SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
Mr.ARUN MOHANDAS
I YEAR M .Sc NURSING
CHILD HEALTH NURSING
2012-2014
THE AMBIGARA CHOWDAIAH COLLEGE OF NURSING
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
Mr.ARUN MOHANDAS
1st yr Msc.NURSING
1.
NAME OF THE CANDIDATE AND
ADDRESS
AMBIGARA CHOWDIAH COLLEGE OF
NURSING
.
.AMBIGARA CHOWDIAH COLLEGE OF
NURSING
NAME OF THE INSTITUTION
2.
3.
4.
5.
COURSE OF THE STUDY AND
SUBJECT
DATE OF ADMISSION TO THE
COURSE
TITLE OF THE STUDY
I YEAR M. Sc NURSING
CHILD HEALTH NURSING
30-06-2012
“TO
EVALUATE
THE
EFFECTIVENESS
OF
SELF
INSTRUCTIONAL
MODULE
ON
KNOWLEDGE
REGARDING
PAEDIATRIC
NEUROLOGICAL
ASSESSMENT
AMONG
STAFF
NURSES OF PAEDIATRIC SURGICAL
UNITS AT SELECTED HOSPITALS IN
BENGALURU.”
6 BRIEF DESCRIPTION OF INDENTED STUDY
6.1 INTRODUCTION
Neurological assessment should be an integral part of the entire physical
assessment. The approach to neurological assessment should be systematic and include
pertinent health history, for example coexisting conditions, the developmental status of
the child, the nature and extent of the injury or surgery performed, and potential
complications . Care planning should be a team approach that involves the parents and
the multidisciplinary team to assure optimal outcomes. Factors that impact the assessment
will be the age of the child, the family dynamics, the nature of the child’s illness, the
setting in which the assessment takes place, and input from other member of the
multidisciplinary team.1
The accuracy of the assessment data and the nurses critical thinking skill to
identify the change, interpret its significance and take appropriate action from the
foundation of neuroscience nursing practice. The neurological assessment is a key
component in the care of the neurological patient. It can help the Nursing staff to detect
the presence of neurological disease or injury and monitor its progression, determine the
type of care and gauge the patients’ response to intervention.2
Serial, consistent, and well-documented neurological assessments are the most
important aspect of nursing care for the pediatric neurosurgical patient. The nurses
response to assessment changes is essential to the prevention of secondary neurological
sequelae and other complications associated with neurological disorders .1 These
potential complications include, among others, inability to protect the airway, immobility,
endocrine disorders related to central hormonal dysregulation, impaired communication,
and behavioral issues 3
The neurological assessment is a key component in the care of the neurological
patient. The initial assessment should be a comprehensive exam covering several critical
areas: level of consciousness and mentation, cranial nerves, movement, sensation,
cerebellar function, and reflexes. The patient's diagnosis and the acuity of her condition
will determine how extensive your problem-focused assessments will be and how
frequently you'll need to conduct them.4
Neurological assessment usually depends on the condition of the person and the
urgency of the situation. Assessment of mental status, level of consciousness, language
and speech, perceptual status and sensory status are vital.
Nursing management of the neurological patient is based upon highly
developed nursing assessment and clinical reasoning skills. The nursemust know what
parameters to assess, proper technique for assessment and appropriate method of
documentation and how to interpret the data to decide what action, if should be taken. To
detect subtle and obvious changes in the neurological examination and to incorporate
such information into the context of the patient profile.5
The purpose of neurological assessment for the advanced practice nurse
functioning in an expanded role is:

To identify the presence of nervous system dysfunction

To determine the effects of nervous system dysfunction on activities of daily living
and independent function.

To detect life threatening situations.

To establish neurological database for the patient.

To provide database upon which nursing diagnosis, will be based
Neurological assessment usually depends on the condition of the person and the
urgency of the situation. Assessment of mental status, level of consciousness, language
and speech, perceptual status and sensory status are vital.
Assessment of a client experiencing a Neurologic disorder is a challenge.
