Effectiveness of Structured teaching program on
Knowledge and Practice of Blood and Blood components Transfusion among Staff
Nurses
K. Gopalakrishnan1, Sonukasare Sangita
Diwakar2*
1HOD and Professor, Department of Medical Surgical
Nursing, AECS Maaruti College of Nursing, Behind Maaruti Dental College,
Kammanahalli, Off Bannerghatta Road, Bangalore-560076, Karnataka, India.
2Community health officer, Health and Wellness Centre Hirpur,
Primary Health centre, Jamathi, Budruk, Maharastra,
India.
*Corresponding Author E-mail:
goldgopal_k@yahoo.com
ABSTRACT:
Background: Blood is a collection of cells that have
been specialized to perform a set oftasks within an organism. It is described
as the fluid connective tissue that carriesoxygen and nutrients to the body. It
is straw in colour, the average volume of blood inthe human body is 5 litres
generally, the PH of blood is 7.4, which is slightly alkaline. The blood
comprises 8% of our total body weight. It is composed of plasma, about 55% and
45% cells, respectively. Blood transfusion is when apatient receives a blood
product through an intravenous line or the introduction of newmatching blood
into the bloodstream or/and of any specific blood components. Objectives:
The study aimed to assess the knowledge and practice of a structured teaching
programme on blood and blood components among staff nurses. Methods: 50
Staff nurses were selected by a non-probabilityconvenient sampling technique.
Quasi-experimental design with one grouppre-test and post-test design was used.
The tools used to collect the data consisted of a structuredknowledge
questionnaireand structured practice scale on blood and blood component
transfusion. The reliability was checked using test-retest method showed that
the tools were highly reliable. Results: The good knowledge score was
increased from pretest (12%) to posttest (32%). Moderate practice score was
increased from pretest (50%) to posttest (78%). There was a significant
difference (p<0.05) between mean pretest knowledge and practice scores with
mean post test knowledge and practice scores. So, the structured teaching
program was effective in improving the knowledge and practice of staff nurses
regarding blood and blood components. The Chi-square test showed that there was
a significant association with knowledge and gender, practice and marital
status, education. The other variables are not showing association. Conclusion:
The findings revealed thatstaff nurses’ knowledge and practice regarding
bloodand blood components transfusion wasimproved after the teaching program.
KEYWORDS: Blood, Blood components, Knowledge, Practice, Staff
nurses, Transfusion.
INTRODUCTION:
Blood is a collection of several types of
cells, each of which performs a specific job inside an organism. It is defined
as the body's fluid connective tissue, which transports nutrients and oxygen.1
The blood is straw in colour and has a
normal volume of five liters in the human body, with a slightly alkaline pH of
7.4. The blood constitutes roughly 8% of our total body weight. Blood is a clear,
straw-colored liquid comprising roughly 55% plasma and 45% cells, respectively.
All blood cells begin as pluripotent stem cells, and only after that, through
the process of hematopoiesis, are they differentiated into red blood cells,
white blood cells, and platelets.2,3 Our blood travels throughout
our body, supplying the cells with vital materials like nutrition and oxygen.
Moreover, it removes waste products from metabolism from those same cells.
Blood cannot be substituted. It cannotbe produced or made. Patients needing a
blood transfusion have no other source of blood except kind donors.4
A blood transfusion is known as giving a patient a blood product via an
intravenous line, introducing fresh, compatible blood into their system, or
supplying them with certain blood components.Blood and blood product
transfusions may be required to treat severe anemia, leucopenia, and
thrombocytopenia brought on by a disease process or therapy.1 Whole
blood, packed red blood cells platelets, plasma, and concentrated clotting
factors and other blood products refill volume, the oxygen-carrying capacity,
platelet volume, and clotting factors. If not carried out carefully in
compliance with facility regulations and safe nursing practice, this
potentially life-saving surgery could become potentially fatal.4,5
Nurses play a crucial role in the
transfusion process. They frequently participate in pre-transfusion sampling,
patient information provision, blood requests from the laboratory, blood
collection, transfusion administration, and patient response monitoring before,
during, and after the transfusion event. As professionals, they bear personal
responsibility.6,7 As the last line of
defence against a mistransfusion, nurses oversee the final bedside examination
before transfusion. The blood items that nurse transfusion most frequently are
platelets, fresh frozen plasma, and packed red blood cells.8 To
safely give and monitor transfusions, one must be thoroughly awareof the
pathophysiology of transfusion reactions, symptoms, and treatment options.
Through the creation of accessible blood transfusion regulations, auditable
performance standards, and training and educational programmes, nurses can
decrease the likelihood of errors and promote compliance in high-risk areas of
the transfusionprocess.9,10 Previous study results showed that
nurses have insufficient knowledge of blood transfusion reflected in
undesirable practice.11,12 Hence, the researcher felt intervention
programmes would help the staff nurses to improve the knowledge and practice on
blood transfusion in their setting.
