“A Study To Assess The Effectiveness Of Self
Instructional Module on ABG analysis and ABG
Interpretation among Staff nurses working in Critical
Care Units in selected Hospitals Bangalore.”
PROFORMA FOR REGISTRATION
OF
SUBJECT FOR DISSERTATION
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
Proforma for registration of subject for dissertation
1. Name of the candidate and address
: Carrole Earnest
1st year M.Sc Nursing
Mallige Institute of Nursing
HMT Sector-2, Bangalore-13
2. Name of the Institution
: Mallige Institute of Nursing
HMT Sector-2, Bangalore-13
: 1st year M.Sc nursing
3. Course of Study and Subject
Medical and Surgical Nursing
4. Date of Admission to Course
: 01-06-09
5. Title of the Topic
: “A study to assess the
effectiveness of self
instructional module on ABG
analysis and ABG interpretation
among staff nurses working in
critical care units in selected
hospitals Bangalore”
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6. BRIEF RESUME OF THE INTENDED STUDY
6.1. NEED FOR THE STUDY
“ Knowledge is the wing where by we fly to Heaven”
(William shakespeare)
Nurses are integral part to health care delivery and it is important that they have a clear
understanding of the nature of the procedures that they would have to perform for the patients. The
critical care nurse serves as a catalyst in the healing process, making complex and timely judgments
and decisions and taking actions for which the nurse remains accountable. The rationale of such
decision is based upon the thorough knowledge of the health and life saving procedures. The
knowledge base is upgraded continuously by new clinical and educational experiences that reinforce
the critical care nurses’ professional practice and autonomy.
Blood is a connective tissue. The primary function of blood is to transport O2 from lungs to
the body tissues and CO2 from the tissues to the lungs. This function is essential in order to prevent the
death of the tissues due to hypoxia. If body tissues are not getting adequate supply of oxygen, acidbase imbalance will occur. Arterial blood gas studies are concerned with respiration the exchange of
gases between the lungs and blood and between blood and tissues. The term ‘blood gas’ strictly refers
to the measurement of tension or partial pressure of O2 and CO2 in blood but the determination of acidbase imbalance is an integral part of blood gas measurement which occurs due to improper oxidation
of carbohydrates and fats. The result is there is an increased production of lactic acids and keto acids.
Estimation of H+ ion concentration or pH is an integral part of blood gas measurement.1
An arterial blood gas analysis (ABGA) is a blood test that is performed using blood from an
artery. It involves puncturing an artery with a thin needle and heparinized syringe and drawing a small
volume of blood (approximately 1ml). The most common puncture site is the radial artery at the wrist,
but sometimes the femoral artery in the groin or other sites are used. The blood can also be drawn from
an arterial catheter. The test is used to determine the pH of the blood, the partial pressure of carbon
dioxide and oxygen, and the bicarbonate level. Many blood gas analyzers will also report
concentrations of lactate, hemoglobin, several electrolytes.2
3
In order to understand and interpret ABGs one has to have a clear knowledge regarding the
nomenclature, physiology and types of acid base disorders. Disorders of acid base balance can
complicate many disease states and occasionally the abnormality may be so severe as to be life
threatening. Monitoring of ABGs is an essential part in the anaesthetic management of the high-risk
patients as well as in the care of critically ill patients in the ICU. Since both areas manifest sudden and
life threatening changes in all systems concerned, a thorough understanding of acid base balance is
mandatory for any physician, the anesthesiologist and the nurse is no exception.3
An ABG is typically requested to determine the pH of the blood and the partial pressures of
carbon dioxide (PaCO2) and oxygen (PaO2) within it. It is used to assess the effectiveness of gaseous
exchange and ventilation, be it spontaneous or mechanical. If the pH becomes deranged, normal cell
metabolism is affected. The ABG allows patients’ metabolic status to be assessed, giving an indication
of how they are coping with their illness. It would therefore seem logical to request an ABG on any
