A PROGRAMME TO ENHANCE KNOWLEDGE ON GLASGOW COMA SCALE AMONG THE NURSES

Background and objective: ToAssesstheknowledge gain after use of Coma Scale among the nurses The aim of the study was to determine the existing knowledge on Glasgow Coma Scale and the impact of Intervention regarding the Glasgow ComaScale in terms of knowledge enhancement. Methods: Pre-experimental One group pre-test post-test evaluative study comprising 40 nurses selected with lottery method was done with a Questionnaire. On the first day pre test was conducted using knowledge questionnaire regarding Glasgow Coma Scale and the Self Instructional Module were then given to the respondent on the same day after completion of the pre test. The post test was conducted on the 8th day. Results: The study findings revealed that mean pre-test knowledge score was 12.600 with SD 4.754 and mean post-test knowledge score Association between pre-test level of knowledge and age: Association of pre test knowledge on Glasgow Coma Scale with selected socio demographic variables such as age, professional qualification, working experience was computed by using person chi-square at p<0.05 significant level.The data shows that Chi square = 14.311, at p=0.26 whichinfers that there is a significant relationship between pre test level of knowledge and the age of the nurses. There is no significant relationship between pre test level of knowledge and the professional qualification.The data shows that Chi square = 15.645, significant (2 tailed) p=0.0004 which infers that there is relationship between pre test level of knowledge and working experience.

consciousness can be assessed in severely ill, comatose, or anesthetized people, and how to treat conditions in which consciousness is impaired or disrupted. 2 There are several tools used for assessing and monitoring the consciousness of the clients in critical units as well as other units. One such widely and universally accepted tool isthe GlasgowComaScale,anassessmenttooldesignedtonotetrendsinaclient'sresponsetostimuli. 3 This scale was first developed byGraham Teasdale and Bryan J. Jennet in 1974 at the University of Glasgow, Scotland, as a practical tool to measure depth and duration of impaired consciousness. 4 The GCS is measured in three Components: Eye opening(E), Verbal responsiveness(V) andMotorresponsiveness(M).Thescorefromeachcomponentisaddedtogetatotalscorewhich determines the state of consciousness of the patient. The maximum score 15 indicates a patient is fully alert and the minimum score 3 indicates a patient is deeplyunconscious.
The Glasgow Coma Scale gives a reliable, objective way of recording the conscious state ofapersonforinitialaswellassubsequentassessment. 7 TheGCSwasinitiallyusedtoassesslevelof consciousness after head injury but now it is used by first aid, EMS(emergency) nurses and doctors aswell.However,theGCSisnotwithoutitslimitations.Ithaslimitedapplicabilityinchildrenand there is an increasing evidence that problems are encountered in completing some aspects of the GCS (Waterhouse, 2008) 17 ,further its ease of use allows for misinterpretation (Addison and Crawford,1999 Hence, a nurse through knowledge on Glasgow Coma Scale is very important to save life of the patients. In view of the significance evaluation of GCS for determining the client improvement a study has been undertaken to enhance nurse's knowledge on Glasgow Coma Scale with the help of a Self Instructional Module developed on Glasgow Coma Scale amongnurses working inGauhati Medical College & Hospital (GMCH). Another objective of the study was to find out the association between pre-test knowledge and demographic variables like age, professional qualificationand workingexperience.

Material and Methods:-
The study is aimed at finding out the improvement ofKnowledgeon Glasgow Coma Scale among the Nurses working in Gauhati Medical College and Hospital, Guwahati, Assam, India after implementation of a Self-Instructional Module. The study was conducted by using one group pre test -post test pre-experimental research design. The 40 samples were drawn with the lottery method. The data was collected with -Demographic profile (age, professional qualification, working experience) and Knowledge questionnaire on GCSand a self instructional module was developed. The reliability of the tool was found r=0.86 for the knowledge questionnaire.
Administrative permission and institutional ethical committee approval was obtained prior to the collection of the data. The confidentiality of their identity and responses are assured in order to insure their co-operation and prompt responses. The pre-test structured knowledge questionnaire was administered to the nurses after obtaining consent. Self-Instructional Module was then given on the same day after completion of the pre test.
Post test was administered to the nurses using the same knowledge questionnaire on the 8 th day.