AIM OF THE STUDY:
A study to evaluate the effectiveness of
structured teaching program on knowledge and practice of blood and blood
components transfusion among staff nurses.
OBJECTIVES:
1.
To assess the knowledge
and practice of staff nurses regarding blood and blood components transfusion
in terms of pre-test and post-test knowledge and practice scores.
2. To evaluate the effectiveness of structured
teaching program on knowledge and practice of staff nurses regarding blood and
blood components transfusion by comparing pre-test and post-test knowledge and
practice scores.
3. To find out correlation between knowledge
and practice regarding blood and blood components transfusion among staff
nurses
4. To find the association between the
pre-test knowledge scores on blood and blood components transfusion among staff
nurses and their selected demographic variables.
5. To find the association between the
pre-test practice scores on blood and blood components transfusion among staff
nurses and their selected demographic variables.
MATERIALS AND METHODS:
In this study, a quantitative research
approach was adopted. The pre-experimental one group pretest post test research
design was used for this investigation. The staff nurses working in Shekhar
Hospital, Bengaluru district was found to be the sample for this study. Using a
non-probability convenience sample technique, fifty staff nurses were selected.
Criteria for the selection of samples:
1. Inclusion criteria
Staff nurses who,
·
can understand,
comprehend, and respond in English.
·
are working at a
selected hospital
·
are willing to take
part in the study.
2. Exclusion criteria
·
Staff nurses are who
are absent at the time of data collection.
Description of the tool:
The structured questionnaire was divided
into threeparts, which consist ofdemographic data, a structured knowledge
questionnaire and a structured practice scale.
Part I: Demographic Data:
It consists of 7 items which include age,
gender, marital status, religion, educational qualification, monthly income,
and witnessed orexperienced regarding blood and blood components transfusion.
Part II:
Structured knowledge questionnaire:
This section consists of 36 structured
items with multiple options to assessthe knowledge of staff nurses regarding
blood and blood components transfusion. The right answer was scored asone mark,
and the wrong answer was scored as zero comprising the maximum score of 36. The
total score is arbitrarily divided intoPoor knowledge (0-12), Moderate knowledge
(13-24), and good knowledge (25-36)
Part III:
Structured Practice scale:
This section consists of 32 structured
practice-based knowledge items withthree options always, sometimes, and never.
A score value of two was allotted for each always response. Score one was
assigned for sometimesresponse, and scorezero was allotted for the never
response. The total practice score is 64, which isfurther arbitrarily divided
into three levels: 0-21 Poor practice, 22-42 Moderate Practice, >43 Good
practice. Structured questionnaire and teaching program was prepared by the
researcher and obtained validation from experts. The reliability of the
structured knowledge questionnaire andpractice scale wasr = 0.80 & 0.83,
respectively. This indicates that tools werereliable.
RESULTS:
Table 1: Frequency and Percentage
distribution of respondents according to level of Knowledge regarding blood and
blood components transfusion (n-=50)
|
Level of
knowledge
|
|
Pre test
|
Post test
|
|
Poor
|
Average
|
Good
|
Poor
|
Average
|
Good
|
|
17(34%)
|
27(54%)
|
6(12%)
|
00
|
34(68%)
|
16(32%)
|
Table 2: Frequency and Percentage
distribution of respondents according to level of practice regarding blood and
blood components transfusion (n=50)
|
Level of practice
|
|
Pre test
|
Post test
|
|
Poor
|
Moderate
|
Good
|
Poor
|
Moderate
|
Good
|
|
21(42%)
|
25(50%)
|
04(8%)
|
05(10%)
|
39(78%)
|
06(12%)
|
|
Variable
|
Test
|
Mean
|
SD
|
‘t’ Value
|
|
Knowledge
|
Pre-test
|
14.74
|
5.03
|
13.84*
|
|
Posttest
|
20.76
|
4.71
|
|
Practice
|
Pre-test
|
24.88
|
9.11
|
13.22*
|
|
Posttest
|
30.64
|
9.7
|
Note. Paired ‘t’ test *Significantatp <0.05level
The paired‘t’ test implies that the
difference in the pre-test and posttest
knowledge, practice scores were
found statistically significant at p<0.05 level. There exists a
statistical significance in the difference of knowledge and practice
scoreindicating the positive impact of structured teaching program. This
indicates that staffnurse knowledge and practice is increased after exposed to
structured teaching program. Hence, the research hypothesis H1 is
accepted.
