A study was conducted on the effect of blood transfusion on

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            DESSERTATION PROTOCOL


1    NAME OF THE CANDIDATE AND Ms.KIRANJIT KAUR
     ADDRESS                   D/O GURCHARAN SINGH
                               H.NO B Vll 30, BAJWA PATTI
                               BARNALA (DIST-BARNALA)
                               STATE- PUNJAB

2    NAME OF THE INSTITUTION        HINA COLLEGE OF NURSING
                                    YELAHANKA NEW TOWN
                                    BANGLORE-106

                                     M.Sc NURSING
3    COURSE OF STUDY AND             (PAEDIATRIC NURSING)
     SUBJECT


4    DATE AND ADMISSION TO              25/10/2009
     COURSE




TITLE OF THE TOPIC:
      A study to assess the effectiveness of structured teaching
programme on knowledge and practice of nurses regarding blood
transfusion in selected pediatric hospital,Bengaluru.




6 BRIEF RESUME OF INTENTED WORK


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6.1 NEED FOR STUDY

         The transfer of blood or blood components from one person (the donor) into the
bloodstream of another person (the recipient). This will be done as a lifesaving maneuver
to replace blood cells or blood products lost through bleeding. Transfusion of your own
blood (autologous) is the safest method but requires advance planning and not all
patients are eligible1.

       Majority of Indian population belongs to low socio economic status which more
than 40% constitute children because of these many children are suffering from many
problems. The most common problem is moderate to severe anemia and other problem
includes bone marrow failure, lung disease, heart disease, leukemia and accidents etc.
These are several reasons for child requiring blood transfusion 2.

         Human blood is made of a fluid called plasma(55%) that carries red and white
blood cells and platelets(45%). Red blood cells carry oxygen from the lungs to other
body organs and carry carbon dioxide back to the lungs. A certain number of these cells
are needed for the body to function. Bleeding due to trauma, surgery, or disease may
cause a low red blood cell count. White blood cells fight infections by destroying bacteria,
viruses, and other germs. White blood cell transfusions are rarely given. They are usually
reserved for children who have a low white cell count and severe infection that is not
responsive to antibiotic therapy. Platelets help control bleeding by making clots in the
blood vessels opened by injury or surgery17.

         Blood product transfusion therapy and its concomitant risks pose a special
challenge for the oncology nurse. Knowledge of the pathophysiology of transfusion
reactions, presenting symptoms, and           treatment   is necessary to safely monitor
transfusions. Through meticulous nursing assessment, detection, and intervention,
oncology nurses can prevent and minimize morbidity and mortality in patients receiving
transfusion therapy3


         A study was conducted on Transfusion practice and attitudes among nurses in
Tunisie. A study was conducted on 199 young nurses, working in two university hospitals
in Tunisia. Results indicate that nurses knowledge about blood transfusion is insufficient
to guarantee quality of this medical act. In terms of attitudes and practices, nurses are
not really always implicated in the different stages of blood transfusion process.
Intervention is limited to prescription and blood transfusion record card writing.
Transfusion herself and monitoring were, in particular, delegated to nurses. So
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transfusion incidents were under declared .



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      A study was conducted on implication of nurses in transfusion safety in Gustave-
Roussy institute among nurses. A first survey on nurses transfusion practices at our
Hospital revealed poor knowledge. Good transfusion practices were written, a training
program was implemented and second survey was carried out two years later. This study
was conducted the second survey in which 4 of the questions was identical to those in
the first survey in order to assess the impact of this training strategy. The 4 questions
were on blood sample identification, checking patient identification, checking "use by
date" on blood product bag and the pre-transfusion bedside compatibility test 5.

      The blood transfusion errors that often occur due to negligence of nurses include
the following.Samples being mislabelled with another patient’s identity.Blood being
ordered for wrong patient.Other blood components being ordered for wrong patient.Blood
sample being taken from wrong patient.patient given Rh D+ stock from the trauma
refrigerator when Rh D-available. Patient being transfused with unirradiated blood6.

     Transfusion of blood saves life. An error in blood transfusion, at the same time,
takes life. Children are more vulnerable to disease. Nurses being responsible for the final
bedside check before transfusion, have the final opportunity to prevent a mis-
transfusion. An understanding and knowledge of the pathophysiology of transfusion
reactions,symptoms and treatment is essential to safely administer and monitor
transfusion .So researcher has come across many nurses negligence in blood transfusion
which leads to increased in morbidity and mortality of children. so researcher has found a
need to administer structured teaching programme on blood transfusion among nurses in
order to decrease morbidity and mortality rate7.

