INTRODUCTION:

Health and time are two valuable resources that we do not notice or appreciate until they are depleted. Health is defined as a condition of complete physical, mental, and social well-being, rather than simply the absence of disease or infirmity. Most living things require oxygen for survival. Oxygen allows organisms to grow, reproduce, and convert food into energy. Humans obtain oxygen by breathing via their nose and mouth into their lungs. Oxygen allows our cells to break down food in order to obtain the energy we require to survive⁴. End-tidal capnography is the graphical measurement of the partial pressure of carbon dioxide (in mm Hg) during expiration. Established in the 1930s, clinical usage of EtCO2. First established in the 1930s, clinical use of EtCO2 measurement became accessible in the 1950s with the production and distribution of capnograph monitors².

With continuous technologic advancements, EtCO2 monitoring has become a key component in the advancement of patient safety within anaesthesiology, and the American Society of Anaesthesiologists (ASA) has endorsed end-tidal capnography as a standard of care for general anaesthesia and moderate or deep procedural sedation. Monitoring of end-tidal carbon dioxide (ETCO₂) during CPR was first reported by Kalenda who studied three cardiac arrest patients and reported that ETCO₂ decreased when the compressor got tired and that ETCO₂ increased significantly after return of spontaneous circulation (ROSC)^5. Ten years later, Gudipati et al. reported that ETCO₂ monitoring during CPR may indicate ROSC and the effectiveness of cardiac massage, and may serve as a prognostic indicator of CPR success. Since then, numerous human and animal studies have shown the usefulness of ETCO₂ during CPR and the significant difference in its values between survivors and non-survivors. End-tidal carbon dioxide levels are strongly correlated with cardiac output, myocardial blood flow, aortic diastolic pressure, coronary perfusion pressure, cardiac index, and cerebral perfusion pressure. It may also provide information on ventilation and tissue metabolism. As a result, both the European Resuscitation Council (ERC) and the American Heart Association (AHA) recommend the use of capnographs in advanced CPR. The purpose of this review is to present the benefits and effectiveness of using ETCO2 during CPR, as well as the technique's significant drawbacks⁶.

Over time, intraoperative ventilation techniques have evolved. As a result, desired end-tidal carbon dioxide (ETCO2) levels in patients undergoing general anaesthesia may have changed as well. ETCO2 levels are known to affect many organ systems, which may influence postoperative outcomes. However, there is a lack of research on intended ETCO2 levels and how they fluctuate over time. As a result, we analysed the practice pattern of ETCO2 levels with time using a large multicentre perioperative database. A typical capnograph has a square-wave pattern that starts in the inspiratory phase (peak expiratory CO2 (PECO2) = 0 mmHg) and continues until the expiratory phase. Patients presenting in the emergency room require a quick and reliable assessment of their respiratory state. End-tidal carbon dioxide is one of the strategies utilized to do this in intubated patients. Side stream end-tidal carbon dioxide may be a non-invasive, fast, and reliable predictor of arterial pCO2 in non-intubated patients in respiratory distress. Patients who present to the emergency department must have their oxygenation, breathing, and acid-base balance checked thoroughly. Pulse oximetry and capnography are two non-invasive methods for instant and continuous monitoring⁷.

NEED FOR THE STUDY:

ETCO2 concentration is a good indicator of successful heart compression during CPR, which is related to cardiac output. The first indicator of spontaneous circulation (ROSC) during CPR is an increase in ETCO2, hence monitoring ETCO2 gives highly helpful information to guide treatment during CPR. ETCO2 is a trustworthy indication with a strong predictive value for predicting CPR result. According to studies, cardiac arrest is connected with death in patients with an ETCO2 of 10mmHg or below. Death occurs after 20 minutes of CPR if ETCO2 remains persistently below 10 mmHg, with 100% sensitivity and specificity⁸. ETco2 predicts ROSC more accurately than cerebral oxygen saturations (rSO2). Confirmation of endotracheal intubation is critical in airway treatment in the emergency department, yet there is no definitive diagnostic technique to confirm proper intubation. Capnography was recently adopted as the gold standard for determining the proper positioning of the endotracheal tube. Colorimetric ETCO2 is a safe, dependable, easy, and portable instrument for determining the appropriate insertion of an endotracheal tube in stable hemodynamic patients, and it is especially useful when a capnograph is not available³.

