|Year : 2019 | Volume
| Issue : 2 | Page : 117-124
Effect of campus-based emergency training on knowledge and skills regarding selected medical emergencies among college teachers in a selected college
Phiralynn KharKongor1, Rajeswari Siva2, Samuel Ravi Kumar3, Reginald George Alex4, Bijesh Yadav5
1 Rapsbun School of Nursing, Shillong, Meghalaya, India
2 Department of Community Health Nursing, College of Nursing, CMC, Vellore, Tamil Nadu, India
3 Department of Medical Surgical Nursing, College of Nursing, CMC, Vellore, Tamil Nadu, India
4 Department of Emergency Medicine, CMC, Vellore, Tamil Nadu, India
5 Department of Biostatistics, CMC, Vellore, Tamil Nadu, India
|Date of Submission||31-Jul-2018|
|Date of Acceptance||13-Dec-2019|
|Date of Web Publication||01-Jun-2020|
Ms. Phiralynn KharKongor
College of Nursing, CMC, Vellore, Tamil Nadu
Source of Support: None, Conflict of Interest: None
College campus hems-in not only academic credentials but also provide opportunities for students to explore their interests and passions. Students are vulnerable to injuries and severe accidents. Timely, the administration of first aid in response to the medical emergencies will help to reduce disabilities, complications and the cost of treatment and mortality among them. Teachers are often the first to witness and handle these situations, hence, need to be equipped and empowered with knowledge and skills to be effective and efficient first respondents. A preexperimental study was conducted to assess effectiveness of campus-based emergency training (CBET) on knowledge and skills in the management of selected medical emergencies among college teachers. Fifty-three college teachers participated in the CBET which included lecture cum discussion, video presentation, booklet; skill demonstration and return demonstration as interventions. A self-administered questionnaire for knowledge and observational checklist for skills on the management of selected medical emergencies, constructed by the investigator, were used as data collection tools. Findings showed that majority of the college teachers had inadequate knowledge and skills during the pretest. There was significant improvement in knowledge (mean difference, −13.62) (P < 0.001) and skill (mean difference, −27.66) (P < 0.001) among the teachers after the CBET. Significant association was found between stream of teaching and knowledge (pretest) and skill (posttest) (P < 0.001). There was a strong positive correlation of post knowledge and post skills (P < 0.01). These findings, reiterated a strong need to train college teachers all over the country on the management of selected life threatening medical emergencies to have safe campus, save lives, and ensure a safe India.
Keywords: Campus-based emergency training, college, medical emergencies, skills, teachers knowledge
|How to cite this article:|
KharKongor P, Siva R, Kumar SR, Alex RG, Yadav B. Effect of campus-based emergency training on knowledge and skills regarding selected medical emergencies among college teachers in a selected college. Indian J Cont Nsg Edn 2019;20:117-24
|How to cite this URL:|
KharKongor P, Siva R, Kumar SR, Alex RG, Yadav B. Effect of campus-based emergency training on knowledge and skills regarding selected medical emergencies among college teachers in a selected college. Indian J Cont Nsg Edn [serial online] 2019 [cited 2020 Jul 14];20:117-24. Available from: http://www.ijcne.org/text.asp?2019/20/2/117/285591
| Introduction|| |
Emergency, a term describing serious, unexpected and often life threatening conditions, demands quick decision and immediate action with extraordinary measures. It is usually defined in terms of time, distance and space implying rules of management and an exit strategy. Conceptually, it relates best to response. In emergency situations, lack of proper management can be fatal. College campus is a gathering place for education with lots of exuberant young people who are testing their limits of life, fighting for recognition, spreading their wings, taking time to learn, to explore, and to have fun.
On an average, students in many countries spend about 31.5% of their time (7.5 h) in campus for educational activities alone such as attending classes and doing assignments. Students split the remaining time among a range of activities such as leisure and sports activities (4.0 h) besides travel (1.1 h).
Students are more vulnerable to the risks of accidents and injuries due to the higher level of involvement in physical activities during sporting events or while engaging in extracurricular activities organized by the college. Therefore, many injuries and medical emergencies occur every year in such academic settings.
