“A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING

PROGRAMME ON PRACTICE REGARDING MANAGEMENT OF PATIENTS

WITH HYPOVOLEMIC SHOCK AMONG STAFF NURSES WORKING IN

SELECTED HOSPITALS, BAGALKOT”.

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

MS.SOLLY ELIZABETH JOSEPH

SHRI. B.V.V.SANGHA’S

SAJJALASHREE INSTITUTE OF NURSING SCIENCES,

NAVANAGAR, BAGALKOT, KARNATAKA.

2012

1

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE

ANNEXURE – IIPROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. Name of the candidate and address (in block letters)

MS.SOLLY ELIZABETH JOSEPH,

I YEAR M. Sc. NURSING,

B.V.V.S.SAJJALASHREE INSTITUTE OF

NURSING SCIENCES,

NAVANAGAR,BAGALKOT-587102

2. Name of the Institution SAJJALASHREE INSTITUTE OF

NURSING SCIENCES, BAGALKOT.

3. Course of Study and Subject M. Sc. NURSING,

MEDICAL SURGICAL NURSING.

4. Date of Admission to the course 04/08/2012

5. Title of the Topic

“A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING

PROGRAMME ON PRACTICE REGARDING MANAGEMENT OF PATIENT

WITH HYPOVOLEMIC SHOCK AMONG STAFF NURSES WORKING IN

SELECTED HOSITALS,BAGALKOT”.

2

6.BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

‘’Water is the life’s mater and matrix,

mother and medium. There is no life without water.’’

Can we imagine a life without water? Of course not, because

water is essential to sustain life. Likewise, body fluids are vital to maintain normal body

functioning. The body reacts to internal and environmental changes by adjusting vital

functions to keep fluids and electrolytes in balance, maintaining homeostasis .When

there is a marked fluid loss from our body, the body maintains homeostasis and the

patient may be asymptomatic. But a reduction of intravascular fluid volume of 15% to

25% lead to imbalance in the homeostasis, resulting in metabolic changes continuing

into shock.1

Shock is a medical emergency in which the organs and tissues of

the body are not receiving an adequate flow of blood. This deprives the organs and

tissues of oxygen (carried in the blood) and allows the build up of waste products. Shock

can result in serious damage or even death. As poetically stated by John Collins Warren,

shock is a 'momentary pause in the act of death'. Hypovolemia has historically been

termed desanguination (from Latin sanguis, blood), meaning a massive loss of blood.

The word was possibly used to describe the lack of personality (by death or by

weakness) that often occurred once a person suffered haemorrhage or massive blood

loss.2

Hypovolemic shock refers to a medical or surgical condition in

3

which rapid fluid loss results in multiple organ failure due to inadequate perfusion. The

intravascular fluid loss can be caused by traumatic injury, burns, surgery, sustained

vomiting, diarrhoea or severe dehydration and use of vasodilators. Internal fluid

collection such as ascitis, peritonitis may also cause hypovolemic shock.3

With a fluid loss of less than 750ml, the body may enter into a

compensated state and changes to vital signs may be subtle and difficult to detect. As the

fluid loss increases to more than 750ml, cardiac output begins to fall and changes in vital

signs occur. The patient may develop symptoms like weakness, dizziness, light

headedness, taste of sweetness and even loss of consciousness. The blood pressure of the

patient will decrease, develops and the skin is usually pale and cool and may display a

bluish discolouration. After approximately a 40% fluid loss, the situation can become

life threatening. Multi organ damage and cellular necrosis can occur with impending

death likely.4

Hypovolemic shock recognised early and treated promptly is

associated with a good outcome. However, advanced stages of hypovolemic shock with

a fluid loss of more than 25% of total body fluid are considered irreversible shock and

are usually associated with a poor outcome.5

Primary prevention of shock is an essential focus of nursing

intervention. Hypovolemic shock can be prevented in some instances by close

monitoring patients who are at risk for fluid deficits and assisting in fluid replacement

before intravascular volume is depleted. In other circumstances, hypovolemic shock

cannot be prevented, and nursing care focuses on assisting with treatment targeted,

treating its cause and restoring intravascular volume.6

Thomas Ahrens and colleague suggest intravenous fluid

4

replacement with normal saline to help restore fluid balance and reduce the risk of

hypovolemia, if appropriate.7 The management of shock depends on identifying its cause

while supporting the stricken patient. Depends upon the cause the management differs.

