Demographic Characteristics of study participants
Table 1: Socio-demographic characteristics of the study participants (n=40)
Variable
|
Number
|
Percent
|
Gender
|
|
|
|
|
Male
|
15
|
37.5
|
|
Female
|
25
|
62.5
|
Age (Mean=32.7, SD=6.8, Min.=23 and Max.=52)
|
|
Less than 30
|
20
|
50
|
|
30 to 39
|
11
|
27.5
|
|
Greater or equal 40
|
9
|
22.5
|
Place of Work
|
|
|
|
National Referral Hospital
|
16
|
40
|
|
Zonal Referral Hospital
|
8
|
20
|
|
Community Hospital
|
8
|
20
|
|
Health Center
|
6
|
15
|
|
Health Station
|
2
|
5
|
Qualification
|
|
|
|
Associate Nurse
|
16
|
40
|
|
Diploma Nurse
|
15
|
37.5
|
|
Degree Nurse
|
9
|
22.5
|
Work Experience median=6, IQR=6
|
|
Less than 4 years
|
14
|
35
|
|
5 to 10 years
|
17
|
42.5
|
|
Greater or equal to 11 years
|
9
|
22.5
|
Department
|
|
|
|
Adult
|
27
|
67.5
|
|
Pediatric
|
6
|
15
|
|
Maternity
|
7
|
17.5
|
Abbreviations: SD standard deviation, Min minimum, Max maximum, IQR interquartile range
Table 1 shows the demographic characteristics of the study participants. Female nurses contributed 62.5% (n=25) of the sample while male nurses contributed 37.5% (n=15) of the sample. The mean age of the respondents was 32.7 years (SD=6.8) and half (n=20) of the respondents were less than 30 years, followed by 27.5% (11) nurses of ages between 30 to 39, and 22.5% (9) were 40 years old or older.
Most of the study participants, (40%, n=16) were from national referral hospitals, followed by zonal referral hospitals (20%, n=8), community hospitals (15%, n=6), health centers (15%,n=6), and health stations (5%, n=2). The academic qualification of the respondents shows that, most respondents 40% (16) were trained in certificate level, 37.5% (15) were diploma nurse and the remaining 22.5% (9) had possessed bachelor’s degrees in nursing science.
Less than half (42.5% n=17) of the respondents possessed 5-10 years of work experience, 35% (14) had less than 4 years of work experience, 22.5%(9) were having greater than or equal to eleven years of work experience.
The respondents were from three working departments; such that 67.5% (27) from Adult Medical-Surgical Department, 17.5% (7) nurses from maternity and 15% (6) nurses from pediatric department.
Table 2 shows majority, 67.5% (27) of the study participants did not attend any pre-service training, on the other hand 70% (27) of the respondents attended formal training about BLS in their hospital.
In order to determine the frequency of BLS attempts, the respondents were asked how often they had performed CPR in their clinical settings. The results on table 2 shows that 40% (16) of the respondents had never participated in resuscitation attempts at all, 30% (12) were performing annually, 22.5% (9) respondents were performing BLS on a monthly basis, 5% (2) on a daily basis and the remaining 2.5% (1) were performing on weekly basis.
Table 2: Background of study participants on Basic Life Support (n=40)
Variable
|
|
Frequency
|
Percent
|
BLS Class in college
|
|
|
|
Yes
|
13
|
32.5
|
|
No
|
27
|
67.5
|
BLS Training in hospital
|
|
|
Yes
|
28
|
70
|
|
No
|
12
|
30
|
Frequency of BLS Performance
|
|
Never
|
16
|
40
|
|
Daily
|
2
|
5
|
|
Weekly
|
1
|
2.5
|
|
Monthly
|
9
|
22.5
|
|
Annually
|
12
|
30
|
Abbreviations: BLS basic life support
Knowledge of respondents regarding Adult Basic Life Support
Knowledge of the nurses under this study was assessed using a questionnaire that had mainly 3 domains, namely, general knowledge in BLS, steps in BLS, and chest compression in BLS. The number of items in the domains of general knowledge, steps in BLS, and chest compression were 9, 6 and 5 respectively.
Knowledge of study participants on the domain related to general knowledge about Basic Life Support.
Before intervention, 42.5% of the respondents correctly knew CPR abbreviation and only 5% of the respondents correctly identified the steps in initiating CPR. However, the percentage of knowledge for both CPR abbreviation and steps in initiating CPR steadily increased to 95% immediately after intervention, even though, slight decline had occurred 3 months later. Considerable improvement in the knowledge of the respondents immediately after intervention on brain survival without oxygen (55% to 97.5%), how to recognize someone in need of CPR (67.5% to 85%), and best way to give mouth to mouth ventilation (67.5% to 82.5%) was observed. Even though much difference in percentage was not observed immediately after intervention, increase in proportion of respondents regarding the knowledge of the goal of CPR (72.5% to 90%), and about the maneuver not used to open the airway (62.5% to 95%) was observed 3 months after the intervention. Paradoxically, immediate after training, a decrease in percentage was observed on respondents who correctly knew the benefit of minimizing interruptions during compression.
