Nurses' Knowledge Concerning Early Interventions for Patients with Ventricular Tachycardia at Baghdad Teaching Hospitals

Abstract


INTRODUCTION
Ventricular tachycardia (VT) is a state in which the heartbeat is quite rapid, if rapid enough ,ventricular tachycardia will not allow the hearts chambers to fill with enough blood between beats to produce blood flow sufficient to meet the body's needs (1) . VT is a type of dysrhythmia which clinically presented with severe cardiac disease where it can give rise for vast heart ventricular rate (2) "Causes of ventricular tachycardia areAcute myocardial infarction, Hypertensive heart disease, Cardiomyopathy, Severe infections, and Myocarditis". (3) Where the bifurcation of the bundle in the specialized conduction system of the heart, is the location of ventricular tachycardia disorder, it occurred when electrical impulse is made not well or conducting it improperly as major pathophysiological phenomenon (4) . Jain, et al., (2009) observed that "three or more extra systoles are termed ventricular tachycardia, Sustained VT (more than about 30 beats) often degenerates into ventricular fibrillation, resulting in death " (5) After resolution of VT, Antiarrhythmic medications, implantable cardioverter-defibrillator (ICD),and Catheter ablation are the options for management but depends on the severity of symptoms and degree of structural heart these treatments used when organic heart illness at current time. The focus converts to how to manage the implicit causes for VT in terms of determining the severity of heart disease, how to prognose, and setting a plan for long time management. early intervention suggested for VT require urgent treatment start cardiopulmonary resuscitation if pulseless, if unconscious and hypotensive DC cardioversion followed by IV lignocaine and DC 200-300 joules monophasic shock, If conscious and hemodynamically unstable DC under short general anesthesia, if hemodynamically stable IV lignocaine 100 mg bolus over 2 min followed by 4 mg/min initially, then reduced slowly over 36 hr, correct hypokalemia, hypomagnesaemia and acidosis (6) . Nurses should have knowledge, experience and information toward patient with arrhythmia and specifically with VT because the patient is usually (although not always) unresponsive and pulseless and need critical care that provided by skilled work team (7) .
Nursing responsibility regarding VTwhich can be listed as follows:  Provide quiet and calm environment. Review reasons for limitation of activities during acute phase.  Demonstrate and encourage use of stress management behaviors,: relaxation techniques, guided imagery, slow/deep breathing  Investigate reports of chest pain, documenting location, duration, intensity (0-10  scale), and relieving or aggravating factors. Note nonverbal pain cues: facial grimacing, crying, and changes in BP/heart rate.  Be prepared to initiate cardio-pulmonary resuscitation (CPR) as indicated  Monitor laboratory studies, Electrolytes, Drug levels.  Administer supplemental oxygen as indicated  Administer medications as indicated(Potassium, Antidysrhythmics, cardiac glycosides)  Prepare and assist with elective cardioversion  Insert and maintain IV access.  Prepare for invasive diagnostic procedures and surgery as indicated. Prepare for implantation of cardioverter or defibrillator (ICD) when indicated (8) .

OBJECTIVES
The study aims to assess nurses' knowledge regarding early intervention for patient with ventricular tachycardia and finds out association with their demographic characteristics.