Neurologic disorders range from Simple to Complex & have profound consequences for
activities of daily living (ADL) & Survival. Neurologic assessment establishes baseline
data that are used to compare ongoing assessments, diagnose actual & potential health
problems, manage client care, & evaluate the outcome. Because of the complexity of the
Nervous system, Neurologic assessment is both multifaceted & lengthy. The Three main
components of a Neurologic assessment are.5

A Comprehensive history

A Neurologic physical examination

General & Specific Neuro diagnostic Studies
Assessment is both anatomic & functional. Continuous observations of the client are
made & compared with baseline data. Astute observations are essential because many
Neurologic changes occur subtly. Nurses collect data on the client’s ability to function
physically (e.g., self-care deficit ) & mentally ( e.g., confusion & altered problem solving
). Finally, because many neurologic disorders are serious, the nurse provides skilful ,
crisis-oriented support for the client & significant others.
The Neurological Examination is a systemic process that includes a variety of
clinical tests, observations, and assessments designed to evaluate a complex system. It
divided into five components: Cerebral function, Cranial nerves, Motor system, Sensory
system, and Reflexes to determine whether the Nervous System is Impaired. It is the
foundational database for the nursing staffs to use in making nursing diagnosis, planning
care implementing interventions and evaluating care for the patient.6
NEED FOR STUDY
The accuracy of the assessment data and the nurses critical thinking skill to identify
the change, interpret its significance and take appropriate action from the foundation of
neuroscience nursing practice. The neurological assessment is a key component in the
care of the neurological patient. It can help the Nursing students to detect the presence of
neurological disease or injury and monitor its progression, determine the type of care and
gauge the patients’ response to intervention.5
Neurological disorders are constantly on the rise and they are most of the time costly
as well. The W H O report says the number of people suffering from Alzheimer’s and
other debilitating dementias is currently 24.3 million people, but is expected to double
every 20years.The report “Neurological Disorders: Public health Challenges” by the U.N.
agency says that neurological care should become part of public health care so that under
detected disabilities are diagnosed and treated.7
According to Canadian National Longitudinal Survey of Children and Youth which has
been in effect for over 20 years, identifies various social factors influencing
neurodevelopment. Poverty, maternal mental health and education are reported to be key
determinants of neurobehavioral intellectual development. The survey showed that single
mothers who are new immigrants to Canada are particularly at risk of having children
with neurobehavioral intellectual developmental problems.8
Fifteen percent of paediatric patients with neurological disease including head injury get
admitted in K.L.E.S Hospital, Belgaum, by Tukaram (2004).A baseline assessment of
neurological signs is of prime importance to identify the deviations. The nurse should use
his/her independent clinical judgment to assess the patient which should include
important parameters like vital signs, Glasgow coma scale, Deep tendon reflexes and
superficial reflexes.5
According to British statistics (2004) one million patients get admitted each year with
head injury and it accounts for one percent of all deaths. India has one percent of total
number of vehicle in the world it accounts for six percent of road traffic accident, which
is highest accident rate in the world.5
Study conducted by crimlisk JT and Graude MM (1989) on neurological assessment
skills for the acute nurse showed that efficient neurological skills are vital for acute care
and the nurse need focused assessment of the pertinent history and symptom analysis for
accurate care.
Road traffic accidents are the major contributor 60% to TBIs and Indian accounts for
6% of the world-total of RTAs. In New Delhi alone there were nearly 20000 traffic
accidents and over 2000 traffic-related fatalities during 2001-2002. On an average
80,118 Indians are killed and over 342,200 suffer injuries every year in road traffic
accidents, which is higher than in any other country in the world.
Studies from different parts of India reveal that prevalence of neurological problems
varies between 9/1000 in Bangalore, 5/1000 in Mumbai and 4/1000 in New Delhi. A
population based neuro-epidemiological survey of 102,557 individuals in urban and rural
Bangalore was conducted to determine the prevalence and pattern of neurological
disorder. The study population included subjects from urban (51,502) and rural (51,055)
areas, identified through a two-stage stratified random sampling method. There was a
distinct difference in education, occupation and income levels between urban and rural
areas with all these parameters being lower in the rural population. In the surveyed
population, 3,206 individuals with neurological disorders were detected resulting in crude
and age-adjusted prevalence rates of 3,126 and 3,355 per 100,000 population,
respectively. The prevalence of neurological disorders among women (3,617) was higher
compared with men (2,657). The prevalence rate in urban and rural populations was
2,190 and 4,070/1,00,000, respectively, implying that neurological disorders were twice
as frequent in rural areas as in urban areas.