6.2.REVIEW FO LITERATURE

       A study was conducted on Effect of blood transfusion on survival among children
in a Kenyan hospital. In Africa, blood transfusions are frequently given to treat severe
paediatric anaemic children. Data were collected on clinical presentation, haemoglobin
(Hb), receipt of transfusion, and in-hospital survival. Of 2433 admissions, 29% (684) had
severe anaemia (Hb less than 5.0 g/dl), and 20% (483) received blood transfusions.
Based on laboratory criteria only, children with Hb less than 3.9 g/dl who were not
transfused, but this finding applied only to children transfused on the day of admission or
the day after admission. Based on a combination of laboratory and clinical criteria,
children with clinical signs of respiratory distress.The study conclude that frequency of
blood transfusion can be reduced and survival enhanced by targeting blood to those
children with severe anemia 8.




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       A study was conducted on the effect of blood transfusion on survival among
children in a Kenyan hospital. A total of 2433 children were admitted to the pediatric
ward during the 12-month study period; 29% (684) had severe anemia (hemoglobin
[Hb] 5.0 g/dl) and 20% (483) received blood transfusions. Prevention and effective
treatment of the causes of anemia (such as malaria), targeted to children under 3 years
of age, are critically needed to limit pediatric anemia, blood transfusion, and anemia-
associated mortality 9.
       A study was conducted on Interventions for anemia in pediatric cancer patients in
Italy. Children with cancer frequently develop anemia both from the disease and from
chemo- and radiotherapy. Considered a manageable complication, anemia is often not
treated until it becomes severe, i.e., hemoglobin (Hb) level <or= 7 g/dL. The most
frequent treatment employed for anemia in children with cancer is blood transfusion.The
study concludes that the need for alternatives to transfusions in children make epoetin
alfa an attractive treatment option for anemia in pediatric cancer patients. Clinical
studies are underway to evaluate the efficacy and safety of epoetin alfa in increasing Hb
values and improving outcomes in children with cancer10.
       A study was conducted on blood transfusion knowledge and practice among 100
nurses in Turkey. Data collected through observation and interviews were evaluated
using percentages, correlation methods. Nurses' knowledge and practice related to blood
transfusions were measured against a total score of 100. None of the participating nurses
achieved a score of 100, and only a few had scores higher than 50. Although a positive
correlation existed between the nurses' knowledge and practice scores, the correlation
coefficient was insignificant. There was a statistically significant relation between the
experience and knowledge scores, but not between the experience and practice scores.
The results of the study showed insufficient knowledge about blood transfusion, which
was reflected in undesirable practice11


       A study was conducted on right patient, right blood, right care: safe transfusion
practice among nurses. Blood transfusion therapy can save and enhance patients' lives
but careful consideration must be given to the associated dangers. It is important for
nurses to understand the correct and safe way to approach transfusion practice as it is a
constant and central component of modern health care. The number of people eligible to
donate blood is reducing and each blood component comes from a donation given in
good faith: it is given voluntarily with the expectation that it will be used effectively for
the benefit of patients. Therefore at every stage of the transfusion process the nurse is
responsible for the part they play in making sure that the correct patient receives the
correct blood and also that blood components are used and handled with care12.




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       A study was conducted on Evaluation of knowledge of 122 healthcare workers in
hospitals of Zabol city on proper methods of blood and components transfusion in Iran.
This descriptive study is designed to assess the knowledge of healthcare workers about
proper methods of blood transfusion, and how to promote their knowledge for proper
performance if their knowledge is inadequate. The study conclude that low and moderate
level of knowledge in approximately half our samples and on the importance of blood
transfusion procedure, suggesting that more attempts should be made to build up
knowledge about blood transfusion13.


       A study was conducted on Factors associated with nurses' poor knowledge and
practice of transfusion safety procedures in Aquitaine France. A Survey conducted in 14
hospitals in Aquitaine (one university and 13 general hospitals). Data were collected
anonymously by investigators through structured individual interviews. The questionnaire
contained mainly knowledge and practice questions about blood transfusion regulation.
The study concludes that Low training and transfusion activity were key determinants of
poor transfusion-related knowledge and practice14.
       A study was conducted on Changes in practice and organization surrounding blood
transfusion in NHS trusts in England. The 2005 audit consisted of two parts looking at
organizational factors and bedside practice. To enable comparison with previous audits
and surveys the 2005 data have been limited to English NHS sites (217 sites for
organizational, 211 sites for bedside practice). Hospital transfusion committees were well
established by 2003 though hospital transfusion teams have lagged behind. 86% of
hospitals reported having established teams by 2005 although only 52% reported having
all essential elements of the team in place. Only 38% reported having trained at least
half of their nurses in blood transfusion. Bedside practice has improved, although in
2005, 6% of patients receiving a blood transfusion had no identification wristband in
place, and in 9% of those who did, the details were incomplete. The study was concludes
that many areas of poor practice, and the improvements have not been seen across all
hospitals15.

