INTRODUCTION:

Background of the study:

Endotracheal intubation is a routine procedure in ICU and is often lifesaving. Tracheal intubation or Endotracheal intubation is a routine procedure in ICU and is often life saving. However life threatening complications occurs in significant procedures making ET perhaps one of the most common but unappropriated airway emergency in ICU. In 1778, Dr. Charles Kite is credited with developing the first endotracheal tube.¹ In 1913 the first anesthetic laryngoscope was invented by Jackson and modified by the Magill, Miller and Macintosh. In 1942, curare was introduced as a muscle relaxant for abdominal relaxation during general anaesthesia and endotracheal intubation became routine in major abdominal surgeries.²

According to American Association of Critical Care Nurses (AACN) defines the critical care nursing as that specialty dealing with human responses to life threatening problems. Critical care nurses care for patients with acute unstable physiologic problem, and their caregivers.³The special unit are designed to cater the extreme ill or injured or life threatening conditions for the closed observations, continuous monitoring, intensive care medicines, support from staff and highly advanced equipments that keeps the patients normal body functioning ongoing.⁴The intensive care team uses various type of breathing aids used to maintain the breathing support like nasal prongs, various types of masks, T tubes, endotracheal intubations and tracheostomy.⁵To facilitate the placement of the endotracheal tube, general anaesthesia induction is applied to patients who will be operated and have sufficient fasting time.⁶

Tracheal intubation usually referred to as intubation is the placement of flexible tube in to the trachea (wind pipe) to maintain an open airway through which to administer certain drugs, this procedure is meant to be performed within special units. Endotracheal tube forms an open passage in the upper airways. Intubation without medication to trauma patients with high GCS is not safe, resulting in intracranial pressure increase, vomiting, esophageal intubation and aspiration risk.⁷

Endotracheal intubation can occur in up to 60% of critically ill patients. Despite the frequency with which endotracheal intubation occurs, the current practice is largely unknown. To be able to ventilate the lungs, the air must be free to enter and exit the lungs. Some patient have to be admitted in ICU because they cannot breath on their own and require respiratory support through a machine as a ventilator to continue breathing. The intensive care team uses various type of breathing aids used to maintain the breathing support like nasal prongs, various types of masks, T tubes, endotracheal intubations and tracheostomy. One of the major procedure performed to maintain the ventilation of the patient is endotracheal intubation. The handled tube is a flexible plastic tube which is called endotracheal tube placed on the trachea and has a cuff part that can be inflated with air to prevent airway leakage. To facilitate the placement of the endotracheal tube, general anaesthesia induction is applied to patients who will be operated and have sufficient fasting time.

Patients requiring intubation have at least one of the following four indications:

1. Inability to keep airway open (Dislocation of the tongue toward the pharynx, obstruction of the upper respiratory tract, obstructive sleep apnea, burns).

2. Failure to protect airway from aspiration (oral and nasal bleeding in trauma patients, secfe4tions, fullness of stomach, gastroesophageal reflux).

3. Ventilation failure (abnormalities in airway anatomy: short neck, wide mandible, the upper jaw being in front, mandible being behind, small mouth, obesity) and difficult mask ventilation may be accompanied with difficult intubation.

4. Insufficiency in oxygenation (cyanosis, insufficiency of chest wall movements, presence of obstruction findings in lower respiratory tracts in auscultation, gradual decrease of saturation, inadequacy of spirometric and expiratory measurements).

The most common complications of endotracheal intubation at the bedside is life – threatening hypoxemia, hypercapnia, laryngospasm, bronchospasm, VAP, fractured teeth, laryngeal damage, otitis media, herniation of cuff through vocal cords. Despite regular preoxygenation, a desaturation can develop. For this reason, various strategies have been developed for the preoxygenation period when the patient is intubated.⁸

Care of patients with endotracheal intubation:

a. Maintaining correct tube placement:

b. Maintaining proper cuff inflation:

c. Monitoring oxygenation and ventilation:

d. Providing oral care and maintain skin integrity:

e. Meeting nutritional needs of the patients:

f. Prevention of infection:

g. Promoting communication:

h. Assessing pain and sedation needs

Complications of Endotracheal intubation:

1. Damage to teeth and dental work in oral intubation.

2. Nose bleeding in nasal intubation

3. Mistaken insertion of the tube in the food pipe

4. Aspiration

5. Cardiovascular problems

6. Spinal cord injury

7. Failed intubation that may need surgical opening through the neck into windpipe

8. Blockage or kinking of tube

9. Dislodgement or falling out of the tube after insertion

10. Advancement of tube in to a bronchus

11. Problems related assisted ventilation

12. Ulceration of lips, mouth, pharynx or vocal cords

13. Tongue numbness

14. Laryngitis, sore throat

15. Vocal cord paralysis

16. Vocal cord synechia

17. Tracheal stenosis.

RESEARCH PROBLEM:

A Quasi – Experimental Study to Assess the Effectiveness of Demonstration and Video Assisted Teaching Regarding Endotracheal Intubation And Its Long Term Complications Among The Students Of B.SC (N) 2nd Year of Different Nursing Colleges of District Kangra, Himachal Pradesh.

OBJECTIVES:

a. To assess the pre - test knowledge score of nursing students regarding endotracheal intubation and its long term complications.

b. To assess post - test knowledge score of nursing students regarding endotracheal intubation and its long term complications.

c. To compare pre – test and post – test knowledge score among different colleges of district Kangra, Himachal Pradesh.

d. To find association between level of post – test knowledge with selected socio demographic variables.

Hypothesis:

H₀: There will be no significant difference between pre-test and post-test knowledge score of the nursing students on endotracheal intubation and its long term complications.

H₁: There will be a significant difference between pre-test and post-test knowledge score of the nursing students on endotracheal intubation and its long term complications.

REVIEW OF LITERATURE:

Oren Feldman, Nir Samuel, Noa Kvatinsky, et al (2021):

Conducted a randomized crossover manikin study in a simulation laboratory of neurobiology department in Israel on 18 paramedics participants using a box barrier and actively working in the clinical environment regarding endotracheal intubation of COVID-19 patients. Study participants were 18 paramedics and two groups were divided 9 DL (Direct laryngoscopy) group and 9 Box DL group. The study shows no significant difference between these groups in one attempt success rate (14/18 vs 12/18; P = 0.754) and in over all success rate (16/18 vs 14/18; P = 0.682). the mean SD of the total intubation times for the DL group and the BoxDL group were 27.3 seconds and 36.8 seconds respectively. The finding of this pilot study suggest that paramedics personal protective equipment can successfully perform ETI using a barrier box, but the intubation time may be prolonged. The applicability of these findings to the care of COVID – 19 patients remain to be investigated.⁹

Mrs. Kirti Bakshi (2020), conducted a pre experimental study to assess the effectiveness of planned teaching programme on knowledge regarding nursing care during intubation and suctioning of a patient with endotracheal tube among B.Sc nursing students of selected nursing colleges of Indore. In this study evaluative research approach was used. Research design was pre experimental one group pre-test post – test research design. Probability sampling method was used to collect the sample consisted of 60 students. The study was conducted in Indore M.P sixty. The study concluded that the mean post-test knowledge score (24.75) was higher than the mean pre – test knowledge score (16.37). The dispersion of pre-test score is less than that of post test score and paired ‘t’ test is 15.321 and the mean difference was 8.35 which computed significant difference between pre-test and post-test knowledge score.¹⁰

RESEARCH METHODOLOGY:

RESEARCH APPROACH:

Quantitative research approach.

RESEARCH DESIGN:

A quasi – experimental research design.

RESEARCH SETTING:

The present study was conducted in selected nursing colleges of District Kangra Himachal Pradesh.

Target population:

All the B.Sc (N) 2^nd year students studying in selected colleges of District Kangra.

Sample size:

80 Nursing students.

Sampling technique:

Convenient sampling technique.

Variables Under Study:

a. Independent variables:

Demonstration and Video assisted teaching.

b. Dependent variables: Knowledge regarding endotracheal intubation and its long term complications among the students of B.Sc (N) 2^nd year of different nursing colleges of district Kangra, Himachal Pradesh.

c. Demographic variables: Age, gender, previous exposure, previous information, source of information regarding endotracheal intubation and its long term complications.

Selection and Development of the Tools:

The tool consisted of four sections:

Tool I: Socio demographic data sheet

Tool II: Structured knowledge questionnaire

Tool III: The video assisted teaching was developed on endotracheal intubation

Tool IV: The questionnaire teaching was developed to evaluate the sequence of procedural steps performed by researcher and to evaluate the effective method of teaching that is lecture cum discussion or video assisted teaching.