The emergencies commonly met within college campuses are accidents which lead to minor or serious injuries such as severe bleeding, epistaxis, abrasions, deep cuts, and fracture resulting from falls or falling objects, slips, cuts from broken glasses or test tubes or even injuries related to sports. Berger and O'Shea  revealed in their study that colleges have the highest incidence rate of sudden cardiac arrest (SCA) when compared with lower level schools (preschool, elementary, middle) and high schools. SCA is the leading cause of death in young athletes. However, it was found that 1 in 100 student athletes who suffer SCA survived due to prompt action and treatment. There were 120 sports related death of young athletes in 2008–2009, 50 in 2010, and 40 in 2011.
The incidence of sports related injuries in India is high compared to the global rate, which is mainly due to poor ground conditions accounting to about 40.2% of injury in the students, 30.5% to faulty techniques and the rest attributed injuries to poor fitness levels and improper use of equipment. In a study conducted in Chandigarh, India, 33 schools were surveyed, 27.3% (9/33) had a doctor as health professional, 9.1% (2/33) had a physiotherapist while 66.6% of the schools (22/33) had no health-care professional to attend to their immediate care when there is a medical emergency. As there is no trained health-care provider in many educational institutions, participation of teachers as first respondents to the injured victim will reduce the severity of complications of medical emergencies and reduce youth morbidity and mortality rate. The meticulous care by the first respondent can help the individual in postincidence sequelae.
The study conducted by Sobrino and Shafi  on trauma victims showed 50% of the death occured within the 1st h of the accident, 30% between 1 h and 1 week and 20% occur after the 1st week. The “golden hour” and the “platinum hour” highlight the importance of trauma care. Timely administration of care in response to injuries and medical emergencies within the campus will help in reducing the complications, cost of treatment and mortality in the young adults. Teachers are the second parents of every student as most time is spent with them within the campus.
Barth  emphasizes that students learn when teachers lead and only when teachers learn will students learn. They also act as “change agents,” who could help in developing health consciousness and lending helping hands during any emergency among the students. Empowered teachers are in the best position to empower students. Thus, the aim of the study was to sensitize and train the teachers in the college to be effective and efficient first respondents during any medical emergencies which may occur in the college premises.
The objectives of the study were to
- Evaluate the effect of the Campus Based Emergency Training (CBET) on knowledge and skills of college teachers in the management of selected medical emergencies
- Determine the relationship between knowledge and selected skills among college teachers in the management of selected medical emergencies on CBET
- Determine the association between the knowledge and skills among college teachers in the management of selected medical emergencies and the selected demographic variables.
The hypotheses of the study were as follows:
- H1: There will be a significant increase in the knowledge and skills of college teachers in the management of selected medical emergencies after the CBET
- H2: There will be a significant association between the knowledge and skills of college teachers regarding the management of selected medical emergencies with selected socio-demographic variables
- H3: There will be a significant relationship between the knowledge and skills of college teachers regarding management of selected medical emergencies and the CBET.
The conceptual framework selected for the study was based on the Modified Integrated General System Theory and Roberta StraesseAbruzzese evaluation Model (1992) as shown in [Flow Chart 1]. This model has four steps as levels of evaluation leading from simple (process evaluation) to the complex (impact evaluation). The four main concepts in this model are content evaluation, process evaluation, outcome evaluation and impact evaluation. The system acts as a whole. A dysfunction of a part can cause system disturbance rather than loss of a single function in all the system activity that could be resolved into an aggregation of feedback circuits such as input, throughput and output. The feedback circuits helps in the maintenance of an intact system. In this model, input refers to content evaluation, throughput is the process evaluation and output includes outcome evaluation and impact evaluation.
| Methods|| |
A quasi-experimental (one group pre-test post-test) research design was adopted. The study was conducted in a Womens' Arts and Science College situated in a town in North Tamil Nadu, India. A total of 68 teachers who had worked for more than 6 months and were able to understand and speak English were invited to participate in the study. Of the 68 teachers, 53 teachers were willing to participate and were available throughout the period of study. A written informed consent was obtained from them.
