A STUDY TO ASSESS KNOWLEDGE ON REVISED TRAUMA SCOREAND

ITS IMPACT ON PROGNOSIS OF PATIENT WITH MULTIPLE INJURY IN

ICU AMONG STAFF NURSES WITH THE VIEWS TO DEVELOPING
INFORMATION BOOKLET IN SELECTED.
HOSPITAL AT
SURAT.

BY
MS. PATEL KHUSHBU NATHUBHAI .

DISSERTATION SUBMITTED TO SAURASHTRA UNIVERSITY, GUJARAT,

IN PARTIAL FULFILMENT OF REQUIREMENT FOR THE DEGREE OF
M.Sc. NURSING
2023 – 2024
A STUDY TO ASSESS KNOWLEDGE ON REVISED TRAUMA SCOREAND
ITS IMPACT ON PROGNOSIS OF PATIENT WITH MULTIPLE INJURY IN
ICU AMONG STAFF NURSES WITH THE VIEWS TO DEVELOPING
INFORMATION BOOKLET IN SELECTED
HOSPITAL AT
SURAT.

BY
MS. PATEL KHUSHBU NATHUBHAI

DISSERTATION SUBMITTED TO SAURASHTRA UNIVERSITY, GUJARAT,

IN PARTIAL FULFILMENT OF REQUIREMENT FOR THE DEGREE OF
M.Sc. NURSING
2023 – 2024
A STUDY TO ASSESS KNOWLEDGE ON REVISED TRAUMA SCORE AND
ITS IMPACT ON PROGNOSIS OF PATIENT WITH MULTIPLE INJURY IN
ICU AMONG STAFF NURSES WITH THE VIEWS TO DEVELOPING
INFORMATION BOOKLET IN SELECTED

HOSPITAL AT

SURAT.

BY
MS. PATEL KHUSHBU NATHUBHAI

DISSERTATION SUBMITTED TO SAURASHTRA UNIVERSITY, GUJARAT,

IN PARTIAL FULFILMENT OF REQUIREMENT FOR THE DEGREE OF
M.Sc. NURSING
2023 – 2024
A STUDY TO ASSESS KNOWLEDGE ON REVISED TRAUMA SCORE
AND ITS IMPACT ON PROGNOSIS OF PATIENT WITH MULTIPLE
INJURY IN ICU AMONG STAFF NURSES WITH THE VIEWS TO
DEVELOPING INFORMATION BOOKLET IN SELECTED

HOSPITAL AT

SURAT.

APPROVED BY THE DESSERTATION COMMITTEE ON

………………….
RESEARCH GUIDE ……………………………………………
Mrs. SUDESHNA
BANERJEE, M.Sc. (N),
ASSISTANT PROFESSOR
AHN DEPARTMENT,
SHRI ANAND INSTITUTE OF
NURSING,RAJKOT.

DISSERTATION SUBMITTED TO SAURASHTRA UNIVERSITY, GUJARAT,

IN PARTIAL FULFILMENT OF REQUIREMENT FOR THE DEGREE OF
M.Sc. NURSING
2023 – 2024
 DEDICATION

“Dedication is like climbing a mountain with all your skill, hard work and persistence,
when you reach to speak after all the obstacles, that feeling of achievement tells, how
your dedication help reach your goal”

I thank God for making all these wonderful thing happen to me and pray for his
continued blessing and success.

MY HUSBAND : I am very grateful for being my back bond who always

supporting me throughout my study and research. Thank you very much for always
believing in me and motivating me in my tough time. I LOVE YOU THE MOST.

MY PARENTS : Thank you for unconditional support with my studies. I am

honoured to have you as my parents. Thank you for giving me a chance to prove and
improve my-self through all my walks of life Please do not ever change. I Love You.

MY FAMILY : Thank you to my family for believing in me; for allowing me to

further my studies. Please do not ever doubt my dedication and love towards you.