Table 4: Relationship between knowledge and practice scores blood and blood
components of structured teaching program (n=50)
Variables
|
Meanscore
|
Pearson Correlation
|
|
Knowledge Scores
|
14.74
|
0.18
|
|
Practice Score
|
24.88
|
The data presented in Table 4 shows the
correlation between knowledge and practice scores. Pearson correlation was
calculated and found no significant correlation. Thus, hypothesis H2
is rejected, indicating no relationship between knowledge and practice scores.
Table 5: Association between knowledge scores and the selecteddemographic variables
of staff nurses (n=50)
|
S. No.
|
Demographic variables
|
Knowledge Score
|
Chi-Square Value
|
Sig
|
|
 Poor
|
Average
|
Good
|
|
1.
|
Ageinyears
|
|
|
|
2.98
|
NS
|
|
|
25 year and below
|
5
|
9
|
1
|
|
|
|
26– 30 years
|
5
|
10
|
1
|
|
|
|
31years and above
|
7
|
8
|
4
|
|
|
|
2.
|
Gender
|
|
|
|
|
|
|
|
Female
|
12
|
14
|
4
|
6.65*
|
S
|
|
Male
|
5
|
13
|
2
|
|
|
|
3.
|
Marital status
|
|
|
|
|
NS
|
|
|
Married
|
11
|
17
|
3
|
0.43
|
|
|
Single
|
6
|
10
|
3
|
|
|
|
4.
|
Religion
|
|
|
|
|
NS
|
|
|
Hindu
|
12
|
14
|
4
|
4.07
|
|
|
Muslim
|
5
|
8
|
1
|
|
|
|
Christian
|
0
|
5
|
1
|
|
|
|
5.
|
Education
|
|
|
|
|
|
|
|
GNM
|
5
|
7
|
1
|
|
|
|
B.Sc. Nursing
|
4
|
11
|
2
|
4.06
|
NS
|
|
PB BSc. Nursing
|
5
|
7
|
1
|
|
|
|
MSc. Nursing
|
3
|
2
|
2
|
|
|
|
6.
|
Monthly Income
|
|
|
|
|
|
|
|
Below 10,000
|
3
|
8
|
1
|
|
|
|
10,001-20,000
|
8
|
13
|
4
|
2.85
|
NS
|
|
20,001- 30,000
|
4
|
3
|
1
|
|
|
|
30,001 & above
|
2
|
3
|
0
|
|
|
|
7.
|
Witnesses or experienced regarding blood and blood
components transfusion
|
|
|
|
|
|
|
|
Witnessed
|
9
|
12
|
2
|
|
|
|
Experienced
|
5
|
10
|
3
|
0.95
|
NS
|
|
None
|
3
|
5
|
1
|
|
|
Note. *Sig- Significant at
p<0.05 level
Table 6:
Association between
practice score and the selected demographic variables of staff nurses(n=50)
|
Sl. No.
|
Demographicvariables
|
Practicescore
|
Chi-square value
|
Sig.
|
|
Poor
|
Moderate
|
Good
|
|
1
|
Ageinyears
|
|
|
|
|
|
|
|
25 year and below
|
7
|
8
|
0
|
|
|
|
26– 30 years
|
8
|
5
|
3
|
6.31
|
NS
|
|
31years and above
|
6
|
12
|
1
|
|
|
|
2
|
Gender
|
|
|
|
|
|
|
|
Female
|
11
|
15
|
4
|
3.17
|
NS
|
|
Male
|
10
|
10
|
0
|
|
|
|
3.
|
Marital status
|
|
|
|
|
|
|
|
Married
|
10
|
20
|
1
|
7.60*
|
S
|
|
Single
|
11
|
5
|
3
|
|
|
|
4
|
Religion
|
|
|
|
|
|
|
|
Hindu
|
13
|
14
|
3
|
|
|
|
Muslim
|
7
|
7
|
0
|
3.37
|
NS
|
|
Christian
|
1
|
4
|
1
|
|
|
|
5
|
Educational qualification
|
|
|
|
|
|
|
|
GNM
|
6
|
7
|
0
|
|
|
|
B.Sc. Nursing
|
8
|
5
|
4
|
|
|
|
PBBSc.Nursing
|
5
|
8
|
0
|
13.73*
|
S
|
|
MSc. Nursing
|
2
|
5
|
4
|
|
|
|
6.
|
FamilyIncome/ Month
|
|
|
|
|
|
|
|
Below10,000/-
|
5
|
7
|
0
|
|
|
|
10,001- 20,000/-
|
11
|
10
|
4
|
6.72
|
NS
|
|
20,001-30,001
|
2
|
6
|
0
|
|
|
|
30,001& above
|
3
|
2
|
4
|
|
|
|
7.
|
Witnessedor experiencedregarding
bloodandbloodcomponentstransfusion
|
|
|
|
|
|
|
|
Witnessed
|
10
|
11
|
2
|
|
|
|
Experienced
|
7
|
11
|
0
|
4.76
|
NS
|
|
None
|
4
|
3
|
2
|
|
|
Note. *Sig- Significant at
p<0.05 level
Data presented in Table 5 shows the
association between knowledge scores and the selected demographic variables of
staff nurses. Chi-square value was calculated. The calculated value shows a
significant association between gender and the knowledge scores at p<0.05
level. Other variables do not showan association. It implies a significant
association betweengender and the knowledge scores of staff nurses on blood and
blood components transfusion. Hence, Hypothesis 3 is partially accepted.