External bleeding should be controlled by direct pressure. If direct pressure fails, other

techniques such as elevation of pressure points should be considered. If a first-aid

provider recognizes internal bleeding, the life-saving measure to take is to immediately

call for emergency assistance. Emergency oxygen should be immediately employed to

increase the efficiency of the patient's remaining blood supply. This intervention can be

life-saving. The use of IV drip may help compensate for lost fluid volume, and blood

substitutes like colloid or crystalloid IV fluids will also used. These all information

figures out that clinical persons especially nurses, should have sufficient knowledge

about different causes and treatment and should act immediately for to save the life of a

person.8

6.1 NEED FOR THE STUDY

“Good practice is dependent upon sound

theoretical knowledge and in no profession is this more

self-evident than in that of nursing, that most practical

of all callings.”

Hypovolemic shock is a life threatening medical emergency and one

of the leading causes of death for critically ill patients. Definitive care of hypovolemic

patient require hospital and sometimes surgical intervention needed for the patient.

Hypovolemic shock is the common form of shock, starts insidiously but progresses with

startling rapidity to a life threatening situation. Knowing the early signs and symptoms

and how to deal with the situation can help to prevent a devastating chain of events.9

5

In the year 2005, Department of Health, England published a

hospitalization statistics of shock that occurred between the year 2002-2003.During this

period, 92% of people with shock required hospital admission. In that 51% of hospital

consultant episode occurred in >75years old and 11% occurred in 15-59 years old

people. 6 to 7days was the average length of stay in hospitals for shock and 0% of

hospital consultant episodes for shock were single episodes.10

In the United States, the hospital emergency department reports

more than 1million cases of shock each year.11 Mortality rate is variable according to the

cause. All over the world more than10 million children are dying each year. India

accounts for 25% of global child death, in that 18% of children are dying due to

dehydration and hypovolemic shock. In Karnataka, under five mortality rate is 72

per1000 live births and diarrhea accounts for 23% of under five deaths.12

A prospective study was conducted to determine the frequency,

etiology, type and outcome of shock in hospitalized children in the age group of 1 month

to 15 years in Punjab in the year 2006.There were 98 cases of shock, constituting 4.3%

out of total admissions. Mean age was 2.8 +/-3.4 years. Maximum number of patients

(39) was seen in infancy. Hypovolemic shock due to acute diarrheal disease is the

commonest type [45.9%].Compensated stage was common in hypovolemic shock

[88.9%] and the survival rate was best in hypovolemic shock [97.7%]. Inotropes and

ventilatory support were required in 46% and 23% patients, respectively. Diagnosis and

management of shock in compensated stage carried better prognosis than in

uncompensated shock irrespective of the age of the patient. So close monitoring of

patients general condition and vital signs are necessary for a good outcome.13

6

India has a maternal mortality rate of 200/1, 00,000 live births

estimated for the year 2010 due to bleeding and shock.14 In initial stage, because of

compensatory mechanism patients may be asymptomatic. Shock is a potentially life-

threatening situation and the nurse aider must therefore be able to recognize

its development and take immediate act.4

According to WHO, in India over 10 lakh people are moderately

or severely burnt by every year and nearly 1.05 lakh people die in road accidents 15.Post

operative hypovolemia and dengue hemorrhagic fever also have high mortality rate in

India. A significant number of these deaths are the result of hypovolemic shock. Rapid

identification and ensuring correct, aggressive treatment are necessary for patient

survival. The critical care nurse plays an important role as part of the team involved in

the resuscitation and ongoing care of these patients. Understanding the underlying

pathophysiology, recognizing signs and symptoms and being prepared to effectively

respond will further enable the nurse to contribute to positive patient outcomes.4

A retrospective study was conducted to find out pattern of chest

injuries in road traffic accident victims in Belgam, Karnataka. In this study a total of 227

samples, fatal cases of thoracic trauma autopsied during the period 01/01/2004 to