However, when patients use a bag or mask ventilation or consume fizzy beverages or antacids, the test can produce a false positive result, although it normally returns the correct result after 6 breaths. Using sodium bicarbonate results in a greater level of ETCO2 for 5 to 10 minutes. During a cardiac arrest, which causes a decrease in tissue-pulmonary CO2 transfer, capnography may indicate a valid intubation as a false negative. Capnography is an effective approach for diagnosing early respiratory depression and airway abnormalities, particularly during sedation, which leads to less significant sequelae. Capnography improved patient safety under sedation⁹. Oxygen prescription has no influence on the respiratory function parameters measured by capnography. It detects decreased airway function faster than any other technology, 5 to 240 seconds before pulse oximetry. Capnography is more sensitive than clinical evaluation in diagnosing respiratory failure; for example, in many situations where apnea occurred during sedation, doctors at the bedside did not recognize the apnoea, but capnography did.

Hypoventilation in obstructive airway conditions can result in shortness of breath and hypercarbia. There is a link between ETCO2 and partial arterial carbon dioxide (PaCO2) in patients with acute asthma in the emergency department. Capnography is the dynamic monitoring of patients with acute respiratory distress syndromes such as asthma, chronic obstructive pulmonary disease (COPD), bronchiolitis, and heart failure. Bronchospasm is associated with a prolonged expiratory phase (E1, E2, E3) in capnograms in individuals with obstructive disorders like COPD. ETCO2 and expiratory phase slope changes were associated with (E1, E2, E3) forced expiratory volume in one second (FEV1) and peak expiratory flow rate (PEFR). ETCO2 is an essential tool for determining the severity of obstructive respiratory illness in the emergency room.¹⁰ ETCO2 is higher in COPD exacerbation patients admitted to the hospital than in those discharged from the emergency department.

End-tidal carbon dioxide cannot rule out serious injury in patients who match the trauma care criteria. Low ETCO2 levels (≤30 mmHg) may increase the risk of serious traumatic injuries. Because there is a negative link between pre-hospital ETCO2 and traumatic fatality rates, ETCO2 can be used to improve triage while also assisting emergency medical care personnel in organizing patient transfers to the proper trauma centre. Low ETCO2 levels are strongly associated with shock in trauma patients and indicate the severity of the patient's condition within the first six hours after admission.
I believe that ETCO2 monitoring is an important element of the nursing profession. As a result, I decided to focus my research on ETCO2 monitoring¹¹.

STATEMENT OF THE PROBLEM:

To assess the effect of planned teaching programme on knowledge regarding the End-Tidal Carbon Dioxide Monitoring among Nursing students in a selected College in Mumbai.

OBJECTIVES OF THE STUDY:

· To assess the knowledge regarding ETCO₂ Monitoring among the student nurses before and after planned teaching.

· To compare the effect of planned teaching programme on knowledge regarding ETCO₂ Monitoring among the student nurses.

· To find the association between knowledge and demographic variables regarding ETCO₂ Monitoring among the student nurses.

HYPOTHESIS:

H₁: There will be a significant difference between pre-test and post-test knowledge scores of students regarding ETCO₂ Monitoring.

H₂: There will be a significant association between pre-test knowledge scores of students regarding ETCO₂ Monitoring with their selected demographic variables.

Operational definitions:

· Assess

It refers to the evaluation of the level of knowledge regarding ETCO₂ Monitoring among the student nurses.