patient who is or has the potential to become critically ill. This includes patients in critical care areas
and those on wards who ‘trigger’ early-warning scoring systems. Others who give cause for concern
are patients with acute illnesses or exacerbations of conditions and those in the peri-operative and periarrest periods.4
Acid-base problems can be easily identified by the nurse when a systematic approach is
utilized during arterial blood gas interpretation. Furthermore, understanding the underlying principles
of acid-base balance assists the nurse in choosing the appropriate intervention. By intervening early,
many emergency situations can be avoided. Since nurse is the primary care giver, and is most readily
available for the clients, early interventions to correct acid-base problems would expedite the client’s
recovery.5
According to an article published by Simpson, he views that interpretation of arterial blood
gas analysis values has become an essential skill for all healthcare practitioners. It provides important
information with regard to adequacy of ventilation, oxygen delivery to the tissues and acid-base
balance. Although each patient's clinical presentation will be judged individually, situations that
warrant analysis of a blood gas sample include respiratory compromise, post-cardio-respiratory arrest,
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and evaluation of interventions such as oxygen therapy, respiratory support and as a baseline before
surgery.6
Sonali Ganguly , Mangalore has conducted a study on “effectiveness of a need based teaching
protocol on ‘nurses’ responsibility in ABG analysis for the nursing personnel working in the critical
care units.” She found out that, though the nurses take an active part in collecting ABG samples, their
knowledge in interpreting ABG reports is inadequate. The study shows that the teaching protocol was
found to be effective in promoting the knowledge level of nursing personnel on “nurses’ responsibility
in ABG analysis.7
Another study was done by Schneiderman J, et al. on demonstrating the effectiveness of an
online computer-based learning module for arterial blood gas analysis. The purpose of the study was
to determine the effectiveness of a computer-based learning module specific to arterial blood gas
(ABG) interpretation. The finding was Staff nurses' knowledge increased significantly after viewing
the computer-based learning module. This improvement was irrespective of experience or department.
The study concluded that such studies need to be carried out on a large scale.8
Based upon the above mentioned articles and studies and with the investigator’s personal
experience it is found that knowledge of staff nurses on ABG analysis and its interpretation is not
adequate. ABG analysis is one of the most common tests ordered, as it provides clinicians with
valuable information on a patient's oxygenation and acid-base balance. Interpreting ABG analysis
results can be challenging, even for the most experienced nurses, because it requires knowledge of the
physiology and cause-and-effect relationship of the disturbances. Hence investigator is of the strong
view that staff nurses should be educated regarding correct interpretation of ABG analysis. Even
though the investigator is unable to access studies regarding effectiveness of self instructional module
on ABG analysis and interpretation among staff nurses, some studies which prove that self
instructional module is effective in improving the knowledge of staff nurses. Keeping this in view, the
investigator justified the need to improve nurses’ knowledge by developing a self instructional module
on ‘ABG analysis and its interpretation’.
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6.2. REVIEW OF LITERATURE
A review of literature refers to activities involved in identifying and searching for information on a
topic, developing and understanding the state of knowledge on a topic. It is an extensive, systematic
selection of potential sources of previous work, which acquaints the investigator with fact finding
work after scrutinization. Polit& Hungler state that review of literature provides readers with a
background for understanding the significant of the study. The sources selected to obtain more
information on the selected topic are books, internet research and published journals.