6.3. STATEMENT OF PROBLEM:

     A Study to assess the effectiveness of structured teaching programme on
knowledge and practice of nurses regarding blood transfusion in selected pediatric
hospital, Bengaluru.




6.4.OBJECTIVES OF THE STUDY:



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1. To assess the knowledge of nurses regarding blood transfusion.
2. To assess the practice of nurses regarding blood transfusion
3. To evaluate the effectiveness of structural teaching programme on knowledge and
   practice of nurses on blood transfusion.
4. To determine the association between knowledge and practice of nurses with their
   demographic variables.

   6.5. RESEARCH HYPOTHESES:

   H1:      There     will    be      significant      correlation   between    knowledge
   and practice of nurses on blood transfusion.

   H2 : There will be significant difference between pre and post knowledge and practice
   score of nurses on blood transfusion

   H3 : There will be significant   association between post test knowledge and practice
   score with their demographic variables of nurses.

   6.6. OPERATIONAL DEFINITION:

   ASSESS:

         Refers to measurement of knowledge and practice on blood transfusion based score.

   EFFECTIVENESS:

             It is significant improvement in knowledge and practice among the nurses after
   implementation of structured teaching programme as evidence by difference in pre and
   post test score.

   STRUCTURED TEACHING PROGRAMME :

          It refers to well planned information given to nurses implemented to promote
   knowledge and practice regarding blood transfusion .


   KNOWLEDGE:

         Refers to correct response on nurses to the knowledge item close ended
   questionnaire regarding blood transfusion.




   PRACTICE:



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         In this study practice refers to correct verbal response to practice to nurses
   regarding blood transfusion.

   NURSES:

         Refers to who are registered nurses working in pediatric hospital and cares for

   children with various medical problems.

   PAEDITARIC HOSPITAL:

         Refers to the place where the children of different age group receiving nursing and
   medical management for various medical problems.

   BLOOD TRANSFUSION:

        Blood transfusion is the intravenous administration of whole blood component such as
   Plasma packed RBC or Platelets.




    6.7.ASSUMPTIONS:

1. Nurses will be having some knowledge and practice regarding blood transfusion.
2. Structured teaching program will enhance the knowledge and practice to nurses
   regarding blood transfusion.
3. The knowledge and practice of nurses will vary from one individual to another individual.

   7.MATERIALS AND METHODS:

   7.1.SOURCES OF DATA:

           Data will be collected from nurses who are working in selected pediatric hospital,
   Bengaluru.

   7.1.1RESEARCH DESIGN AND APPROACH:

         The research design adopted for this study is quasi experimental design with one
   group pre and post test approach without control group.

   7.1.2.SETTING:

         The study will be conducted in selected pediatric hospital at Bengaluru.

       7.1.3.POPULATION:


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                The population of the present study will be the nurses who are working in selected
         paediatric hospital Bangaluru.

         7.2.METHODS OF DATA COLLECTION:

         7.2.1 SAMPLING TECHNIQUE:

               The data will be collected by investigator her self by using structured closed ended
         questionnaire.

         PERIOD OF DATA COLLECTION:

               Study will be conducted in the month of March/April/2011.

         7.2.2.SAMPLE SIZE:

               Approximate sample size will be 50 nurses working in pediatric hospital ,Bengaluru.

         7.3.SAMPLING TECHNIQUE:

         7.2.5 INCLUSION CRITERIA:

                    Nurses who are-

     -   Working in selected pediatric hospital.
     -   Available during data collection period.
     -   Able to read and write English.
     -   .willing to participate in this study.
     -   both male and female.


               7.2.6 EXCLUSIVE CRITERIA:

             Nurses who are not,

     -   willing to participate in this study.
     -   able to read and write English.
     -   Available during the time of data collection.
     -   Both male female.

7.2.8 DATA COLLECTION TOOL:
 -       Standard closed ended Questionnaire for assess the knowledge of nurses            regarding
         blood transfusion.
     -       Rating scale for assess practice of nurses regarding blood transfusion.




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-       Structured teaching program enhance the knowledge of nurses regarding                blood
    transfusion.

             7.2.9 DATA ANALYSIS METHODS:

1. Data will be analyzed according to the objectives of the study using descriptive and
    inferential statistics and will be presented in the form of tables,graphs and diagram.
2. The significance of relationship between selected demographic variable and knowledge
    score will be analyzed by using chi-square test.
3. The effectiveness of pre and post test knowledge score will be analyzed by paired           -T-
    test.