A study was conducted by C.A. Thompson, A. Foster, I. Cole, D.W. Dowdin in UK in
2005. Using conjoint analysis, within the theoretical framework of social judgement
theory, this study illustrates a novel means of examining nurses’ use of clinical
information when diagnosing hypovolemic shock in a series of simulated cases presented
via computer. The study examines changes in information usage before and after a
traditional lecture. The results show that nurses’ information use is not linear and the
utility for decision judgement derived from clinical information is not distributed equally.
The study also suggests that some clinical information example, the Glasgow Coma
Score, cranial nerve and mental status
examination is not well understood and
incorporated into clinical judgment.
Nurses being the frontline workers who work round the clock and evaluate patient
condition and interpret improvement, they should master the skill of neurological
examination so that they can provide a comprehensive care to the patients. But literature
reveals they are not competent enough in neurological examination of the patients, either
they have insufficient knowledge or the don’t practice there skills, because of various
reasons, this made me to take up a chance to improve the knowledge and skills in
neurological assessment among staff nurses so that they can
provide
professional
service to the patients.
The investigator has a felt need to do this study among nurses, because when he came
across an incident in clinical practice. He felt that scale which is commonly using
presently for assessing the stroke patients is not specific. It gives only the general
impression about motor, verbal and eye opening. With help of 15-item neurologic
examination scale used to evaluate the effect of acute cerebral infarction through the
assessment of cranial nerve functions, motor functions, cerebellar functions, sensory and
language area. The evaluation of assessment depends upon the ability of the observer to
accurately and consistently assess the patient. This incidence persuaded me to take up a
study like this for educating staff nurse regarding the assessment of paediatric
neurological assessment.
REVIEW OF LITERATURE
“Literature review is a critical summary of research on a topic of interest often prepared
to put a research problem in the context or as the basis for an implementation project”
- Polit and Hungler
The purpose of the review of literature is to discover what has previously done
about the problem to be studied, what remains to be done, what methods have been
employed in other research and how the results of other research in the area can be
combined to develop knowledge.
Thus a review of literature can help to clarify a problem, justify research for the
proposed problem, shed light on appropriate methodologies and contribute toward the
development of a conceptual frame work. It can be done before and after selecting the
problem.
According to Abdellah and Levine, the material gathered in the literature review
should be created as an integral part of research data, since what is found in literature not
only can have an important influence on formulation of problem and design of research,
but also provide comparative material when the data collected in research is analyzed.
I.
Review related to knowledge regarding pediatric neurological assessment among
nurses working in paediatric surgical unit.
II.
Review related to effectiveness of self instructional module regarding pediatric
neurological assessment among nurses working in paediatric surgical unit
Review related to knowledge regarding pediatric neurological assessment among nurses
working in paediatric surgical unit
Brandee Cox and Lori conducted a study in Australia in 2007 to determine the
need for registered nurses to be adequately equipped to conduct systematic
neurological assessments. 50 nurses were selected by random sampling technique
and used a questionnaire designed to elicit short-answer responses in order to
investigate how registered nurses described their neurological assessment practices
and what type of data they collected. The findings indicated that only 33%
respondents possess divergent conceptualizations of neurological assessment, and
only 37% nurses were able to conduct neurological examination.9
Silver, Cheryl 2000 Empirical investigation of the degree to which testing
predicts children's real-world functioning following traumatic brain injury (TBI) is
sparse. This article reviews the research in neuropsychology, which offers only moderate
correlations between test scores and everyday functioning. This line of research is
hindered by several methodological issues: difficulty translating performance on
standardized testing into real-world capacities, measurement of real-world functioning,
developmental factors, and the influence of intervening variables in the natural
environment. Ecologically valid assessment may require multiple data sources. More
research is needed to respond effectively to questions about children's everyday
functioning after traumatic brain injury. 10
Baran Stecker 2011 The purpose of this project was to evaluate the impact of a
structured educational program for nurses on an EMU in the assessment of patients with
clinical events by quantitatively measuring nursing assessments before and after the
program. There were two objectives for this project. The first objective was to measure
nurses' assessments of patients on the EMU in a quantifiable form. The second objective
was to evaluate the effectiveness of an educational program on the scores on the Nursing
Assessment Rating Scale. Twenty-Five nurses working on the EMU participated in the
study. Nurses' assessments were quantified using a criterion based rating scale with seven
primary quality indicators. The indicators were characterized as Superior (3 points),
Good (2 points), Satisfactory (1 point) and Unsatisfactory (0 points). 11
Way, Christine; Segatore, Milena 1994 The purpose of this study was to test a
neurological assessment instrument (NAI), used to assess neurological function in
peadiatrics and adults with acute brain lesions. Instrument items were designed to reflect
different aspects of neurological function and assess consciousness along the
arousal/awareness continuum as described by Plum and Posner.20 Content of the NAI
was validated by 10 neuroscience expert physicians, nurses and speech pathologists.