The data collection instrument was prepared by the investigator after extensive review of literature, expert opinion and guidance. It consisted of multiple choice questionnaires for assessing knowledge of the college teachers on selected medical emergencies and also observational checklist for assessing skills in managing them. The instrument consisted of three sections.
Section I: Demographic data
The questionnaire requested information about the participants' demographic characteristics such as age, marital status, educational status, type of family, stream of teaching (indicates the science stream), years of teaching experience and formal emergency training.
Section II: Knowledge questionnaire
The knowledge questionnaire consists of 30 multiple choice questions to assess the knowledge of the college teachers, under the following sub-categories, basic emergency (4 items), emergency management on bleeding (4 items), emergency management on nose bleeding (3 items), emergency management on fracture (5 items), emergency management on sprain (3 items) and Basic Life Support (11 items). The maximum score was 30 and results were converted into percentages and was interpreted as inadequate knowledge (<50th percentile), moderately adequate knowledge (51th–74th percentile and adequate knowledge (75th percentile and above).
Section III: Observational checklist
The observation checklist to assess the skills of the college teachers in managing selected medical emergencies consisted of 40 items. Observation was made on the following sub-categories management of severe external bleeding (12 items), management of fracture of upper extremities (11 items) and cardio-pulmonary resuscitation (CPR) (17 items). The maximum score for management of severe external bleeding was 12 and fracture of upper extremities was 11. The results were converted into percentile and were interpreted as inadequate skill (<50th percentile), moderately adequate skill (51th–74th percentile) and adequate skill (75th and above percentile). The maximum score for skill on CPR was 17, results was converted into percentile and was interpreted as Inadequate skill (<90th percentile) and adequate skill (90th percentile and above).
The content validity of the instrument was done by 6 experts in the field of Community Health Nursing Department and Accident and Emergency Department. The related validity index score (S-CVI/Ave based on I-CVI) for the knowledge and skill assessment tool was established at 0.844 and 0.908 respectively and the reliability score for the same (using Cronbach's alpha reliability) was 0.79 and 0.85, respectively, indicating acceptable and good internal consistency. A pilot study enabled the investigator to test the reliability of the instrument.
Data collection procedure
Permission was obtained from the concerned college to conduct the study. Since the study aimed to also assess CPR the investigator underwent the training and got certified for successfulcompletion of training program on 'CPR'. CBET module was prepared for the intervention of the study based on extensive review of literature and expert guidance.
Campus based emergency training module
The training module included power-point presentation slides for lecture and discussion, a video programme for 25 min and a booklet in English on the management of selected medical emergencies such as severe bleeding, nose bleeding, fracture, sprain and CPR. This training module was validated by the experts in the field of Accident and Emergency and Community Health Nursing and Health Education.
The materials for the demonstration such as roller bandages, triangular bandages required for managing upper arm fracture, gauze pieces, cotton pads to manage bleeding, plasters, scissors, bell, curtains rope, mat, Little Anne for CPR, LCD projector and microphones were provided by the college for the training program.
In order to assist the investigator to carry out the objective structured clinical evaluation (OSCE) stations for evaluation of skills, three Community Health Nursing staff from the department, were trained on skills in the management of severe bleeding and fracture of the upper arm and their skills were verified by the experts in the fields. They were also trained in the organization and conduction of OSCE.