Sonali Ganguly, Mangalore (2007) has conducted a study on “effectiveness of a need based
teaching protocol on ‘nurses’ responsibility in ABG analysis for the nursing personnel working in the
critical care units.” She found out that though the nurses take an active part in collecting ABG
samples, their knowledge in interpreting ABG reports is inadequate and in all the learning need areas,
the expressed learning need as “Necessary” and “Desirable” were 100%. The result shows that
teaching protocol was found to be effective in promoting the knowledge level of nursing personnel on
“nurses’ responsibility in ABG analysis (t29=6.529, P<0.05). She recommended for regular
demonstration classes should be included in in-service education program for collecting ABG sample
by puncturing the radial artery.7
Another study was done by Frutiger A, Brunner JX (1993) regarding Computerized blood
gas interpretation as tool for classroom and ICU. The objective of the study was to describe structure
and function of a PC based blood gas interpretation program (ABG consultant) developed for nurses
and physicians, and to test educational impact and user acceptance. A first group of nurses was
subjected to a written examination, then the ABG-consultant was made available for them for 2
months, and finally the same examination was taken again. Additionally, they completed a
questionnaire related to the performance of the ABG-consultant. A second group of nurses took the
same sequence of examinations but had no access to the ABG-consultant. The score of the
examinations increased by 4.8 points in the first group (p < 0.0001) and by 1.3 points (p < 0.16) in the
second group. The study shows that exposure to the ABG-consultant has increased the blood gas
knowledge of the ICU nurses.9
6
Valero Marco AV, et al (2008) conducted a study at Hospital General Universitario, Spain to
examine attitudes and beliefs among nurses and third-year undergraduate nursing students in hospital
training regarding the use of local anesthesia when performing arterial puncture and to assess their
knowledge of the technique. Nurses and nursing students were issued a 15-item questionnaire
consisting of 2 parts. The first part contained questions on the nurse's use of local anesthesia when
extracting arterial blood for analysis and the second part involved questions regarding technical
knowledge of this test. The questionnaire was answered by the 131 nurses surveyed. Questionnaires
returned by nurses from the respiratory medicine department (n=11) were separated from those
returned by the rest of nurses. The main reasons given by nurses for not using local anesthesia were
lack of knowledge (54%), need to perform 2 punctures when anesthesia is used (11%), belief that the
same amount of pain is caused with anesthesia (8%), and success on the first attempt at arterial
puncture (7%). The study states that local anesthesia is used very little in arterial puncture. Knowledge
about how to perform arterial blood extraction for blood gas analysis is insufficient and needs to be
improved among both nurses and nursing students.10
A study conducted at Mahidol University (2009) to determine agreement between potassium
obtained from venous and arterial blood gas in emergency patients. It was a cross-sectional study
performed in 53 patients who presented to the emergency department of Siriraj Hospital. Potassium
level measured from ABG was compared to venous route. The result shows that the mean of venous,
arterial potassium and difference between each pair were 3.95, 3.46, and 0.49 mmol/L respectively.
The Intra-class Correlation Coefficient between each pair of two methods and 95% CI of agreement
were 0.904 and 0.839 to 0.943, p < 0.01.The study concluded that agreement between ABG and
venous potassium measurement are confirmed. Clinicians can use ABG's potassium level as a
guideline for treatment instead of using the conventional venous potassium level.11
A study conducted in France (2008) to identify whether Arterial Blood Gas analysis is useful
for cardiovascular surgery in elderly patients. They retrospectively studied ABG’s in 201 patients,
aged 70–92 years with normal or near normal ventilatory function awaiting a planned cardiovascular
surgery. PaO2 averaged 81.6±7.6 mmHg and PaCO2 averaged 37.7±3.2 mmHg. Both were
independent of age. The study stated that PaO2 values in elderly patients with cardiac disease and
normal ventilatory function are greater than those obtained by extrapolation from healthy younger
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subjects. Arterial blood gas measurement should be recommended prior to cardiovascular surgery in
elderly patients since a low PaO2 with strictly normal ventilatory function is significantly associated
with an increased risk for postoperative mortality.12
A study has done by Schneiderman J. et al.(2009) to determine the effectiveness of a
computer-based learning module specific to arterial blood gas (ABG) interpretation. A pretest and
posttest design was used to assess staff nurses' ability to interpret ABGs before and after engaging in a
computer-based module. Fifty-eight staff nurses completed the online learning module and the pretest
and posttest measures. The finding was Staff nurses' knowledge increased significantly after viewing
the computer-based learning module(t = 6.3; P < .001). This improvement was irrespective of
experience or department. The study concluded that such studies need to be carried out on a large
scale.8
A study was conducted at the John Hopkins University (2001) to evaluate the effectiveness
of a self-instructional module in increasing nurses' knowledge of genetics. The researchers adopted a
pretest/post test study design. The participants were Sixty-five registered nurses working at
reproductive health centers. The result shows that there was a significant increase of 20.8% in
participants' mean knowledge score on the posttest (M = 89.0%, SD = 8%, range = 67%-100%) as
compared with the pretest (M = 69.0%, SD = 12%, range = 42%-92%), based on paired t-test analysis
(t = 11.74, SE = 0.426, p < .0001). A genetics self-instructional module for registered nurses was
effective in increasing knowledge of basic human genetic concepts and risk assessment.13
Letha K. Mathew (2004) conducted a study on ‘effectiveness of self-instructional module on
body mechanics for staff nurses (n=100) in selected hospitals at Mangalore’. Simple random sampling
technique was used. The study revealed that the mean percentage in post-test increase to 76.38% after
the administration of SIM from the mean percentage of 36.52% in the pre-test. Very high significant
difference was found between pre-test and post-test knowledge scores of the staff nurses on body
mechanics in all areas. The study showed that the SIM was very highly effective in improving the
knowledge of staff nurses on body mechanics.14
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6.3 OBJECTIVES OF THE STUDY
1. Assess the knowledge of staff nurses regarding ABG analysis and ABG interpretation by
conducting pre-test.
