3. The posi-tive mean difference shows that video-assisted teaching was effective. The calculated ‘t’ value of 5.59 at p<0.05 level shows that there is a significant difference in knowledge level of staff nurses working in selected hospitals of Bhopal (Table 1). The research findings show that there is a significant difference in pre- and post-interventional knowledge level of selected staff nurses. 

 

Session E: Association of pre-interventional knowledge score of staff nurse: The demographic variables such as age, professional qualification showed significant association between the demographic whereas pre-interventional knowledge scores was found to be independent of selected demographic variables such as age, sex, working experience, area of current work-ing and , previous exposure to the topic as evident by the computed chisquare value.

Implications

The findings of present study have implications for nursing practice, nursing education, nursing administration and nursing research. 

Nursing practice: The study revealed that the interpretive educative session regarding arterial blood gas values was an effective method to improve the knowledge on interpretation of staff and nurses 

Nursing administration: The study findings can be used by the nurse administrator to assess the need for educating the staff nurses regarding the inter-pretation of arterial blood gas values. 

Nursing education: The nurse educator can prepare and teach various measures for improving the knowledge on interpretation of staff nurses regard-ing arterial blood gas values who are undergoing interpretive educative session. 

 

Nursing research: The study helps the nurse re-searcher to develop an insight into the development of interpretive educative session and materials on arterial blood gas values towards promotion of quality of life. Nurse researcher can investigate various aspects of interpretation of arterial blood gas values and can add to the knowledge and practice base.

Recommendations

On the basis of findings of the study, the following recommendations are made:

  1. A similar study can be replicated on a large sample to generalise the findings.
  2. A similar study can be conducted amongst all the critical care nurses who are working in vari-ous areas of hospital.
  3. An experimental study can be undertaken with control group for effective comparison.
  4. A descriptive survey can be carried out to determine level of knowledge regarding arterial blood gas analysis and interpretation among staff nurses working in various settings.
  5. A similar study can be conducted using true ex-perimental design so that generalisation could be made.

Limitations

  1. Nursing related literature in Indian context were limited in number.
  2. The study was conducted for a small sample size in a selected setting by purposive sampling, which limits the generalisation of principles.

Acknowledgement: The valuable encouragement and suggestions of the guide and cooperation of respondents to participate in the study is gratefully acknowledged.

Conclusion

The video-assisted teaching on arterial blood gas analysis and interpretation is quite effective in enhancing knowledge level of staff nurses.

References

  1. Barbara J Bergs, Cynthia. Laboratory Test & Diagnostic Procedures, 2nd edn, 1997. Philadelphia: WB Saunders Company
  2. Black M Joyce. Medical surgical nursing clinical management for positive outcomes, 8th edn, 2010. St Louis: Saunders
  3. Carol Taylor, Pricille Lemona. Fundamentals of Nursing - The Art & Science of Nursing Care, 5th edn, 2005. Phila-delphia: Lippincott Williams & Wilkins
  4. Dokwal CP. Interpretation of arterial blood gases. Bangladesh Journal Online 2009; p15 Retrieved on http:/ /www.banglajol.info/index.php/PULSE/article/view/6547
  5. Philip Woodrow. Arterial blood gas analysis. Nursing Stan-dards 2004; 18(21): 45-52
Author: Subin S
Clinical Instructor, Pragyan College of Nursing, Near RGPV Gandhinagar,  Bhopal (MP)
 
Source: TNAI Journal