METHODOLOGY:
Descriptive design has been done on 50 samples from nurses. The study was carried out to identify nurses' knowledge concerning early intervention for patients with ventricular tachycardia in Baghdad teaching hospitals.Baghdad teaching hospital/ medical city directorate and Ghazi Al-Hareeri for specialized surgeries hospital/medical city directorate at critical care units (including emergency care units, intensive care units, and coronary care units).
In order to obtain comprehensive data a specifically a questionnaire is constructed by the researchers according to reviewing literatures related to the topic of the study. It is consist of two parts: Part I: consists of socio-demographic characteristic consist of (9) items Part II: consists of (23) items to measures nurses knowledge concerning early intervention for patient with ventricular tachycardia. An official requestare issued and submitted through the college of nursing /University of Baghdadto obtain permission for data collection to Baghdad teaching hospitals. Validity of questionnaire determined through panels of experts and Reliability of the questionnaires was determined by internal consistency through calculating Cronbach s' Coefficient alpha = 0.803 A non-probability (purposive) sample of 50 nurse taken from above -mentioned hospitals. The data collection phase took two months from the first January 2016 to the end of March 2016.data was collected by using Self report method. Descriptive data analysis was done through (frequency, percentage, mean, standard deviation and cut-off point was as follows and inferential data analysis was done by Mann-Whitney testand Kruskal-Wallis test) through application by SPSS version 20.  F= frequency %=percentage This table shows nearly two thirds (64.0%) of studied sample were males (64.0%), roughly half (48.0 %) of them were within age group (25-28),high percentage of studied sample were married (62%), also high percentage of them was graduated bachelor degree (62.0 %), less than half of them were at intensive care unit (48.0 %), the vast majority (80.0%) of the present sample was within (1-3) as experience at above mentioned workplace, three quarters (76.0%) of studied sample have experience within (1-4years) category, also three quarters of them have training inside country (74.0%), and high percentage (86.0%). of current studied sample have no training sessions outside country .  This table shows that nurses knowledge related to early intervention was low level on one hand, that assessment level was low for two thirds of studied sample (66.0%), on the other hand rest of them have middle level according to their responses. It can be seen clearly from this table that there is statistically significant association between studied sample's knowledge scores and age groups at significance level (0.05). Also this table shows that there is no statistically significant relationship between other dichotomous demographic variables otherwise age groups which are (gender, training sessions inside, and training Sessions outside) at significance level (0.05). It can be shown markedly from this table that there is statistically significant relationship between marital status, and experience at nursing profession with sample's knowledge scores at significance value (0.05). As well as, this table shows that there is no statistically significant association between following demographic variable (educational level, workplace at hospital, and experience years at above-mentioned workplace at hospital) and knowledge scores for studied sample at significance value (0.05).

DISCUSSION:
Throughout the course of the data analysis of present study, the findings show that nearly two thirds of studied sample were males (64.0%), related to age group(48.0 %) of them were within age group (25-28), concerning the marital status more than half of them were married (62%), as regards to educational level high percentage of them was graduated bachelor degree (62.0 %), nearly half of them were at intensive care unit (48.0 %), and the vast majority (80.0%) of the present sample was within (1-3) as experience at above mentioned workplace, three quarters (76.0%) of them have experience within (1-4years) category, also three quarters of them have training inside country (74.0%), and high percentage (86.0%). of current studied sample have no training sessions outside country.
As regards to data analysis, the present study illustrated that the overall assessment of nurses knowledge about VT was low, the high percentage 66.0% of nurses their knowledge less than 50%;This finding disagreed with the study result submitted by (Mohan Sanacy,2010) who found that 88.88% of nurses have above average level of knowledge regarding interpretation of life threatening arrhythmias and its emergency management (9) .While it's reinforced by Raines and Keller (2005) who conducted a study to identify critical nurses' perception of arrhythmia knowledge that there is a deficit in nurses' ability to recognize and identify specific arrhythmia (10) .
Our findings explore that there's significant relationship between marital status of the studied samples and their knowledge scores at p value 0.05 in addition to if we see that most of studied samples are single. This can be attributed to that single persons have less responsibility in their life and have more time and they can continue reading articles, scientific facts and more curious than others ,thus they have more knowledge.
This study demonstrated that there is statistically significant association between studied sample's knowledge scores and age groups at significance level (0.05).), this agreed with a study done to identify Impact of a designed teaching protocol about Advanced Cardiac Life Support (ACLs) On critical care nurse's knowledge and practices, The study showed a positive correlation between knowledge, practice and age with a highly statistical significant (11) .Also our present studyhas found a statistically significant association between studied sample's knowledge scores and experience at nursing profession that supported by following studies that confirm years of experience at clinical practice has impact on nurses' knowledge ,skills ,and experience (12-13) .

CONCLUSIONS
The nurses' knowledge showed low level regarding anatomy and physiology items according to studied sample questionnaire. Also there was a poor knowledge regarding disease related items according to studied sample questionnaire. There was a deficient knowledge regarding detection of disease items according to sample questionnaire. The sample knowledge was low regarding nursing management items according to studied sample questionnaire. In general the overall assessment of samples knowledge was low. There was strong relationship between studied sample's knowledge scores and age groups, marital status, and experience years at nursing profession while there is poor relationship between other demographic variables like (gender, training sessions inside, and training Sessions outside) and sample's knowledge scores