Reliability was tested with one pair of raters on 39 neurologically stable patients with
acute brain lesions. Based on preliminary findings, the critical preliminary steps have
been taken towards establishing a reliable and valid instrument with the potential of
improving the assessment of neurological function in patients with acute brain lesions.12
Birse, Jason 2006 : Neurological assessment can be a challenge in young children
because of their physical, behavioral, and cognitive immaturity. The use of an infant
neurological assessment tool allows nurses to easily perform a comprehensive
neurological assessment. The Starship Infant Neurological Assessment (SINA) tool is a
21-item instrument designed for use with children under 2 years of age. This study tested
its reliability. Four children under 2 years old were videotaped as they were assessed
using the SINA. Seven nurses viewed the tapes and indicated their assessment on the
tool. Interrater analysis using intraclass correlation coefficients demonstrated good
reliability for 17 of 21 items. Areas for future development and research include addition
of extra items and further testing.13
Lehman, Cheryl A. etal 2003 A menu-driven, problem-focused neurological
assessment system was constructed and implemented after concerns at a six-hospital
teaching center about the quality of nursing assessments for patients with neurological
diagnoses were validated. This system enables the physician to guide the nurse's
assessment by ordering specific neurological tests for each patient. Extensive staff
training took place to develop competence with this system. This new system has resulted
in positive changes for this facility. Nurses acknowledge greater comfort with performing
neurological assessment; documentation of assessment has improved; and the
assessments are becoming more individualized for each patient. This system resulted in a
higher quality of neurological care for patients. 14
En chiu, Kuei-Yueh Cheng Tzu-Kuan Sun Ku-Chou Chang, in 2006 conducted a
study in Taiwan in Teaching inexperienced nurses in assessing neurologic function of
acute ischemic stroke patients
selected 100 nurses and were stratified based on their
clinical level of experience and prior training on the National Institute of Health Stroke
Scale The results showed that in the second post-test, that 73 out of 100 nurses after
formal training on neurological assessment
demonstrated very good knowledge and
skills in neurological assessment of stroke patients.15
A Study conducted At La Trobe University, In Australia, to establish whether
registered nurses perceived health assessment to be a central component of their nursing
practice. A pre- and post-test design was used to evaluate nursing knowledge and skill
level following an educational program.The target population was all registered nurses
enrolled in a health assessment subject offered in a post-registration Bachelor of Nursing
course. In addition, statistically significant changes were demonstrated in the group's
perceived comfortableness with health assessment knowledge and skill level. The results
of this project have been used to guide and shape nursing curricula in the area of teaching
health assessment.16
Review related to effectiveness of self instructional module regarding pediatric
neurological assessment among nurses working in paediatric surgical unit
O'Farrell, Breeda; Zou, Guang Yong 2008 The Canadian Neurological Scale
(CNS), a validated stroke assessment tool, was implemented for the neurological
assessment of patients with stroke. The purpose of this study was to explore nurses'
values and perceptions of best-practice guidelines (BPGs) and the CNS assessment, to
evaluate the effect of a workshop and implementation process on nurses' self-efficacy for
CNS use, to determine whether the workshop and implementation process met the needs
of the nurses, and to evaluate the accuracy and appropriateness of CNS assessment
documentation. Nurses were moderately confident while performing the CNS assessment
before the workshop. Confidence increased immediately afterward (p < .0001), and then
decreased slightly at 3 months. The majority of nurses said the workshop met their
learning needs. A chart audit demonstrated that only 69% of patients appropriate for the
CNS assessment were assessed with this tool. Although nurses are aware of BPGs,
translating these changes into practice takes time and may require BPG modification to
best fit the needs of the areas in which they will be used. When choosing a validated
stroke assessment tool, clinicians must consider how often the tool will be used for
assessments, particularly in the acute phase. 17
Cohen, Jennifer 2009 The Glasgow Coma Scale (GCS) was developed in 1974 to
objectively describe neurological status and predict outcome in neuroscience patients.