Result and Analysis:-
The data was collected at GMCH from 40 nursing personnels. The study findings were presented in the following tables: Most ofthesamplebelongstotheagegroup31-40years52% followed by age group 21-30 years 30% and only 5% belong to the age group 51-60years. Maximum participants were having GNM as educational background. Among them 37.5% of the nurses have more than 10 years of working experience followed by 32.5% of the nurses have 3-5 years of work experience and the rest 30% have 6-10 years working experience.  In order to establish the significance of difference between the mean of pre test and post test knowledge scores regarding the Glasgow Coma Scale among the nurses working in Gauhati Medical College and Hospital 't' value was computed, the result shows that 't (39) = -10.339, p=0.000,p<0.05. It indicates that post testknowledge scores due to intervention; the Self Instructional Module is significantly higher than that of the pre-intervention scores.

Association between pre-test level of knowledge and age:
Association of pre test knowledge on Glasgow Coma Scale with selected socio demographic variables such as age, professional qualification, working experience was computed by using person chi-square at p<0.05 significant level.The data shows that Chi square = 14.311, at p=0.26 whichinfers that there is a significant relationship between pre test level of knowledge and the age of the nurses. There is no significant relationship between pre test level of knowledge and the professional qualification.The data shows that Chi square = 15.645, significant (2 tailed) p=0.0004 which infers that there is relationship between pre test level of knowledge and working experience.

Discussion:-
The GCS is a tool that, with education, is simple to use, highlights changes in the patient's conditionandallowsnursesanddoctorsworkingindifferent hospitalstocommunicate thepatient's state of consciousness in a clear and objective way'. Addison and Crawford (1999) recommend that all new staff to be taught how to apply the GCS tool in clinical practice. This should be extended to all healthcare practitioners involved in the care and management of potentiallyvulnerableandunconsciouspatients,andshouldapplytoallneurologicalobservations. (Addison and Crawford1999) 18 The present study was conducted to assess the effectiveness of Self Instructional Module on Glasgow Coma Scale among the nurses working in Gauhati Medical College and Hospital, Guwahati,Assam.Before administration of SIM the nurses were given knowledge questionnaire in order to assess their existing knowledge. The overall knowledge score revealed that 7(17.5 %) had inadequate knowledge, 29(72.5%) had moderate knowledge and 4(10%) had adequate knowledge. The mean score obtained to be 12.60,which showed that the nurses had moderately adequate knowledge regarding the Glasgow Coma Scale. The study has been supported by studies like Batool  survey method with an aim to explore 3 rd year nursing students understanding the Glasgow Coma Scale. A convenientsampleof65,studentswasselectedfromuniversityfacultyofnursinginScotland. The study revealed that most respondent (n = 24, 62 %) were not confident in practical use of the Glasgow Coma Scale. However, they wanted to improve their theoretical knowledge as well as their practicalskill.
Catheryne Waterhouse (2008) 17 conducted an observational study to assess and evaluate registered nurses baseline knowledge to review the recording of Glasgow Coma Scale in neuroscienceareascomparedwithnonspecificunitsstudywasconcludedthatthoughseveralareas for improvement were identified but still nurses were failed to give response to the path, physiological understanding the 3 componnents that makes the scale. This study also recommended that a basic knowledge of physiology through local training might enable the practitioner to identify more suitable signs of altered level ofconsciousness. 3 It was observed that majority of the nurses have inadequate knowledge.This shows that educational intervention is required for the improvement of knowledge of the nurses.

Conclusion:-
It was observed from the study findings that majority of the participant's pre-test was moderately adequate and only 10%had adequate knowledge. But the knowledge of the nurses have significantly improved after the administration of Self Instructional Module as evident from the obtained't' value (p=0.000 <0.05). So it can be concluded that the present study participants benefited by Self Instructional Module. It was also found statistically that there is a significant association between nurses' pre-test knowledge and age and working experience.To produce competent and knowledgeable nurse, emphasis should be made on in-service education program and frequent evaluation of nurses' performances which will help in proper assessment and 690 management of clients through monitoring and formulating early diagnosis. Nursing supervisors and incharges should take the initiation to continue staff development program in the unit.

Source of Funding:
Nil.