    7.3      DOES     THE     STUDY       REQUIRED         ANY     INVESTIGATION              OR
    INTERVENTION TO BE CONDUCTEDON PATIENT OR OTHERS HUMANS OR
    ANIMALS? IF SO,PLEASE DESCRIBE BRIEFLY.

                                 -YES-

    7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR
    INSTITUTION?
    Necessary permission will be taken by research committee and concerned authority
    before              perceeding                to              data               collection.




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     BIBLIOGRAPHY:

1.       Potter perry ,’blood transfusion’ ,fundamental of nursing,7th          edition ,published by
     elsevier p.1021

2. Williams &Wilkins,’ Blood Transfusion’; medical dicitionary, edition 6th p.119-20.           .
3. LabovichTM.,’Transfusion therapy’, nursing implications, journal of clinical oncology
     nursing 1997 Jul;vol 1(3):61-72
4. Njah M, Naira A, Jacob S’. Blood transfusion practice and          attitudes’. journal of medical
     nursing. 2002 Jun;80(6):306-11.


5. Tramalloni D, Aupérin A, Oubouzar N, ‘Implication of nurses in transfusion safety:
     knowledge assessment and practice evaluation at the Gustave-Roussy institute’. Transfus
     Clin Biol. 2005 Dec;12(6):427-32.


6    Hainsworth      T   (2004).’   Guidance   for   preventing   errors   in   administering       blood
     transfusions’journal. Nurses Times 100(43):45.
7    Lackritz E.M, Campbell CC, ‘Ruebush TK 2nd, ‘. Effect of blood transfusion on survival
     among children in a Kenyan hospital. Lancet’. 1992 Aug 29;340(8818):524-8.
8    Global programme on AIDS. ‘A study on the effect of blood transfusion on survival
     among children in a Kenyan hospita’l. Wkly Epidemiol Rec. 1994 Mar 11;69(10):69-71.
9    Ruggiero A, Riccardi R. ‘Interventions for anemia in pediatric cancer patients’. Med
     Pediatr Oncol. 2002 Oct;39(4):451-4.
10            Bayraktar N, Erdil F. ‘Blood transfusion knowledge and practice among nurses in
     Turkey’. Journal of intravenous nursing. 2000 Sep-Oct;23(5):310-7.
11 Oldham J, Sinclair L, Hendry C. ‘Right patient, right blood, right care: safe transfusion
     practice’nursing journal 2009 Mar 12-25;18(5):312-320.
12 Ali Reza Piri, Vahed Aziz Shahraki, Taghavi. ‘Evaluation of knowledge of healthcare
     workers in hospitals of Zabol city on proper methods of blood and components
     transfusion’. 2009; 3(2):78-81.
13            Nathan M, Selwood K. ‘The use of blood products in paediatric oncology units in
     the UK’. Paediatr Nurs. 2006 Sep;18(7):14-7.
14 Saillour-Glénisson F, Tricaud S,. ‘Factors associated with nurses' poor knowledge and
     practice of transfusion safety procedures in Aquitaine’,        france internationl journal of
     quality health care. 2002 Feb;14(1):25-32.
15            Tsylor C. G, Murphy M F, Lowe D, Pearson M. ‘Changes in practice and
     organisation surrounding blood transfusion in NHS trusts in England’. Qual Saf Health
     Care 2008;17:239-243.



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16 Lippncott William Willkilns ‘Blood transfusion “9th edition published by Wolters ,p 1001-
     1009
17          Anne Waugh, Allison grant “Blood component”10th p58-67




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    8    SIGNATURE    OF   THE
         CANDIDATE



    9    REMARKS OF THE GUIDE     The study is feasible to conduct and
                                  researchable.The need for study and the
                                  methodology is appropriate to the
                                  statement of problem,Hence can be
                                  approved.

    10 NAME AND DESIGATION        Mrs.Varalakshm
         OF GUIDE                     Assit.prof

                                      Hina college of Nursing,

                                      Bangalore-106

    10.1 GUIDE SIGNATURE

    10.2 HEAD OF THE                  Mrs.Varalakshmi
         DEPARTMENT                    Assit.prof

                                       Hina college of Nursing,

                                        Bangalore-106

    10.3 SIGNATURE

    11   REMARKS OF THE           The study is useful and benefit for
                                  nurses regarding blood transfusion
         CHAIRMAN/PRINCIPAL       ,Hence it is approved by research
                                  committee.

    11.1 SIGNATURE




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