· Effectiveness

It refers to the significant gain in knowledge regarding ETCO₂ Monitoring among the student nurses by planned health teaching.

· Structured teaching programme

It refers to significant planned teaching programme designed to impart information regarding ETCO₂ Monitoring among the student nurses.

· Knowledge

It refers to the information and skills acquired by the student nurses through structured teaching programme.

· ETCO₂ Monitoring

End-tidal carbon dioxide (ETCO₂) monitoring provides valuable information about CO2 production and clearance (ventilation). Also called capnometry or capnography, this non-invasive technique provides a breath-by-breath analysis and a continuous recording of ventilatory

RESEARCH METHODOLOGY:

In this study, a descriptive technique was utilized to describe nursing students' current knowledge of ETCO2 monitoring. The evaluation approach assisted the investigator in determining the impact of a structured teaching program on nursing students' knowledge of ETCO2 monitoring. This study used a one-group pre-test and post-test design. The study was done among nursing students at the designated college. 30 nursing students were chosen using the non-probability convenient Sampling Technique.

Validity:

The content validity of the tool was assessed by specialists in their respective domains, including six from medical surgical nursing and four from paediatric nursing. Following professional ideas and opinions, pertinent improvements were incorporated, along with any necessary modifications.

Reliability:

The reliability of the questionnaire was established using the test-retest method and split half method. The reliability was calculated by spearman’s rank correlation formula. A high correlation coefficient o r = 0.850 was obtained indicating the tool was reliable.

Setting of the Study:

Setting is defined as a physical location and condition in which data collection takes place. The Study was conducted at selected nursing colleges.

Population:

The word population refers to the total set of humans (or objects) who share some traits. The population is the total group to which the researcher generalizes the study findings. In the current study, the population consisted of third-year GNM and BSc nursing students at a specific nursing college.

Target Population:

The target population is the aggregate of cases about which the researcher would like to generalize.The entire population in which the researcher was interested and in which they would like to generalize the research finding.The target population of this study consisted of third year GNM and BSc nursing students at selected nursing college, who meet inclusion and exclusion criteria.

Accessible Population:

The accessible population is the aggregate of the cases that cases that conform to designated criteria and that are accessible as the subjects for the study. In this study the accessible population consisted of third year GNM and BSc nursing students at selected nursing colleges.

Sample:

A sample is the subgroup of individuals in the population, usually proportionately few in number, selected so as to be, to some degree, representative of the population.

In this study, the sample consisted of the school teachers working in the rural areas.

Sample Size:

Sample size consisted of 30 third year GNM and BSc nursing students at selected nursing colleges.

Sampling Technique:

Sampling is the process of picking a subset of the population to represent the whole population. The sample is a subset of the population of interest chosen for participation in this study.

Sampling technique is an important part of the research process. It is the process of selecting representative units or subgroups of a study population for research purposes. A non-probability convenient sampling strategy was employed to choose the sample. On-probability convenient sampling comprises selecting the most conveniently available individuals as subjects for the study. It symbolizes a typical condition and study knowledge about his community, and its components can be utilized to handpick cases. The investigator chose samples from various nursing colleges.

MAJOR FINDING OF THE STUDY:

Sample characteristics:

1. Majority of the student nurses (16.6%) were in the age group of 17-18 years, (60%) were in the age group of 19-20 years, (16.6%) were in the age group of 21-22 years and (6.8%) were in the age group above 22 years.

2. Majority of student nurses (43.3%) were Christians, (36.6%) were Hindu’s, (13.3 %) were Muslim’s and (6.8%) others

3. Majority of student nurses are (60%) of GNM with science background and (40%) of GNM without science back ground

Knowledge on ETCO₂Monitoring

1. Majority of the student nurses (22) were not aware about cord blood stem cell banking as they scored below 50% in the pretest.

2. Majority of the student nurses (27) scored above 50% in the post test, which shows the planned teaching was effective.