31/12/2009 were analyzed at the department of forensic medicine and toxicology. The

result of the study was, 67.8% of victims were 40years old or younger and women were

less involved than men.63 people [27.8%] were died due to shock and hemorrhage, the

lungs were injured in 40.1%, the major blood vessels in 25.5% and the heart was injured

in 20.3%cases. Haemothorax was seen in 38.3% cases and pneumothorax was seen in

20.7%cases.They concluded the study as in a trauma patient shock is considered to be

hypovolemic and should be manage before decompensation.16

7

Hypovolemic shock can occur any of the hospital settings such

as emergency department, intensive critical care unit, neonatal intensive critical care unit

or any of the wards. Nurses have the responsibility to monitor closely the patients who

are at risk, proper positioning, safe administration of fluids and medicines and safe

administration of fluids and medicines.6

Brendan Docherty,[ Critical Care Manager, Queen Elizabeth

Hospital , London, 2002], says that nurses have to be aware of the implications of fluid

management and should be empowered to advocate for the patient and for best practice

within the health-care team . With reduced junior doctor hours and the advent of nurse

prescribing, nurses are not only responsible for monitoring and detecting fluid problems,

but are now starting to prescribe fluid regimens in some clinical areas. The management

of fluid balance requires the nurse to have a complex mixture of skills, including an

understanding of the principles of fluid balance in the body and of the different

intravenous fluids. The nurse must also have an understanding of the body's responses to

fluid depletion and be able to recognise those signs and respond appropriately.17

These all data clearly proves that the prognosis from the

hypovolemic shock completely depend on the nurse to detect the hypovolemia as early

as possible. The nurse should have a confidence to manage the emergencies. For this, a

thorough knowledge about disease process, pharmacology is necessary. The work

experience also helps to act quickly. The nurse should monitor the heart rate, respiratory

rate, blood pressure, peripheral vascular changes, and urine output of the patient. A

minute changes in these all signs may be an indicator of life threatening complications.

Nurses are the only health professional who can detect a minute changes in patients

health. So her improper care or delay in treatment may lose the life of a person.17

The researcher herself had an experience when working as a

8

staff nurse in a major hospital in north India. A patient was brought to the emergency

department, with crushed injury in the left lower limb. At that time the patient was

severely bleeding and GCS score was low. The staff nurses were only aware of how to

control the bleeding. The patient’s condition was getting worse. At that time casualty

doctor was busy in managing other critically ill patients. After the doctor came, then

only the treatment got started. This incidence motivated the researcher to select the topic

as the research problem, to improve the nurse’s practice regarding management of

patients with hypovolemic shock.

6.2 REVIEW OF LITERATURE

Good research generally builds upon existing knowledge. The more

developed the network linking a new study with other research is, the more of the

contribution it is likely to make. The accumulation of scientific knowledge is very much

analogous to the fitting together of a jig saw puzzle. Every piece of the puzzle, small

though it may be, may help to link together other parts of the puzzle. Review of

literature is important step in research process. It refers to an extensive, exhaustive and

systematic examination of publication relevant to the research project.

A prospective study was conducted to find out the occurrence,

etiology of shock in paediatric age group and to find out association of various clinical

and laboratory parameters of shock with outcome in Indira Gandhi institute of child

health , Bangalore in the year 2007. Children who admitted in the paediatric intensive

care unit between >1month to 16 yrs were selected by simple random technique. The

result of the study was total 100 cases of shock were identified out of 784 PICU

admissions, which accounts for 12.7% of admissions. Most common age group was

between >1month –5 years. Male children are more common than females. Most

common etiology was septic shock (48%) followed by hypovolemic and cardiogenic

9

shock .Least mortality was seen in hypovolemic and anaphylactic shock. Persistence of

tachycardia, low blood pressure, decreased urine output, low GCS score, low platelet

count, low oxygen saturation, hypoxemia, hypercarbia, high creatinine levels were noted

in nonsurvivors, Most common etiology was septic shock followed by hypovolemic

shock and cardiogenic shock. They concluded the study as persistence of tachycardia,

low blood pressure, decreased urine output, low oxygen saturation may be an indicator

of shock and it will lead to organ damage and eventually death. So early detection and

management is necessary for a good outcome.18

A retrospective study was conducted with the objective of protective

measures against hypovolemic shock after severe loss of blood which can occur after

total knee arthroplasty and to ensure safety of the patient post total knee arthroplasty

surgery in Thailand. A total number of 139 subjects who received total knee arthroplasty

surgery are selected for this study. The result of the study was out of the 139 subjects, 20

subjects experienced hypovolemic shock after total knee arthroplasty surgery and 119

subjects did not. The study concluded that total knee arthroplasty surgery can cause

severe blood loss that can lead to hypovolemic shock, which can cause life threatening

complications for the patient. Therefore, it is critical to maintain proper care and close

observation for post-surgical patients who received the procedure 4 hours prior.19

A study was conducted to understand the process of decision making

by auxiliary nurses regarding postpartum bleeding among women in the Dominican

Republic in USA in the year 2006. A semi structured interview method was used to

collect data from participants. The result of the study explaining that auxiliary nurses use

specific criteria and logic to decide if postpartum maternal bleeding is excessive.