Description of the intervention
A tentative schedule of date, time, venue and the teachers to be relieved to participate in the study was prepared in consultation with the principal and the assigned senior professor. A pre-test self-administered questionnaire was given to assess the knowledge on selected medical emergencies. Instructions were given to the teachers related to the questionnaire. The teachers completed the questionnaire between 30 and 45 min. In order to assess the skills on management of selected medical emergencies, three stations were planned using OSCE. The OSCE consisted of three skill stations and a time period of 5 min for each was given. Thus, the allotted time for each teacher was 15 min to complete all the stations of OSCE. The OSCE stations were manned by three evaluators of which two were nursing staff from the Community Health Nursing Department and the investigator of the study served as the third evaluator who organized the stations. Instructions and scenario were displayed on the table at each station. For the evaluation of the skills observational checklist on the management of severe bleeding, management for fracture of the upper arm and CPR were given for respective evaluators. The OSCE was carried out for three consecutive days. Each teacher was allotted a number (sample number) which was pinned on them. They were rotated around three stations spending 5 min in each station. At each station the teachers were asked to read the instruction and perform the skills. The evaluators evaluated the teachers at each skill station using the observational checklist. After the completion of OSCE, the observational checklist was collected by the investigator from the evaluators. The teachers were welcomed to attend the intervention-CBET programme. This programme was carried out in four sessions. Each session lasted for 30 min. Prior to the day of training, teachers were reminded of their dates and timings as per the schedule. A total number of four groups with 13–15 teachers were included in one group and teachers were assigned to each group according to their department as it was more convenient for them. The first session was on knowledge of selected medical emergencies such as basics of emergency, bleeding, nose bleeding, fracture, sprain and CPR. Seating arrangements were made in seminar hall for conducting the session. The investigator educated the teachers through lecture and discussion using power-point presentation. Video-assisted teaching was done for the second session with the aim of strengthening the learning from lecture and discussion. The third session was demonstration of the selected medical emergencies on the management of severe bleeding and management of upper arm fracture. Each of the skills was demonstrated with the help of a volunteer and each skill demonstration lasted for 10 min. The fourth session was the return demonstration done by the teachers on the selected medical emergencies which was conducted in the same venue. Each of the teachers demonstrated every skill on a volunteer which was observed, corrected and assisted to learn the right way of performing the skills by the investigator. Doubts were cleared and mistakes were rectified. A booklet on CBET was given to each of the teacher at the end of the training session and was asked to read and strengthen their knowledge. The materials needed for the management of severe bleeding and fracture were given to the teachers to practice on each other to refine their skills. Post-test was conducted after an interval of 12 days on the completion of CBET in the same way how the pre-test was conducted.
| Results|| |
This study looked at the effect of CBET on the knowledge and skills related to selected emergencies among college teachers. Amongst those who participated 19 (35.8%) of the college teachers were above 30 years of age, their mean age was 30.53 (standard deviation [SD] = 6.87), 31 (58.5%) belonged to science stream and 22 (41.5%) to arts. Twenty-one (39.6%) subjects had a teaching experience of 1–5 years and 32 (60.4%) had a postgraduation or doctoral degree. Half of the teachers (50.9%) were married, 49.1% were single and 28 (52.8%) lived in nuclear family [Table 1].
|Table 1: Distribution of college teachers according to demographic variables (n=53)|
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The mean knowledge scores during the pre-test was 10.89 (SD = 4.18) and post-test was 24.51 (SD = 25) and the difference was statically significant (P < 0.001). The mean score for skills in the pre-test was 6.26 (SD = 2.79) and the post-test mean scores was 33.92 (SD = 5.32) and the difference was statically significant (P < 0.001) [Table 2].
|Table 2: Mean, median, standard deviation, minimum and maximum scores of knowledge and skills obtained by the college teachers on management of selected medical emergencies (n=53)|
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The significant increase in knowledge was noted in all aspects of selected emergencies such as basics of emergency care, severe bleeding, nose bleeds, sprains and CPR at P < 0.001 [Figure 1].
|Figure 1: Overall mean scores of knowledge on selected medical emergencies.|
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Similarly, a significant increase was found on skills regarding the management of selected medical emergencies after CBET at P < 0.001 [Figure 2].
|Figure 2: Overall mean scores of skills on the management of selected medical emergencies.|
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A significant association was found between knowledge and the stream of teaching among the college teachers in the pre-test and between skills and the stream of teaching among the college teachers in the post-test. No association was elicited between the knowledge or skills and other demographic factors [Table 3].
|Table 3: Association between knowledge and skills among college teachers regarding selected medical emergencies and selected demographic variables|
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There was a weak positive correlation between pre-test knowledge and skills of the college teachers (r = 0.21) that was not statistically significant [Figure 3]. However, a statically significant strong correlation was found between post-test knowledge and post-test skills of the college teachers (r = 0.58) [Figure 3].