3. Over all post test knowledge score were higher as compared to pretest knowledge scores.

4. Post test knowledge was excellent compared to pretest which shows the planned teaching was effective.

5. The association between the knowledge and Age. (Chi square 21.99), but there is no significant association between knowledge regarding cord blood stem cell banking and religion (Chi square 6.11), and Qualification (Chi-square 5.4).

6. The mean of the post-test (71) is higher than the mean of the pre-test (39) and the ‘t’ value (9.92) is significant showing the effectiveness of the planned teaching Programme

Effect of Planned Teaching on Knowledge:

The mean difference of pre-test and post-test knowledge scores was = 32

The calculated’ value (14.58) was greater than the table value of 9.92 Which suggest that Planned Teaching Programme was effective in increasing the overall knowledge of the sample.

Hence null hypothesis was rejected and research hypothesis was accepted showing that there is significant difference between pre-test and post-test knowledge scores after Planned Teaching Programme.

RECOMENDATION FOR FURTHER STUDY:

· An observational study also can be done on ETCO₂Monitoring, where only practice can be assessed.

· A similar study can be replicated on a large scale. It can help to draw more definite conclusions and make generalizations.

· A comparative study could be done to assess the effectiveness of other teaching modalities like self-instructional information booklet on the topic.

· A comparative study could be done between two groups to establish the effect of planned teaching programme.

· A study can be conducted over a longer period of time to assess the effectiveness of planned teaching regarding ETCO₂Monitoring.

PERSONAL EXPERIENCE:

The current investigation provided the researchers with valuable learning experiences. The researchers gained firsthand experience dealing with all aspects of research. The researchers received the necessary cooperation from all of the student nurses who participated in the study.
The guide's quick assistance and instruction helped the researcher to overcome all of the first barriers and successfully complete the study.

CONCLUSION:

· The study revealed that the planned teaching is and effective means to improve the knowledge of student nurses on ETCO₂Monitoring.

· It is essential to have a regular in-service education programme for student nurses to improve their knowledge.

· Knowledge of the student nurses in selected college were inadequate before the planned teaching programme was conducted. There was a significant association in gain in knowledge among the student nurses with a selected demographic variable.

· Over all the entire study was carried out smoothly and gave a feeling of satisfaction and accomplishment. The finding of the study proved that the teaching through planned teaching is really effective to increase the knowledge and practice of student nurse

REFERENCE:

1. Harigopal S., et al, literature review of End-tidal carbon dioxide monitoring in neonates 2018 available from, https://www.infantjournal.co.uk/pdf/inf_020_cts.pdf.

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8. Justin T Hamrick et al End-Tidal Carbon Dioxide–Guided Chest Compression Delivery Improves Survival in a Neonatal Asphyxial Cardiac Arrest Model 2018 available from, https://pmc.ncbi.nlm.nih.gov/articles/PMC5669831/

9. Bhavani Shankar Kodali et al Capnography during cardiopulmonary resuscitation: Current evidence and future directions 2014 available from, https://pmc.ncbi.nlm.nih.gov/articles/PMC4231274/

10. Nik Hisamuddin et al The use of capnometry to predict arterial partial pressure of CO2 in non-intubated breathless patients in the emergency department 2010 available from, https://pmc.ncbi.nlm.nih.gov/articles/PMC3047830/

11. Stratil P, et al a review A retrospective observational study of Initial end-tidal carbon dioxide as a predictive factor for return of spontaneous circulation in no shockable out-of-hospital cardiac arrest patients, 2023 available at https://pubmed.ncbi.nlm.nih.gov/37530717

Received on 28.09.2024 Revised on 07.12.2024

Accepted on 20.01.2025 Published on 28.02.2025

Available online from March 26, 2025

A and V Pub Int. J. of Nursing and Med. Res. 2025; 4(1):20-24.

DOI: 10.52711/ijnmr.2025.04

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