However, systematic postpartum assessments are not routinely conducted on every

woman. They concluded the study as a collaboration of U.S. midwives and

10

Dominican nurses will build on the assets of the auxiliary nurses. The U.S. midwives

and Dominican nurses are committed to finding empowering and effective ways to

improve maternity care.20

A study was conducted to assess the degree of use of Trendelenburg

positions and the sources of knowledge and beliefs and their efficacy among critical care

nurses in USA in the year 1997. A survey was mailed to 1000 nurses were randomly

selected from the membership list of the American Association of Critical-Care Nurses.

The result of the study was Ninety-nine percent of the respondents had used the

Trendelenburg position, and 80% had used the modified Trendelenburg position, mostly

for treatment of hypotension. Most of them are learned about these positions from their

nursing education, nurse colleagues, supervisors, and physicians. Although 80% of the

respondents believed that use of the Trendelenburg position improves hypotension

almost always or sometimes, They concluded that tradition-based therapy still underlies

some interventions used in the care of critically ill patients and that some nurses may be

relying on an outdated knowledge.21

A prospective cohort study was conducted to find out the ability of

nursing staff to predict hypovolemia or hypervolemia, based on their interpretation of

available hemodynamic data in Netherland. In this study, intensive care unit and medium

care unit nurses, currently treating patients with recent subarachnoid haemorrhage, were

asked to predict present volume status. A total of 350 combinations of volume

predictions and circulating blood volume measurements were obtained in 43 patients.

They got a result as prediction of hypovolemia had a sensitivity of 0.10 (95% confidence

interval [ci] = 0.06 to 0.16) and a positive predictive value of 0.37 (95% ci = s0.23 to

0.53) for actual hypovolemia. The prediction of hypervolemia had a sensitivity of 0.06

(95% ci = 0.01 to 0.16) and a positive predictive value of 0.06 (95% ci = 0.02 to 0.19)

11

for actual hypervolemia. They concluded the study as assessment of hemodynamic

condition in patients with subarachnoid haemorrhage by intensive care unit or medium

care unit nurses does not adequately predict hypovolemia or hypervolemia, as measured

using pulse dye densitometry. Fluid therapy after subarachnoid haemorrhage may

require guidance with more advanced techniques than interpretation of usual

hemodynamic parameters.22

A study was conducted to examine the ability of final-year nursing

students to assess, identify and respond to patients either deteriorating or at risk of

deterioration in Australia. They selected fifty-one final- year, final-semester student by

simple random method. Students completed a knowledge questionnaire and two video-

recorded simulated scenarios to assess skill performance. The result of the study was,

they got mean knowledge score of 74% (range 46-100%) and the mean skill

performance score across both scenarios was 60% (range 30-78%). Skill performance

improved significantly (p < 0.01) by the second scenario. However, skill performance

declined significantly in both scenarios as the patient's condition deteriorated .They

concluded the study as knowledge scores suggest, on average, a satisfactory academic

preparation, but this study identified significant deficits in students' ability to manage

patient deterioration.23

A study to evaluate the effectiveness of structured teaching program on

knowledge of staff nurses regarding management of patients with fluid and electrolyte

imbalance was conducted at Wockhardt hospital, Bangalore. A quasi experimental, one

group pre-test and post-test design was adopted for the study, with purposive sampling

technique. 40 samples were selected in which most of the subjects 36 (90%) were found

to be female and 4(10%) were found to be male. Structured knowledge questionnaire

was developed and administered to collect the data. Collected data were analyzed and

12

interpreted based on descriptive and inferential statistics. The study results revealed that

the pre-test knowledge score obtained by staff nurse was 18.25. After the administration

of structured teaching programme post test mean knowledge score was increased to 28%

with value of 24.60. This supports that increase in the knowledge level of staff nurses is

not by chance but by the developed structured teaching program.24

A prospective, randomized study was conducted with the objective to

find out effect of hypertonic solutions in the treatment of hypovolemic shock in patients

admitted to the emergency room and to assess in Brazil in the year 1992. A double-blind

study method is used on one hundred five adult patients admitted in hypovolemic shock

were selected as subjects. They got result as at the end of the infusion period, and 5 and