Through the years, the GCS has become the gold standard for coma assessment. Despite
its widespread use, the GCS has many limitations that are well documented in the
literature. The Full Outline of Unresponsiveness (FOUR) score is a new coma scale that
was recently developed and validated in adults as a proposed replacement for the GCS.
The purpose of this study was to compare the interrater reliability and predictive validity
of the FOUR score and the GCS in pediatric patients. Outcome prediction analysis
showed that the FOUR score and the GCS are both able to predict in-hospital morbidity
and poor outcome at the end of hospitalization. The results from this pediatric study were
consistent with the adult studies which suggest that the FOUR score is a reliable and
valid tool for use in a wide variety of neuroscience patients.18
Davis 1987 according to this study reports the survival rate and short-term
neurologic outcome of children who sustained cardiac arrests at Henrietta Egleston
Hospital for Children, a pediatric teaching hospital. A commonly held belief in pediatric
centers has been that children tolerate the insult of cardiac arrest better than adults.
Cardiac arrest was defined as the need for external or internal cardiac compressions.
Critical care nurses specially trained for this project collected the arrest data and
performed the serial neurological exams. Results showed that despite a low overall
survival rate, neurological outcome appears to be good after the arrest even in patients
who expire prior to discharge. Major neurologic deficits, such as hemiplegia and severe
developmental delay, do not occur. Nursing implications of the study, which is in its
second year,19
Presciutti, Mary; 2009 Neuromonitoring with the microdialysis technique is now
being utilized at the bedside. Cerebral metabolism monitoring enables identification of
clinical events hours or even days before clinical examination changes, providing clinical
staff an opportunity for earlier intervention. Cerebral microdialysis also allows clinicians
to evaluate the impact of therapeutics on cerebral metabolism and certain metabolic
patterns, which can trigger specific alerts and/or clinical protocols. Cerebral metabolism
monitoring through microdialysis can guide clinicians to institute therapeutic measures
that prevent the occurrence of secondary injury. This article focuses on the state-of-theart application of cerebral microdialysis, the rationale for its use, and the nursing
implications of this technique. 20
A study conducted at the American College Of Rheumatology Philadelphia, on
Neurological Examination in individuals with Fibromyalgia (FM) & relationship to MRI
findings. 39 FM subjects and 20 controls had this evaluation. The FM Subjects
demonstrated significantly more abnormalities on many portions of the neurological
examination, especially in motor (53% abnl. vs. 5% controls), reflexes (31% abnl. vs.