Scoring Procedure:

There are total 25 questions.

For each correct answer score of one (1) was given and for incorrect zero (0) was given.

Maximum score: 25

Minimum score: 0

RELIABILITY OF TOOL:

Reliability of video was determined by the test – retest method was 0.8.

Analysis and Interpretation of Data

Organisation and Interpretation of Data

This data have been organised and represented under following sections:-

Section – 1 To develop a video on endotracheal intubation

Section – 2 Findings related to percentage distribution samples as per selected demographic variables.

Section –3 Findings related to pre-test and post-test knowledge score regarding endotracheal intubation and its long term complications.

Section – 4 Evaluation of effectiveness of demonstration and video assisted teaching regarding endotracheal intubation and its long term complications

Section – 5 Findings related to the association of pre-test and post-test knowledge score of endotracheal intubation with selected socio – demographic variables.

Section – 1

To develop a video on endotracheal intubation:

Self-made video on endotracheal intubation

Section – 2

Findings related to percentage distribution samples as per selected demographic variables.

This section describes the demographic characteristics of nursing students under study. The sample comprises of 80 students and table shows the frequency and percentage distribution.

Table No 1: Frequency Distribution of Demographic variables.

Variables	Options	Percentage	Frequency
Age	15 – 20 years	46.3%	37
	20 – 25 years	52.5%	42
	25 – 30 years	1.2%	1
	30 – 35 years	0.0%	0
Gender Educational status	Male	0.0%	0
Gender Educational status	Female B.Sc. nursing Other	100.0% 100% 0.0%	80 80 0
Educational program	Attended	0.0%	0
Educational program	Not attended	100.0%	80
Attend any program	Yes	40.0%	32
Attend any program	No	60.0%	48
Source of information	Internet	46.3%	37
	Hospital	43.8%	35
	Others	10.0%	8

(N=80)

Table 1 illustrates that majority of 52.5% of subjects were in age group (20-25) years and 1.2% were >25 years of age. Majority of (100%) were females. Majority of subjects (100%) were B.Sc Nursing students. Majority of subjects (60%) did not attend any educational program whereas (40%) attend the educational program. Majority of the students (46.3%) had information source from internet, (43.8%) students had knowledge from hospital whereas (10%) had knowledge from other sources.

Section – 3

Table no. 2 and 3 shows Findings related to pre test and post test knowledge score of subjects regarding endotracheal intubation and its long term complications.

Table no 2: Criteria Measure Of Pretest Knowledge Score N=80

Knowledge Score Level (N= 80)	Pre Test f (%)
Poor. (0-6)	10 (12.5%)
Average. (7-12)	53 (66.3%)
Good. (13-17)	17 (21.2%)
Very-Good (18-25)	0 (0%)

Table no: 3 N = 80

Criteria Measure of Posttest Knowledge Score
Score Level (N= 80)	Post Test f (%)
Poor. (0-6)	0 (0%)
Average.(7-12)	13 (16.2%)
Good. (13-17)	36 (45%)
Very-Good (18-25)	31 (38.8%)

Section – 4

Effectiveness of demonstration and video assisted teaching regarding endotracheal intubation and its long term complications

It is revealed that out of 80 subjects 12.5% had poor knowledge, 66.3% had average knowledge, 21.3% had good knowledge in pre-test whereas in post-test 16.3% had average knowledge, 45% had good knowledge and 38.8% had very knowledge regarding endotracheal intubation and its long term complications.

Table No. 4 Criteria Measure Of Knowledge Score N=80

Score Level (N= 80)	Pre test f (%)	Post test f (%)
Poor. (0-6)	10 (12.5%)	0 (0%)
Average. (7-12)	53 (66.3%)	13 (16.2%)
Good. (13-17)	17 (21.2%)	36 (45%)
Very-Good (18-25)	0 (0%)	31 (38.8%)

Maximum Score=25 Minimum Score=0

Mean, Standard deviation, Mean%, Range, Mean difference, Paired T- test value, P value and table value of Pre-test and Post-test.

It depicts that in the pre – test range was 4 - 15, Mean 9.78, Standard deviation was 2.868, Mean percentage of knowledge score was 39.10% and in post-test range was 7-22, mean 16.13, Mean percentage of knowledge score was 64.50%. The data presented in table no. shows that the mean post-test knowledge score was higher (16.13) than the mean pre-test knowledge score (9.78). The calculated ‘t’ value (15.029Sig) was greater than the table value (t – 1.99) at 0.05 level of significance. Hence, it can be inferred that the demonstration and video assisted teaching was effective in increasing the knowledge.

