Effect of Planned Teaching on Knowledge and Practice Regarding the Care of Patients Receiving Anti-Coagulant Therapy among the Nurses in the Intensive Care Unit in a Selected Hospital

ABSTRACT: Anticoagulants are high-risk drugs so it is very important to monitor the patients receiving anti-coagulant therapy. They are one of the most common types of medications in use today and help prevent and treat a wide variety of health conditions. There is a very small window for therapeutic dosing: too much of a drug can cause bleeding, and too little may lead to clotting. So the nurses and the nurse practitioners should be provided with knowledge and skills necessary to prevent patient harm associated with anticoagulant therapy. They should be taught how to: identify common indications for use of anticoagulants, describe monitoring requirements, consider important safety implications to help prevent complications, and discuss patient/family educational needs related to anticoagulants.

OBJECTIVES: To assess the knowledge and practices of nurses before and after the planned teaching and to find the association between the knowledge and practice of nurses with selected demographic variables.

METHODOLOGY: A descriptive evaluative approach was selected to assess the knowledge and practice of nurses in the intensive care units regarding the care of patients receiving anticoagulation therapy. Evaluative approach was used to test the effectiveness of teaching module on anticoagulation therapy. Descriptive evaluative approach is used in the study and one group pretest post-test design was adopted, where the group was assessed with the Structured Knowledge Questionnaire and Observation Checklist. The content validity of the tool was established by giving it to 10 experts and reliability of the tool was tested by administering it to 3 staff nurses in the ICU. The tool was found reliable r = 0.928 (Structured Knowledge Questionnaire) and r = 0.789 (Observation Check List). Frequency and percentage are used to analyse the sample characteristics. Area wise range, mean, median and standard deviation were also used to analyse the scores. The effectiveness of the planned teaching was assessed by test re-test method. The association between knowledge and practice score with selected demographic variable was assessed by ANOVA method using Cronbach's alpha formula.

FINDINGS OF THE STUDY:

• It showed that none of the subjects were aware that massaging at the injection site can cause bleeding during the pre-test practice whereas in post-test practice scores were 56.7%.
• Practice score of pre-test in checking for the side effects of Heparin therapy such as bleeding gums, haematuria, maleena was nil, whereas in post-test the practice score in this area was 60%.
• In administration of I. V. Heparin, infusion pump rate should not be altered until the next APTT result is known and observing the client for adverse reactions scored nil in pre-test whereas in post-test the scores were 33.3% and 36.7% respectively. 
• The mean pre-test and post-test knowledge scores were 13.73 and 21.77.
• The calculated 't' value (12.68) was greater than the table value of 2.04, which suggests that the planned teaching was effective.
• The calculated value was found to be 12.68 for knowledge and 12.46 practice score for oral anticoagulation therapy, 18.15 for subcutaneous LMWH injections and 17.75 for the administration of I.V Heparin injections. 

CONCLUSION: The study revealed that the planned teaching is an effective means to improve the knowledge and practices of nurses caring patients on anticoagulation therapy in the intensive care units. It is essential to have regular in-service education programmes for nurses to improve their knowledge and practice skills while caring for the patients in order to impart quality care and prevent undue complications during the drug therapy. Knowledge and practices of staff nurses in the intensive care units on anticoagulants were inadequate before the teaching module was administered. There was no significant association between gain in knowledge and practice score with the selected demographic variables. The findings of the study proved that teaching through planned teaching is really effective to increase the knowledge and practice of the nurses.