|Figure 3: Correlation between knowledge and skills in the pretest and the posttest.|
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| Discussion|| |
The findings of the study revealed that the knowledge and skill of college teachers on selected emergencies were inadequate with the mean scores falling well below the average. It is evident that even the teachers who are generally socially classified as educated lacked knowledge on selected emergencies that could happen with in the learning environment and did not have the skills in managing these emergencies. The significant increase in the post-test scores shows the effect of a well-structured campus based training on teachers' knowledge and skills in managing selected emergencies. Earlier study on effect of training on first aid and basic life support training have shown similar significant improvement in the knowledge and skill of school health personnel. Another study result also showed that training or structured educational teaching improved the knowledge and skills of not only the health personnels or teachers, but also students. Addressing and managing medical emergencies at the right time will save young lives in academic environment and therefore, this study highlights the need for such training in all educational institutions.
The present study findings revealed that there was significant association between the stream of teaching of the teachers and their knowledge in managing selected medical emergencies. Teachers who were involved in teaching science subjects had better scores that those who taught other subjects. In congruent to this finding, Behairy and Al-Batanony  study showed an association between stream of teaching with knowledge and practice as evidenced by significant increase in both good knowledge and correct practice performance in the post-intervention and follow-up of intervention phases belonging to the science stream. The association of the stream of teaching with knowledge is possible due to few debatable factors such as the exposure of the teachers to biological terms during coaching for competitive examinations or terminologies and techniques that could have taught while they were students, or their ability to understand concepts better, and their interest in effective participation. As these factors were not studied in this study one cannot make any definite conclusions on this association.
The interactive sessions and sharing of experience also could have been an important factor for the overall increase in knowledge and skill. The participants expressed that the power-point presentation gave them a deeper insight of the content, the video and step by step demonstration was found to be very effective and the booklet gave them the opportunity to revise, recollect and retain the knowledge and skills gained. A qualitative feedback on the intervention and its effectiveness itself need to be thought of in future studies.
Overall, the study environment became a learning environment for the teachers who participated in the study. Demonstration and peer evaluation (What best has she done? What better she could have done? What steps would she do differently if the same scenario would be given?) Of each skill for each teacher helped them to realize their short comings and motivated them to correct themselves. Co-operation and positive competitive spirit developed during the training session which enhanced the learning desire and utility of their potential.
The teachers took time to practice each skill. The skill of doing bandaging, performing the initial steps of resuscitation and the correct depth of giving chest compressions were the few challenges faced during the training session. OSCE was a novel examining technique to all the teachers even though they were informed about it. During the pre-test, they expressed anxiety mixed with enthusiasm before the assessment. Nervousness struck in the skill station as the subjects were expected to perform time bound tasks. In the post assessment OSCE, the teachers had different opinions. Some verbalized their anxiety on performing the skills correctly and/or getting low scores. Others expressed that they would perform well if tasks were not changed. It was observed that some of the teachers were able to perform each skill confidently within the time allotted, few others missed steps while the rest tried to recollect the steps within the allotted time. However, all subjects verbalized that OSCE was a very good examination technique that they had learned. It gave them all equal time for performing and provided a nonthreatening environment as they felt free to perform with no body to interfere or intrude or correct them in between their task. They also felt the evaluation was fairly done in OSCE. The strong positive significant correlation between knowledge and skill yet gain proved that knowledge and skill are closely related and changing one can change the other. In this study both aspects were effectively covered by CBET. Similar relationship between knowledge and skill of school teachers on management of minor injuries has been found in another study. Although the study was conducted in only one college, the findings provide a glimpse of what the teachers know and what difference a well structure training and assessment can make in teachers knowledge and skills especially related to selected medical emergencies.
| Conclusion|| |
Findings from the present study strongly indicate that a CBET can effectively train and empower teachers to be effective first responders in medical emergencies with in an academic environment. Such training may prove helpful if made mandatory for teachers in any educational institutions.
Financial support and sponsorship
Fluid Research Grant, Christian Medical College, Vellore.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3]