10 minutes after infusion, the calculated plasma volume expansion, immediately after

the bolus infusion, was significantly higher (24.1% +/- 1.8% and 24.9% +/- 1.1%) in the

hypertonic groups, compared with isotonic groups (7.9% +/- 1.3%). The incidence of

complications was low, and the mortality rate was similar in all groups. They concluded

the study as infusion of 250 ml hypertonic saline solution in patients with severe

hypovolemia improved map significantly.25

A study was conducted about factors affecting fluid resuscitation in the burn patient and the collaborative role of the advanced practice

nurse in USA.A total of 100 patients admitted in burn unit were selected randomly for this study. They found that, first critical 24 hr after the injury is

sustained, the burn patient must receive fluid resuscitation to prevent hypovolemia and ensure adequate tissue perfusion. Delayed or inadequate fluid

resuscitation resulted in suboptimal tissue perfusion, and caused multisystem organ failure and death. Over resuscitation was more problematic than

under resuscitation and was associated with the development of abdominal compartment syndrome, compartment syndrome of the extremities, airway

obstruction, and pulmonary edema. The study concluded that factors affecting fluid resuscitation in the burn patient are at the cornerstone of burn

management. The advanced practice nurse plays a vital role in implementing strategies to ensure optimal resuscitation in the burn patient. Through

collaboration, the advance practice nurse in both the burn centre and the emergency department must make certain that the educational needs of the staff

are addressed and be diligent in providing significant education, essential tools, and assistance to the staff nurses in an effort to promote best-practice and

13

evidence-based care.26

6.3 STATEMENT OF THE PROBLEM

“A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED

TEACHING PROGRAMME ON PRACTICE REGARDING MANAGEMENT

OF PATIENTS WITH HYPOVOLEMIC SHOCK AMONG STAFF NURSES

WORKING IN SELECTED HOSPITALS, BAGALKOT”.

6.4 OBJECTIVES OF THE STUDY

1. To assess the practice of staff nurses regarding management of patient with

hypovolemic shock.

2. To develop a planned teaching programme on practice regarding

management of patients with hypovolemic shock among staff nurses.14

3. To assess the effectiveness of planned teaching programme on practice

regarding management of patient with hypovolemic shock among staff

nurses.

4. To find out the association between practice of management of patients

with hypovolemic shock with their selected socio-demographic variables.

6.5 OPERATIONAL DEFINITIONS

1.Assess:-In this study assess refers to an organized, systematic and continuous

process of collecting information from staff nurses to measure practice

regarding management of patients with hypovolemic shock.

2.Effectiveness:-In this study effectiveness refers to influence of the planned

teaching programme on the practice of staff nurses regarding management

of patients with hypovolemic shock.

3.Planned teaching programme:- In this study planned teaching programme

refers to systematically organised teaching plan to provide information to

staff nurses regarding management of patients with hypovolemic shock.

4.Practice:-In this study practice refers to the ability of the staff nurses to

manage a patient with hypovolemic shock, measured by checklist method.

5.Management:-In this study, management refers to improve or maintain

the condition of a patient with hypovolemic shock.

6. Patient:-In this study Patient refers to the person with hypovolemic shock.

7.Hypovolemic shock:-In this study hypovolemic shock refers to an

emergency condition in which severe blood and fluid loss makes the heart

unable to pump enough blood to the body, which results in multiple organ

failure.

15

8.Staff nurses:-In this study staff nurses refers to, the staff nurses working

in selected hospitals of Bagalkot.

6.6 ASSUMPTIONS

1) Staff nurses have some ability to manage a patient with hypovolemic shock.

2) Planned teaching programme will improve the skill of staff nurses to manage

the patient with hypovolemic shock.

3) The post test practice scores will be more than pre test scores.

4) There is a significant association between selected socio-demographic variables

and nurses ability to manage a patient with hypovolemic shock.

6.7 HYPOTHESIS

H1: More than 50% of nurses will be good in practice related to management of

patients with hypovolemic shock.

H2: A significant difference will be found between pretest and post test scores of nurses

related to management of patient with hypovolemic shock.

H3: There will be significant association between the practices regarding management

of patient with hypovolemic shock with their selected socio-demographic variables.

6.8 DELIMITATION

The study is delimited to the staff nurses working in selected hospitals,

Bagalkot.

6.9 CRITERIA FOR SAMPLING

1. Inclusion Criteria

The study includes the staff nurses

Who are available at the time of data collection.