2. Develop and administer self instructional module for staff nurses on ABG analysis and ABG
interpretation.
3. Evaluate the effectiveness of self instructional module regarding ABG analysis and ABG
interpretation among staff nurses by comparing mean pretest and posttest knowledge scores.
4. Determine the association between knowledge scores of staff nurses regarding ABG analysis
and ABG interpretation with selected demographic variables
6.4 HYPOTHESIS
 H0 :- There will be no significant difference between mean pre test and post test knowledge
scores among nurses working in critical care units on knowledge of ABG analysis and ABG
interpretation.
 H1 :- There will be significant difference between mean pre test and post test knowledge scores
among nurses working in critical care units on knowledge of ABG analysis and ABG
interpretation.
6.5 OPERATIONAL DEFINITIONS

Effectiveness: It refers to the changes that the self instructional module will produce in the
knowledge of the staff nurses. In this study the investigator evaluates it with the help of
comparing pre test and post test scores.

Self instructional module: Refers to a written material providing information on ABG
analysis and ABG interpretation.

Knowledge: Refers to awareness of staff nurses on ABG analysis and ABG interpretation
measured by the scores obtained according to their response to the items on a structured
questionnaire.

Staff nurses: Staff nurses refer to the nurses who have completed the diploma or bachelor
degree in nursing, working in critical care units and who is acquainted with ABG analysis.
9

ABG analysis:: Refers to the drawing out of small amount of blood from an artery in a
heparinized syringe and testing the blood for pH, PO2, PCO2, HCO3 , electrolytes, Hemoglobin
etc in an ABG analyzer.

ABG interpretation: Refers to how the staff nurse is identifying and understanding the
obtained results of ABG analysis.
7. MATERIAL AND METHODS
7.1. SOURCES OF DATA: Data will be collected from staff nurses working in critical care areas in
selected hospitals Bangalore.
7.2 METHOD OF COLLECTION OF DATA
7.2.1 Inclusion and exclusion criteria
Inclusion criteria:
 Staff nurses who are working in critical care units.
 Staff nurses who are willing to participate in the study.
 Staff nurses who are available during the data collection period.
Exclusion criteria
 Staff nurses who are not present at the time of the study.
 Staff nurses who are not willing to participate in the study.
7.2.2 Research design: Quazi-experimental one group pre test and post test design.
7.2.3 Setting: Critical care units in selected hospitals in Bangalore.
7.2.4 Sampling technique: Convenience sampling technique as a Non probability sampling method.
7.2.5 Sample size: The sample size will be 30.
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7.2.6 Tools of research: A structured self administered questionnaire will be given to staff nurses to
assess the pre test and post test knowledge.
7.2.7 Collection of data: The investigator herself collects the data from the staff nurses. Samples will
be selected based on inclusion and exclusion criteria. Pre test will be conducted 5 to 10 samples per
day using structured self administered questionnaire. Immediately self administered module will be
given to help staff nurses to acquire knowledge on ABG analysis and ABG interpretation. After 10
days the same questionnaire will be distributed and used as post test to assess the effectiveness of self
instructional module.
7.2.8 Method of data analysis and presentation: Data analysis will be done through descriptive and
inferential statistics.
 Descriptive statistics: The investigator will use descriptive statistical techniques like mean,
median, mode, percentile and standard deviation for data analysis. The analyzed data will be
presented in the form of tables, diagrams and graphs based on the findings.