Table 3: Responses of study participants on domains related to general knowledge about Basic Life Support (n=40)
General knowledge
|
Pre-intervention n (%)
|
Immediate Post
n (%)
|
3 months later
n (%)
|
CPR Abbreviation
|
|
|
|
|
Correct
|
17(42.5%)
|
38(95%)
|
36(90%)
|
|
Incorrect
|
23(57.25%)
|
2(5%)
|
4(10%)
|
Brain survival without oxygen
|
|
|
|
|
Correct
|
22(55%)
|
39(97.5%)
|
31(77.5)
|
|
Incorrect
|
18(45%)
|
1(2.5%)
|
9(22.5%)
|
The organ that cannot survive without oxygen
|
|
|
|
Correct
|
25(62.5%)
|
29(72.5%)
|
31(77.5%)
|
|
Incorrect
|
15(37.5%)
|
11(27.5%)
|
9(22.5%)
|
The goal of CPR
|
|
|
|
Correct
|
30(75%)
|
29(72.5%)
|
36(90%)
|
|
Incorrect
|
10(25%)
|
11(27.5%)
|
4(10%)
|
Steps for initiating CPR
|
|
|
|
|
Correct
|
2(5%)
|
38(95%)
|
29(72.5%)
|
|
Incorrect
|
38(95%)
|
2(5%)
|
11(27.5%)
|
How to recognize someone in need of CPR
|
|
|
|
Correct
|
27(67.5%)
|
34(85%)
|
29(72.5%)
|
|
Incorrect
|
13(32.5%)
|
6(15%)
|
11(27.5%)
|
Benefit of minimizing interruptions during compression
|
|
|
|
Correct
|
31(77.5%)
|
22(72.5%)
|
23(57.5%)
|
|
Incorrect
|
9(22.5%)
|
18(27.5%)
|
17(42.5%)
|
Best way to give mouth to mouth ventilation
|
|
|
|
Correct
|
27(67.5%)
|
33(82.5%)
|
32(80%)
|
|
Incorrect
|
13(32.5%)
|
17(17.5%)
|
8(20%)
|
Maneuver not used to open the airway
|
|
|
|
|
Correct
|
22(55%)
|
25(62.5%)
|
38(95%)
|
|
Incorrect
|
18(45%)
|
15(37.5%)
|
2(5%)
|
Abbreviations: CPR cardiopulmonary resuscitation
Knowledge of respondents on the domain related to steps on BLS
Before intervention more than 50% of study participants failed to answer what the next step is after patient lie unconscious (52.5%), what to do next if patient has no response (75.0%), what to do next after 30 compressions and two breaths (62.5%) and fail to arrange steps in correct order (90.0%). Immediate after intervention, marked improvement was recorded in identifying next step after 30 compressions and two breaths(37.5% to 95.0%),what to do next after patient lie unconscious (47.5% to 82.5%) and what to do if patient has no response (25.0% to 57.5%) even though there was some reduction three month after intervention . On putting the steps on correct sequence, even though marked improvement was seen after intervention (10.0% to 45.0%) still less than half of the study participants can correctly order it.
Before intervention the number of respondents who knew on what to do if patient is breathing but unresponsive was 62.5% and after intervention it was increased to 87.5%.
After training, slight decrease was observed in the number of respondents who knew what to do if no scene of danger (55.0% to 52.5%).
Table 4: Knowledge of respondents on the domain related to steps on Basic Life Support (n=40)
Steps on BLS
|
Pre-intervention
n (%)
|
Immediate Post
n (%)
|
3 months later
n (%)
|
What you will do next if no scene of danger
|
|
|
|
Correct
|
22(55%)
|
21(52.5%)
|
20(50%)
|
|
Incorrect
|
18(45%)
|
19(47.5%)
|
20(50%)
|
What you will do next if patient lie unconscious in safe place
|
|
|
Correct
|
19(47.5%)
|
33(82.5%)
|
27(67.5)
|
|
Incorrect
|
21(52.5%)
|
7(17.5%)
|
13(32.5%)
|
Putting in correct sequence
|
|
|
|
Correct
|
4(10%)
|
18(45%)
|
21(52.5%)
|
|
Incorrect
|
36(90%)
|
22(55%)
|
19(47.5%)
|
What will you do next if patient do not have response
|
|
|
|
Correct
|
10(25%)
|
23(57.5%)
|
16(40%)
|
|
Incorrect
|
30(75%)
|
17(42.5%)
|
24(60%)
|
What will you do next after 30 compression and 2 breaths
|
|
Correct
|
15(37.5%)
|
38(95%)
|
34(85%)
|
|
Incorrect
|
25(62.5%)
|
2(5%)
|
6(15%)
|
what will you if victim starts breathing but is unresponsive
|
|
Correct
|
25(62.5%)
|
35(87.5%)
|
38(95%)
|
|
Incorrect
|
15(37.5%)
|
5(12.5%)
|
2(5%)
|
Knowledge of study participants on the domain related to compression during BLS
Before intervention 65.0% of the respondents correctly knew the compression to ventilation ratio, but on the position of hand during compression, depth of compression, rate of compression, and maximum interruption during compression, the number of respondents who correctly knew were 42.5%, 40.0%, 20.0% and 30.0% respectively.