Who are willing to participate in the study.

2. Exclusion criteria

The study excludes the staff nurses

16

Who are sick at the time of data collection.

Who are leave at the time of data collection.

7. MATERIALS AND METHODS

7.1 SOURCE OF DATA

The data will be collected from staff nurses who are working in selected

hospitals of Bagalkot.

7.1.1RESEARCH DESIGN

A quasi experimental design [one group pretest and posttest design without a

control group] is found to be appropriate for conducting the present study.

7.1.2 SETTING

The present study will be conducted in selected hospitals of Bagalkot.

7.1.3 POPULATION

For the present study staff nurses are the population.

Target population

Staff nurses who are working in Bagalkot.

Accessible population

Staff nurses who are working in selected hospitals of Bagalkot.

7.1.4 SAMPLE

A sample consists of subject of units that comprises the population for

present study.

In the present study sample are staff nurses who are working in selected

hospitals of Bagalkot.

7.1.5 SAMPLE SIZE

A total of 40 staff nurses working in selected hospitals will be selected for

17

the present study.

7.1.6 SAMPLING TECHNIQUE:

Simple random sampling technique will be used to select the staff nurses as

subjects.

7.1.7 SELECTED VARIABLES: Variables selected in the present study are

Independent Variable: Planned teaching programme on practice regarding

management of patient with hypovolemic shock.

Dependent Variable: Practice of staff nurses regarding management of patient

with hypovolemic shock.

Socio demographic variables: Socio demographic variable includes socio

demographic characteristic of staff nurses working in selected hospitals,

Bagalkot, like their age, sex, educational status, experience, source of

information, previous exposure to hypovolemic conditions.

7.1.8 DURATION OF STUDY

Duration of the present study is 6 weeks.

7.2 METHODS OF DATA COLLECTION

7.2.1 DATA COLLECTION INSTRUMENTS

The investigator has planned to assess the practice of staff nurses by checklist.

It consist of 2 sections namely section 1, section 2.

Section 1-deals with socio demographic data related to sample.

Section 2-deals with the checklist related to assessment of practice

regarding management of patients with hypovolemic shock.

7.2.2 DATA COLLECTION METHOD

Prior permission will be obtained by the significant authorities and from

the subjects. The investigator used checklist to assess the practice regarding management

18

of patients with hypovolemic shock. The data will be conducted in the study area

between 9am to 5 pm, depending on the availability of subjects. The data will be

gathered within 6 weeks.

7.2.3 PLAN FOR DATA ANALYSIS

Numerical data obtained from the sample will be organized and

summarized with the help of descriptive statistics like percentage, mean, median, and

standard deviation.

Testing the level of significance of hypotheses and identifying

relationship between socio demographic variables and practice regarding management of

patient with hypovolemic shock will be done with the help of inferential statistics, tests

like Chi- square test, co efficient correlation and paired t-test will be used.

7.2.4 PROJECTED OUTCOME

The present study will help the staff nurses to learn regarding management

of hypovolemic shock, which help them to take the measures to prevent and to manage

hypovolemic shock and death.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR

INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER

HUMANS OR ANIMALS? IF SO PLEASE DESCRIBE BRIEFLY.

Yes,

In present study investigation is done on human beings i.e assessment of

practice of staff nurses regarding management of patient with hypovolemic shock.

Intervention is given i.e. administration of planned teaching programme on management

of paients with hypovolemic shock.

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR

19

INSTITUTION IN CASE OF 7.3?

Yes,

A]Permission will be obtained from the principal of Shri.B.V.V.Sangha’s

Sajjalashree Institute of Nursing Sciences, Navanagar, Bagalkot.

B]Permission will be obtained from the institutional ethical and research

rese committee of Shri.B.V.V. Sangha’s Sajjalashree Institute of Nursing Sciences,

Navanagar, Bagalkot.

C]Permission will be obtained from the concerned head of selected hospitals,

Bagalkot.

D] Written consent will be obtained from participants.

8.LIST OF REFERENCES

1. Ann Crawford, Helene Harris, IV fluids what nurses need to know,

Lippincottnursingcentre.com.

2. Gecraedts, H.Haasjagar, Exsanguination in trauma ;a review of diagnostics and

treatment options. Injury40 [1]11-20, en.wikipedia.org.