MY COLLEAGUES : Finally, and above all, I cannot begin to express my

unfailing gratitude and love to my colleagues, who has supported me throughout this
process and has constantly encouraged me when the tasks seemed arduous and
insurmountable.
 ACKNOWLEDGEMENT

A journey is easier we travel together. Interdependence is certainly more valuable

than independence. This dissertation is the result of unbound, immeasurable
contribution and support from many people. It is a pleasure that, I have an opportunity
to express our gratitude to all of them.

I expres I am grateful to god almighty for his grace, blessing guidance and support
which strengthened us in the research process and sustained us throughout this
endeavor.

It is my sincere thanks to our beloved principal, Mr. JEENATH JUSTIN DOSS. K,

Ph.D., PGDCA, for his constant guidance, motivation, encouragement and support
throughout the study.

I am highly obliged the dynamic due, eminent personality Vice-principal and guide,
MR. SUNEESH P.M M.Sc. (N), HOD, Department Medical Surgical Nursing, for
his valuable suggestion, guidance, support and encouragement to achieve this goal.
and my CLASS CO-ORDINATOR, MRS. SUDESHNA BANERJI DATTA,
M.Sc.(N), MEDICAL

SURGICAL NURSING, for her valuable suggestion, guidance, supportand encouragement to

achieve this goal.

Excellent teachers is a complex matrix of builder, artist, leader and harvester. I would like to
express my immense gratitude and whole hearted thanks to our subject guide, Nursing Tutor,
MRs SUDESHNA BANERJI DATTA., M.Sc. (N), Department of medical surgical nursing,
and MS. MITAL JAGATIYA., M.Sc. (N), Department of medical surgical nursing, for their
insisting support, constructive suggestions and immense encouragement which enable us to
reach my objectives. I consider it as a great honor and privilege to have completed under their
supervision. I would like to thanks for their continuous support as it wouldn’t have possible to
complete my study without their guidance.

I have immense pleasure in thanking

DR.J.P.SONAVALE,M.B.B.S.,M.,S.F.M.A.S.F.L.A.G.E.S.GENERAL &
LAPAROSCOPIC SURGEON who kindly consented to shoulder the most difficult
task of our performance and for his expert guidance and valuable suggestions,
encouragement keen interest in the conception, planning and execution of the study. I
wish to extend my sincere thanks to head of department ,Doctors and staff of vibrant
multispecialty hospital Surat , who offered timely support and guidance in conducting
the study.

I proudly and honestly express our deep sincere thanks and gratitude to, to MR.
FRANCIS, M.Sc.(N), ASSISTANT PROFFESOR, HOD OF MENTAL
HEALTH NURSING, MS. MITAL JAGATIYA, M.Sc.(N) TUTOR,
DEPARTMENT OF MEDICAL SURGICAL NURSING, MS . TWINKLE
VORA, M.Sc.(N) TUTOR, DEPARTMENT OF CHILD HEALTH NURSING ,
MS. CHANDANI APARNATHI, M.Sc.(N) TUTOR, DEPARTMENT OF
MEDICAL SURGICAL NURSING , MRS MANSI MEHTA, M.Sc.(N) TUTOR,
DEPARTMENT OF MENTAL HEALTH NURSING, MS. JANKI
MARADIYA, M.Sc.(N) TUTOR, DEPARTMENT OF OBSTETRICS AND
GYNAECOLOGY, MR. PARTH BHANUGARIYA, M.Sc.(N) TUTOR,
DEPARTMENT OF COOMUNITY HEALTH NURSING, for their
illuminating comments, patience and intuitiveness and untiring interest shown
throughout the study. They showed usdifferent ways to approach research.

I would like to thank my family members – GRAND PARENTS, PARENTS,

BROTHERS, and all my special friends, for their love, support, constant prayer and
encouragements with forbearance during theentire period of my study.

I would like to acknowledge and thank our college for allowing me to conduct my
research and providing any assistance requested special thanks goes to the members of
staff for their continued support. Their excitement and willingness to provide feedback
made the completion ofthis research an enjoyable experience.