Immediate after training, on all items that asses’ respondents’ knowledge on compression, good improvement was seen in the number of participants who responded correctly.
Three month after intervention, slight decrease was observed in the number of participants who responded correctly to most of these items.
Table 5: Respondents knowledge on the domain related to compression during BLS (n=40)
Compression
|
Pre-intervention n (%)
|
Immediate Post n (%)
|
3 months later n (%)
|
Hand position during compression
|
|
Correct
|
17(42.5%)
|
35(87.5%)
|
36(90%)
|
|
Incorrect
|
23(57.5%)
|
5(12.5%)
|
4(10%)
|
Compression to ventilation ratio
|
|
Correct
|
26(65%)
|
40(100%)
|
38(95%)
|
|
Incorrect
|
14(35%)
|
0(0%)
|
2(5%)
|
Depth of chest compression
|
|
Correct
|
16(40%)
|
32(80%)
|
32(80%)
|
|
Incorrect
|
24(60%)
|
8(20%)
|
8(20%)
|
Rate of chest compression
|
|
Correct
|
8(20%)
|
38(95%)
|
35(87.5%)
|
|
Incorrect
|
32(80%)
|
2(5.0%)
|
5(12.5%)
|
Maximum interruption during compression
|
|
Correct
|
12(30%)
|
29(72.5%)
|
28(70.0%)
|
|
Incorrect
|
28(70%)
|
11(17.5%)
|
12(30.0%)
|
Overall Knowledge Status
The pass mark for the knowledge is a score of 85% or above.
Accordingly, none of the study participants got a passing mark on knowledge about Basic Life Support before the intervention. However, 55.0% (n=22) and 40% (n=16) of the participants got a passing mark right after intervention and 3 months later, respectively.
Effect of Intervention on knowledge of study participants through time
A one way repeated measures ANOVA was conducted to look over the contribution of an educational intervention on the knowledge scores of the study participants through time. Total of 40 participants were taken in the study and no missing data was found at the three time periods. The average knowledge scores at time 1(prior to the intervention), Time 2 (following the intervention) and Time 3 (three month after intervention) were 9.58 (SD±2.81), 15.9 (SD±3.53), and 14.88 (SD±3.63) respectively (Table 6). Mauchly’s test indicated that there was an evidence of sphericity (Mauchly’s W=0.88, p=0.089). Hence, assuming sphericity, significant effect for time (p<0.001) was found using univariate ANOVA. Moreover, significant effect for time (Wilks’ Lambda=0.189, F (2, 38) = 81.3, p<0.001), was observed using multivariate ANOVA (Multivariate partial eta squared =0.811).
Table 6: Comparison of participants’ level of knowledge at Time 1, Time 2 and Time 3 (n=40)
Time Period
|
N
|
Mean (SD)
|
Test of Sphericity
|
Wilk’s Lambda
|
RANOVA
p-value
|
Time 1 (pre-intervention)
|
40
|
9.58(2.81)
|
Mauchly’s W=0.88
p=0.089
|
Wilk’sλ=0.189
F(2,38)=81.3
p<0.0001
partial eta squared=0.811
|
<0.0001
|
Time 2 (Post intervention)
|
40
|
15.9(3.53)
|
Time 3 (3-month follow up)
|
40
|
14.88(3.63)
|
Furthermore, Bonferroni post-hoc test revealed that the knowledge of study participants have significantly higher at immediate post intervention than pre-intervention (p<0.001), 3 months later than pre-intervention (p<0.001), and immediate post intervention than 3 months later (p =0.025). In addition, a significant linear trend in the level of knowledge was observed across the three time periods (p<0.001).
Table 7: Post-hoc comparison for the knowledge of study participants (n=40)
Post-hoc Comparison
|
Mean Difference
(95% CI)
|
p-value
|
p-value
for Trend
|
Immediate post and pre-intervention
|
6.33(5.08-7.57)
|
<0.001
|
<0.001
|
3 months later and pre-intervention
|
5.30(4.07-6.53)
|
<0.001
|
|
Immediate post and 3 months later
|
1.03 (0.10-1.95)
|
0.025
|
|
As shown in figure 2, immediate after intervention there was marked improvement in knowledge of study participants while three months after intervention it shows slight decrement.