10% of controls), gait (33% abnl. vs. 15% of controls) and sensory (23% abnl. vs 5%
controls) components. There was no relationship between MRI findings and physical
examination findings in either group butFM patients had abnormal in neurological
examination. 21
A Prospective study was conducted at the Keio University UK, on usefulness
of neurological examination for diagnosis of the affected level in patients with cervical
compressive myelopathy(CCM).Fifty patients who underwent successful decompressive
surgery for cervical myelopathy caused by single level disc herniation (38 men & 12
women, mean age 60 yrs). One of the three surgeons made a diagnosis of CCM, and the
other two conducted the Neurological Examination including deep tendon reflex,
pinprick response, muscle weakness & numbness in the hand only, knowing that the
patient had CCM, & established the Neurological-level diagnosis. The result of this study
suggested that Neurological Examination in patients with CCM is accurate.22
A comparative study conducted regarding neurological examination scores and
quantitative sensory testing in diagnosis of diabetic polyneuropathy,at Andhra Medical
College, in India. Diabetic Neuropathy examination score (DNE), quantitative Sensory
Testing by Vibration Perception Threshold (VPT) in the diagnosis of diabetic
polyneuropathy and seek an optimal screening method. The result shows that Seventy
one of 100 subjects had evidence of neuropathy confirmed by Nerve Conduction Studies,
while 29 did not have neuropathy. The DNE score gave a sensitivity of 83% and a
specificity of 79%.Vibration Perception Thresholds yielded a sensitivity of 86% and a
specificity of 76%. This Study Found that A Simple Neurological Examination score is as
good as Vibration Perception,in evaluation of polyneuropathy.23
Recently study conducted in Taiwan to examine the effectiveness of interactive
computer assisted instruction compared to videotaped instruction for teaching nurses to
assess neurological function of stroke patients. In that study they were using experimental
research design with two groups, one pre-test and two post-tests was utilized. The pre test
score shows that nurses have poor knowledge in neurological assessment of stroke
patients.24
Another study conducted by American Association of Neuroscience Nurses in USA reveals
that after implementation of the interventions, the percentage of nurses who had experience with
the NIHSS scale increased from 57% to 97%. After the interventions, a larger percentage of
nurses felt the NIHSS made a difference in their patient care (97% compared to 91%), and with
repeated use, nurses believed that they were able to perform the scale more rapidly. The number
of nurses who did not know how to use the scale decreased from 50% to 9%. Most staff nurses
felt comfortable using the NIHSS after the interventions (85% versus 30%) and more nurses felt
it was a useful tool to communicate patient neurological status (94% versus 50%).25
STATEMENT OF THE PROBLEM
“TO EVALUATE THE EFFECTIVENESS OF SELF
INSTRUCTIONAL MODULE ON KNOWLEDGE REGARDING PAEDIATRIC
NEUROLOGICAL ASSESSMENT AMONG STAFF NURSES OF PAEDIATRIC
SURGICAL UNIT AT SELECTED HOSPITALS IN BENGALURU.”
6.4
OBJECTIVES OF STUDY
1.
Assess the existing knowledge of staff nurses on paediatric neurological
assessment at selected hospitals Bengaluru.
2.
To evaluate the effectiveness of self instructional module on knowledge of staff
nurses on paediatric neurological assessment at selected hospitals Bengaluru.
3.
To find association between post test knowledge scores with selected sociodemographic variables.
6.4.1
HYPOTHESIS
H1
There will be a significant difference between mean pre test-post test
knowledge scores regarding paediatric neurological assessment among staff nurses
H2
There will be significant association between post test knowledge scores
regarding pediatric neurological assessment with selected socio demographic variables.
6.4.2
VARIABLES
(a)
Independent variable: self instructional module on paediatric neurological
assessment.
(b)
Dependent variable: Post test knowledge scores of staff nurses on paediatric
neurological assessment working in paediatric surgical unit.
(c)
Attribute variable: Age, sex, family income, type of family, general qualification,
professional qualification, years of experience, marital status, exposure to in-service
training.
6.4.3
OPERATIONAL DEFINITIONS
Effectiveness: In this study effectiveness refers to the difference in the percentage of
correct response and mean knowledge scores of pre test and post test conducted for the
staff nurses.
Video assisted teaching programme: It refers to a systematically organized standardized
video assisted teaching plan on paediatric neurological assessment.
Knowledge: It is the ability of staff nurses response to structured knowledge
questionnaire regarding paediatric neurological assessment.
Paediatric Neurological assessment: Paediatric Neurological assessment is a systematic
process that includes series of steps such as mental status examinations followed
bycranial nerves, motor system, sensory system, coordination, and gait.
Staff nurse: A person working in a hospital and registered in state nursing council.
7.
MATERIALS AND METHODS
7.1
Source of Data
:
Staff nurses working in selected Hospitals,
Bengaluru.
7.2
Method of Collection of Data : Random sampling, Staff nurses who are
registered in State Nursing Council and working
in selected Hospitals, Bengaluru.
7.2.2
Inclusion and Exclusion Criteria
(a)
Inclusion Criteria
:
(i) Staff nurses who are present at the time of data
collection.
:
(ii) Staff nurses who are willing to participate in the
study.
(b)
Exclusion Criteria
:
(i) Staff nurses who are sick or leave on the day of
data collection.