Data presented in Table 6 shows the
association between practice scores and the selected demographic variables of
staff nurses. Chi-square value was calculated. The calculated value shows a significant association
between marital status and educational qualification with the practice score at
p<0.05 level.Other variables do not show an association. It implies a significant association between the
Marital status, educational qualification and the practice scores of staff
nurses on blood and blood components transfusion. Hence,
Hypothesis 4 is partially accepted.
DISCUSSION:
The results of the present study
revealed that
the pre-test level of
knowledge shows that a maximum of 27(54%) respondents
had average knowledge, 17(34%) respondents had poor knowledge,
and remaining 6(12%) respondents had good knowledge. During the post-test a maximum of 34 (68%) respondents had average knowledge, and 16(32%) respondentshad good knowledge. Concerning
knowledge scores of participants, the findings reveal that the post-test mean knowledge scores was higher [mean=20.76, SD of 4.71] when
compared with pre-test mean
knowledge score value which was 14.74 with SD of 5.03.
The statistical paired ‘t’ test implies that the difference in
the pretest and post-test value was found
statistically significant at 5% level (P<0.05) with
a value of 13.84. A statistical significance exists in the
difference of knowledge score indicating the positive impact of structured
teaching program. A similar study was conducted by Vandana et al., (2022), to assess the effectiveness of structured
teaching programme regarding Blood donation and Blood Transfusion on knowledge
among 60 nursing students from P.G. College of
Nursing Bhilai, Durg. Descriptive and inferential statistics were used for data
analysis, the level of significance was at 0.05. In
post-test, majority 52 (86.66%) subjects had excellent
knowledge, 8(13.33%) had very good knowledge and none had poor and average
knowledge regarding blood donation. Analysis related to pre-test and post-test
knowledge score regarding blood transfusion among B.Sc. Nursing second year
students. In Post-test, majority of subjects 43 (71.67%) had excellent
knowledge, 17(28.33%) had good knowledge.13
Regarding the pre-test level of
practice, it shows that, the majority of 25(50%) respondents had moderate practice, 21(42%) respondents had poor
practice, and remaining 4 (8%) had good practice. During the post-test amaximum of 39(78%)
of respondents had moderate practice, 6(12%)
of respondents had good practice, and 5(10%) of respondents had poor
practice. Concerning practice
scores of participants, the findings revealed that the posttest mean practice
scores were higher [mean=30.64, SD of 9.70] when compared with
pre-test mean practice score value
which was 24.88 with SD of 9.11. The statistical paired ‘t’ test implies that the
difference in the pre-test and post test value was found statistically
significantat 5% level (P<0.05)
with apaired ‘t’ value
13.22. A statistical significance exists in the difference of practice score indicating the
positive impact of structured teaching program. A pilot study was undertaken by Diaz (2009), to assess
the effectiveness of an education module for improving transfusion knowledge
among staff nurses. Modules were developed and delivered by experts for nurses
on transfusion technique. Modules were delivered to staff nurses in their first
2 years of training (Surgical Foundations), and to Trainee nurses across all
years of training. Pre module and post module and retention knowledge
assessments were used to assess efficacy. Chi-square tests were used to compare
each group's correct response rates for each question across the three tests.
Transfusion knowledge of staff nurses was improved by a collaborative
educational initiative. This could serve as a model for other training programs
toimprove nurses’ knowledge of evidence-based transfusion practices.14
LIMITATION:
The study is limited to staff nurses who are working
in selected hospitals at Bangalore so, the generalizability of the study
findings is limited.
CONCLUSION:
The overall pretest knowledge and practice
of staff nurses regarding blood and blood components transfusion were average
and moderate respectively. There was a need for teaching program regarding
blood and blood components transfusion among
staff nurses. Posttest results showed significant
improvement in the level of knowledge and practice
regarding blood and blood components transfusion. Thus, it can be concluded
that structured teaching program was effective to increase and update their
knowledge and practice on blood and blood components transfusion. The results
revealed that there is partial association between pre-test knowledge, practice
scores and socio demographic variables.
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