Individual score gain (Effectiveness):

It reveals that mean percentage of effectiveness of Pre-test knowledge score is 39.10% and post test score is 64.50% and the difference score is 25.40% among B.Sc nursing 2^nd year.

Section – 5:

Association of Post – test knowledge Scores with Demographic Variables

In this section chi-square test was used to determine the association between the knowledge score levels and selected demographic variables.

The calculated chi-square values were more than the table value at the 0.05 level of significance in attend any program and there is no significance association between the level of scores and other demographic variables. The calculated chi-square values were less than the table value at the 0.05 level of significance in variables.

SUMMARY:

The present study was conducted to assess the effectiveness of demonstration and video assisted teaching on knowledge regarding endotracheal intubation and its long term complications among B.Sc nursing 2^nd year students of district Kangra. A qualitative research approach was used along with quasi – experimental design for this study. The convenient sampling method is used among B.Sc nursing 2^nd year students who are selected by using random table method from selected nursing colleges of district Kangra Himachal Pradesh. Considerable and integral reviews of literature regarding demonstration and video assisted teaching were identified, it enables the researcher to develop methodology, analysis and interpretation of the data. Data was collected in the month of August. The content validity of the tool was established from nursing experts. Socio demographic variables were age, gender, education, attend any program, source of information. The tool comprised of 25 questionnaire to assess the knowledge of B.Sc nursing 2^nd year students regarding endotracheal intubation and its long term complications. Analysis and interpretation of data was done according to the objectives. The data analysis was done calculating descriptive statistics percentage, mean, median, standard deviation, and chi square and t – test, bar diagram and graph were used to depict the findings.

CONCLUSION:

On the basis of findings, it revealed that the knowledge of the students was good regarding endotracheal intubation and its long term complications and was improved after video assisted teaching and demonstration method which concludes that they need theoretical as well as practical knowledge to improve their skills and is useful in the future.

The association of post – test with socio demographic variables was significant in attend any program and source of information.

REFERENCES:

1. Colombage Dilrukshi Tharangani. Practice of nurses caring for patients with endotracheal tube. Sri Lankan Journal of Anaesthesiology. 2020: 94-10016

2. Ezri Tiberiu, Harefah et al Dec. 2005, Article on Tracheostomy and endotracheal intubation: A short history. Website: pubmed.ncbi.nlm.nih.gov 2

3. Lewandowski A Linda, and Kositsky M, A study by the American Association of Critical Care Nurses, 1983, Heart and lung Journal. Page No. 35-44. Website www.researchgate.net 3

4. Ollerton JE, Trauma fellow, Adult trauma clinical practice guidelines, Emergency Airway Management in the Trauma Patient, 2007, Website: www.aci.health.nsw.gov.au/networks/icnsw/patients4

5. Stauffer JL, Am JMed, 1981, complications and consequences of endotracheal intubation and tracheostomy. A prospective study of 150 critically ill adult patients.14 Website: http://pubmed.ncbi.nlm.nih.gov 5

6. Sahiner Yeliz, indications for endotracheal intubation reviewed in 2018, Website: www.intechopen.com 6

7. May Pech Fernaldo, Lopez Ivan, etal, information extraction approach for clinical practice guidelines representation in a medical decision support sydtem, Oct 2010, Website: www.intechopen.com7

8. Stanaway Nathan, Article on endotracheal tube history, May,12th, 2017.1 Website: www.capnoacademy.com 8

9. Feldman oren, nirsamuel et al, Research Article on ET intubation COVID – 19 patients, 2021. Website: http://slja.sljol.info 9

10. Bakshi Kirti, A pre experimental study to assess effectiveness of PTP on regarding nursing care during intubation and suctioning of a patient with ET tube. Indian Journal of Research. 2020; 9. Website: www.worldwide.journal.com 10

Received on 15.02.2025 Revised on 13.03.2025

Accepted on 03.04.2025 Published on 23.05.2025

Available online from May 26, 2025

A and V Pub Int. J. of Nursing and Med. Res. 2025; 4(2):95-99.

DOI: 10.52711/ijnmr.2025.19

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.