 Inferential statistics: Test of significance such as t-test and chi square will be used depending on
the results obtained.
7.3 Does the study require any investigation to be conducted on patients or other human or
animals? If so, please describe briefly?
The study requires no investigations or interventions to be conducted on patients or other human
beings or animals. This study includes knowledge assessment of staff nurses and providing Self
Instructional Module.
7.4 Has ethical clearance has been obtained from your institution in case of 7.3?
Administrative permission and ethical clearance with regard to the study will be obtained from the
institution and samples prior to conducting the study.
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8. LIST OF REFERENCE
1. Adams, A.P. & Hohn, C.E.W. (1982), Principles and practice of ABG analysis. (2nd ed.). London:
Edinburg, Churchill Livingstone.
2. www.wikipedia.com, Wikipedia, the free encyclopedia
3. Prof. S. Manimala Rao, Dr.V. Nagendranath. Arterial blood gas monitoring. Indian J.Anae.
2002;46(4);289-297
4. Coggon, J.M. (2008) Arterial blood gas analysis 1: understanding ABG reports. Nursing Times; 104: 18,
28–29
5. Robichaud-Ekstrand S. Interpretation of blood gas analysis. Can J Cardiovasc. 1990 Jan;1(3):11-15
6. Simpson H. Interpretation of arterial blood gases: a clinical guide for nurses:.Br J Nurs. 2004 May 1326;13(9):522-8.
7. Sonali Ganguly. Effectiveness of a need based teaching protocol 0n “nurses’ responsibility in ABG
Analysis” for the nursing personnel working in the critical care units. Asian J of Cardiovascular nsg. 2007
Jun.15(2).12-17
8. Schneiderman J, Corbridge S, Zerwic JJ. Demonstrating the effectiveness of an online, computer-based
learning module for arterial blood gas analysis. Clin Nurse Spec. 2009 May-Jun;23(3):151-5.
9. Frutiger A, Brunner JX. Computerized blood gas interpretation as tool for classroom and ICU. Intensive
Care Med. 1993;19(4):209-14.
10. Valero Marco AV. et al. Local anesthesia in arterial puncture: nurses' knowledge and attitudes.Arch
Bronconeumol. 2008 Jul;44(7):360-3.
11. Wongyingsinn M, Suksuriyayothin S. Use of rapid ABG analyzer in measurement of potassium
concentration: Does it agree with venous concentration? J Med Assoc Thai. 2009 Jul;92(7):925-9
12. Bruno Chenuel; et al ; Arterial Oxygen Partial Pressure and Cardiovascular Surgery in Elderly Patients.
Interactive Cardiovascular and Thoracic Surgery ; 2008 Oct 7(5).819-24.
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13. Swank C, et al. Effectiveness of a genetics self-instructional module for nurses involved in egg donor
screening. J Obstet Gynecol Neonatal Nurs. 2001 Nov-Dec;30(6):617-25.
14. Letha K. Mathew. 2004. “Effectiveness of Self-instructional Module on body mechanics for the staff nurses
in selected hospitals at Mangalore”. Unpublished M.Sc. Nursing Thesis, Rajiv Gandhi University of Health
Sciences, Bangalore.
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9. Signature of the candidate:
10. Remarks of the guide:
The research topic selected is appropriate
as it attempts to enrich with the better
knowledge among staff nurses who are
working in critical care units regarding
ABG analysis and ABG interpretation.
11. Name and Designation of:
11.1. Guide:
Mrs. Padmavathi.S,
Asso. Professor,
Mallige Institute of Nursing,
H.M.T Post, Sector 2, Bangalore 13.
11.2 Signature:
11.3 Co-guide:
Mrs.Mariam Jaisy G,
Asst. Professor,
Mallige Institute of Nursing,
H.M.T Post, Sector 2, Bangalore 13.
11.4 Signature:
11.5 Head of the Department:
Mrs.Padmavathi.S,
Asso. Professor,
Mallige Institute of Nursing,
H.M.T Post, Sector 2, Bangalore 13.
11.6 Signature:
12.
Remarks of the Chairman/Principal:
12.1 Signature:
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