3. Paul Kolecki, David FM, Brown, hypovolemic shock, emedicine.medscape.com.

4. Garretson.s, Maberti.s, Understanding hypovolemic ,cardiogenic and septic shock,

2007,clinicalinfo/hypovolcardisepsisshock.pdf.

5. Medical disability guidelines, Hypovolemic shock, www.mgguidelines.com.

6. Brenda bare, Susanne.c.smeltzer, Brunner and Suddarth’s text book of Medical

surgical nursing, Lippincott William and Wilkins publication,10th edition,

page no:305.

7. Elizabeth otto, Causes of hypovolemia, aug18, 2010, www.livestrong.com.

20

8. G.Thomas Shires MD, Management of hypovolemic shock, Newyork,

Jvsmedicscorner.com.

9. Paul Kolecki, David FM, Hypovolemic shock treatment and management,

March 21, 2012, emedicine.medscape.com.

10. Statistics about shock, www.rightdiagnosis.com.

11. Merck, Shock, www.merckmanuvals.com.

12. Diarrhoea causes, dehydration, rehydrate.org.

13. Daljit Singh, Atul chopra, Punect Pooni, RC Bhatia, Clinical profile of shock

in children, Punjab,2006, poonipa@yahoo.com.

14. India maternal mortality rate, 2010, www.indexmundi.com.

15. List of countries by traffic related and burn related prevalence, Wikipedia free

encyclopaedia, 2010, en.wikipedia.org.

16. Kumar AG, Honnungar RS, Pattern of chest injuries in road traffic incident

victims, Belgam, Med sci law,2011, 51[2]:93-96.

17. Brendan Docherty, Nursing considerations in fluid management in hypovolemia,

London, 2002, www.nursingtimes.net.

18. Ravikant, Clinical profile of shock in children with special reference to prognostic

determinants, RGUHS Dissertations, 2007.

19. Tanongsak Homsapaya, Pakasith Anahanlipaiboon, Hypovolemic shock in

total knee arthroplasty, Siraj journal, volume 63, number 3, 2011.

20. Foster J, Regueira Y, Decision making by auxiliary nurses to assess

postpartum bleeding in a dominician republic maternity ward, 2006.

21. Ostrow CL, Use of the trendlenburg position by critical care nurses, USA, 1997.

22. Hoff RG, Rinkel G, Nurses prediction of volume status after aneurysmal

subarachnoid haemorrhage, Netherlands, 2008.

21

23. Ravikumar, A study to evaluate the effectiveness of structured teaching

programme on nurses knowledge regarding management of patients with fluid and

electrolyte imbalance in Wokhardt hospital, Bangalore, 2009.

24. Cooper.s, Kinsman L, Managing and deteriorating patient in a simulated

environment: Nursing students knowledge, skill, and situation awareness, Australia,

2010.

25.Younes RN, Arun F, Hypertonic solutions in the treatment of hypovolemic shock,

a prospective randomized study in patients admitted to the emergency room,

Brazil, 1992.

26. Zaletel CL, Factors affecting fluid resuscitation in the burn patient: the

collaborative role of advanced practice nurse, USA, 2008.

9 Signature of Candidate

10 Remarks of the Guide The proposed study is ethically acceptable and socially beneficent. It is feasible for the student researcher to be carried out.

11 Name and Designation of (In

Block letters )

11.1 Guide

MR.VARESH.G .CHILAPUR,ASSISTANT PROFESSOR AND HOD OF MEDICAL SURGICAL NURSING,SHRI. B.V.V.SANGHA’S SAJJALASHREE INSTITUTE OF NURSING SCIENCES, NAVANAGAR, BAGALKOT, KARNATAKA.

11.2 Signature

11.3 Co- Guide (if any)MR.SHRIDHAR PUJARI, ASSISTANT PROFESSOR,SHRI. B.V.V.SANGHA’S SAJJALASHREE INSTITUTE OF NURSING SCIENCES, NAVANAGAR, BAGALKOT, KARNATAKA.

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11.4 Signature

11.5 Head of Department MR.VARESH.G.CHILAPUR,HOD OF MEDICAL SURGICAL NURSING,SHRI. B.V.V.SANGHA’S SAJJALASHREE INSTITUTE OF NURSING SCIENCES, NAVANAGAR, BAGALKOT, KARNATAKA.

11.6 Signature

12 12.1 Remarks of the principal: The topic selected by the candidate is suitable for

current situation. The research and ethical committee is also accepted. Hence candidate

can proceed with this study.

12.2 Signature

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