:
(ii) Staff nurses with higher qualification D P N,
D N N, MSc. (N).
7.2.3
Research Approach :
Evaluatory approach
7.2.4
Research Design
:
One group post test design
7.2.5
:
Selected Hospitals Bangalore
7.2.6
Setting
Sampling Technique :
7.2.7 (a) Sample Size
:
(b) Duration of the Study
7.2.8
Tools of Research
:
Random sampling technique
60 staff nurses
: 4-6 weeks
Structured knowledge questionnaire is used to
collect data. The tool consists of two parts
:
Part I – Socio demographic data
:
Part II – Investigator will develop structured
knowledge questionnaire on Paediatric neurological
assessment
7.2.9
Collection of Data :
After getting written consent from authority and
staff nurses investigator will administer structured
knowledge questionnaire on the same day, then
after 7 days post test will be conducted with the
same structured knowledge questionnaire.
7.2.10 Method of Data Analysis
and Presentation
:(a) Descriptive statistics
(i) Frequency and percentage distribution will be
used to analyze the demographic data of staff
nurses.
:
(ii) Mean percentage and standard deviation will be
used to assess the level of knowledge of staff
nurses.
:
(b) Inferential statistics
:
(i) Paired‘t’ test will be used to assess the
effectiveness of self instructional module
:
(ii) Chi square test will be used to find the
association between post test knowledge with
selected socio- demographic variables.
:
(c) Analyzed data will be presented in form of
tables graphs and pie diagrams based on the
findings.
7.3
Does the study require any investigation to be conducted on patients or other
human or animals? If so please describe briefly.
Yes with prior consent study will be conducted on staff nurses regarding knowledge
regarding paediatric neurological assessment working in paediatric surgical unit at
selected hospitals Bengaluru.
7.4
Has ethical clearance has been obtained from your institution in case of 7.3?

Yes permission will be obtained from concerned authority of the institution before
the study.

Privacy, confidentiality and anonymity will be guarded.

Scientific objectivity of the study will be maintained with honesty.
REFERENCE:
1. Disabato J, Wulf J (1994) Altered neurologic function. In: Betz C, Hunsberger M, Wright
S (eds) Family Centered Nursing Care of Children, 2nd edn. by. Saunders, Philadelphia,
pp 1717–1840
2. Tukaram (2006) ‘’An observational study of the neurological assessment on the clients
with altered sensorium with a view to prepare a learning package and to evaluate the
efficacy of the staff nurses in terms of gain in practice in KLES’S hospital and medical
research centre, Belgaum, Karnataka’’.
3. Hickey J (2003) Th e Clinical Practice of Neurological and Neurosurgical Nursing, 5th
edn. Lippincott, Williams and Wilkins, Philadelphia
4. Pattynoah,rn,msn,cnrnNeurologicalassessment.Arefresher
http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=120796
5. Tukaram (2006) ‘’An observational study of the neurological assessment on the clients
with altered sensorium with a view to prepare a learning package and to evaluate the
efficacy of the staff nurses in terms of gain in practice in KLES’S hospital and medical
research centre, Belgaum, Karnataka’’.
6 Lewis’s (2011), ‘Medical Surgical Nursing –Assessment &management of clinical
problem’ 7TH Edition published by Elsevier, india,p:1406 – 1426.
7 WHO. Country Profile: Atlas, Geneva: Neurological problems statistical analysis (serial
online) 2006 Mar (Cited on 11 may 2006); p. 380-386.
8 To T et al. What factors are associated with poor developmental attainment in young
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Publique, 2004, 95(4):258-63
9 Brandee Cox, Lori. A study to determine nurses competencies in neurological
assessment. Department of nursing sciences Queens hospital Australia: [Cited 2004 Nov
4]; Available from: http://www.science direct.com
10 Silver, Cheryl H. PhD Ecological Validity of Neuropsychological Assessment in
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11 Baran Stecker, Mona, D.N.P., WEST VIRGINIA UNIVERSITY, The Evaluation of the
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http://gradworks.umi.com/34/76/3476542.html
12 Way, Christine; Segatore, Milena Development and Preliminary Testing of the
Neurological Assessment Instrument Journal of Neuroscience Nursing. 26(5):278-287,
October 1994. (C) 1994 American Association of Neuroscience Nurses of this study was
totestaneurologicalasses...
http://journals.lww.com/jnnonline/Abstract/1994/10000/Development_and_Preliminary_
Testing_of_the.5.aspx
13 Birse, Jason Pilot Testing of the Starship Infant Neurological Assessment Tool August
2006 - Volume 38 - Issue 4 > Pilot Testing of the Starship InfantNeurologicalAssessment
http://journals.lww.com/jnnonline/Abstract/2006/08000/Pilot_Testing_of_the_Starship_I
nfant_Neurological.2.aspx
14 Lehman, Cheryl A.; Hayes, Joan M.; LaCroix, Michel; Owen, Steven V.; Nauta, Haring J.W.
Development
and
Implementation
of
a
Problem-Focused
Neurological
Assessment
SystemJournal of Neuroscience Nursing. 35(4):185-192, August 2003. acknowledge greater
comfort with performing neurologic
assessment; documentation of assessment has...
http://journals.lww.com/jnnonline/pages/results.aspx?k=paediatric%20neurological%20assess
ment&Scope=AllIssues&txtKeywords=paediatric%20neurological%20assessment
15 En Chiu, Kuei-Yueh Cheng, Tzu-Kuan Sun, Ku-Chou Chang. Tiwan medical institute Tiwan:
Nursing practice manual for nurses [Cited 2009 dec12]; Available from: http://www.
Science direct.com. Volume 46, Issue 12, December 2009, Pages 1548-1556
16 Michael Wilson (1995),Volume:10 “Health assessment and its relationship to nursing
practice’’ p:7-11.
17 O'Farrell, Breeda; Zou, Guang Yong Implementation of the Canadian Neurological Scale
on an Acute Care Neuroscience Unit: A Program Evaluation Journal of Neuroscience
Nursing. 40(4):201-211, August 2008. The Canadian Neurological Scale (CNS), a
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stroke
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tool,
was
implemented
for
the...
http://journals.lww.com/jnnonline/pages/results.aspx?k=paediatric%20neurological%20a
ssessment&Scope=AllIssues&txtKeywords=paediatric%20neurological%20assessment
18 Cohen, JenniferInterrater Reliability and Predictive Validity of the FOUR Score Coma
Scale in a Pediatric PopulationJournal of Neuroscience Nursing. 41(5):261-267, October
2009.doi: 10.1097/JNN.0b013e3181b2c766 Reliability and Predictive Validity of the
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Pilot
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Cynthia Neurologic Outcome Following Pediatric Resuscitation Journal of Neuroscience
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_Pediatric.6.aspx
20 Presciutti, Mary; Schmidt, J. Michael; Alexander, SheilaNeuromonitoring in Intensive
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June
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Volume
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pp
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Care__Focus_on.4.aspx
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individuals with fibromyalgia(FM) & Relationship to MRI finding. 165-171.
22 Bridge LJ. Wilson M.(2003). Disruption of assessment practice. Journal of Neurology.
P:72
23 Michael Wilson (1995),Volume:10 “Health assessment and its relationship to nursing
practice’’ p:7-11.
24 Chiu SC, Cheng KY, Sun TK, Chang KC, Tan TY, et al. The effectiveness of interactive
computer assisted instruction compared to videotaped instruction for teaching nurses to
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25 Pamela Youde. Effectiveness of neurological assessment tool. Hong Kong Med J 2008
March, Vol: 14: Pp: 367-70. Available from: URL: http://jgate-helinet.informindia.co.in
9
SIGNATUREOF CANDIDATE
This study is feasible and I forward it for
10
11
REMARKS OF THE GUIDE
acceptance.
NAME AND DESIGNATION
PROF. REVATHY A
Professor & HOD
Dept. of Child Health Nursing.
OF
11.1. GUIDE.
Ambigara chowdiah college of nursing
11.2. SIGNATURE
11.3. CO – GUIDE
11.4. SIGNATURE
11.5. HEAD OF THE
DEPT.
11.6. SIGNATURE
12
12.1
REMARKS
OF
THE The topic is discussed with the members of the
CHAIRMAN & PRINCIPAL
research committee and is finalized. He is
permitted to conduct the study.
12.2 SIGNATURE