With Regards,

PATEL KHUSHBU
 ABSTRACT

“A study to assess knowledge on revised traum score and its impact on prognosis of
patent with multiple injury in icu among staff nurse with the views to developing
information booklet inselected hospital surat.”

The improvement of knowledge regarding Revised trauma score and its impact on
prognosis of patient with multiple injury in ICU has an important play in enabling
the Knowledge with the views to developing information booklet as an
independence nursing intervention. The objective of the study is to evaluate the
knowledge levels among staff nurses.

The research design adopted was descriptive study in that pre- test post-test. The
conceptual framework for this study was based on Ludwig von Bertalanffy (1968)
general system theory. The study had been conducted in vibrant multispecialty
hospital surat .

Purposive sampling technique had been adopted to select the desired samples. The
sample size was 60. As a part of intervention, a views to developing information book
let on knowledge regarding revised trauma score and its impact on prognosis of patient
with multiple injury in icu staff nurses 30 minutes and the data was collected by
information booklet on the revised trauma score with structured of questionnaires will
be developed to assess the level of knowledge regarding Revised trauma score.

The data were analysed by using both descriptive and inferential statistical method
paired ‘t’ test was used to evaluating the effectiveness of an information booklet on
knowledge regarding Revised trauma score. The obtained value 9.39, which shows
highly significant at the level of 0.001 there findings of the study revealed, that
distribution of booklet was effective in improving knowledge regarding Revised
truma score and prognosis of patients with multiple injury in ICU. There is significant
association between demographic variables such as age, knowledge, from , previous.
Source of information, previous experience of any educational section, previous
knowledge about trauma care.

KEY WORDS – assess knowledge, distribution of an information booklet on the

Revised trauma score.
 INTRODUCTION

Trauma is a leading cause of mortality and morbidity worldwide, which took the lives
of 4.4 million people in 2019 and constituted 8% of all deaths, with multiple injuries
often presenting complex challenges in intensive care units (ICUs). The Revised
Trauma Score (RTS) is a vital tool used by healthcare professionals to assess the
severity of injuries and predict patient outcomes. Staff nurses play a critical role in the
care of trauma patients within the ICU, and their knowledge of the RTS can
significantly impact patient prognosis and the overall quality of care provided.

The RTS is a scoring system that evaluates three key physiological parameters:
Glasgow Coma Scale (GCS) score, systolic blood pressure (SBP), and respiratory rate
(RR). These parameters are essential in determining the severity of trauma and guiding
the course of treatment. A high RTS indicates less severe injuries, while a low score
suggests more critical conditions. 1

The RTS assigns numerical values to three essential physiological parameters: the
Glasgow Coma Scale (GCS) score, systolic blood pressure (SBP), and respiratory
rate (RR). Each parameter is assessed
Independently, and the resulting scores are combined to generate the RTS. The GCS
evaluates a patient's level of consciousness, SBP reflects their circulatory status, and
RR indicates the adequacy of their breathing (Boyd et al., 1987). 25
The RTS quickly gained widespread acceptance and became an integral part of trauma
care protocols around the world. Healthcare providers, including emergency medical
professionals, trauma surgeons, and nurses, recognized its utility in identifying the
severity of injuries and guiding the allocation of resources and interventions in a time-
sensitive manner (Copes et al., 1988).26
Numerous studies and clinical trials have validated the RTS's effectiveness in
predicting outcomes for trauma patients. Lower RTS scores have consistently been
associated with increased mortality rates, underscoring the critical role this scoring
A adequate knowledge of the RTS can lead to quicker and more accurate assessments,
which, in turn, can enhance patient outcomes and reduce the risk of complications.
However, there is a need to assess the level of knowledge among staff nurses
regarding the RTS and its practical application in the ICU setting. This study aims to
evaluate the extent of staff nurses' knowledge about the RTS and its impact on the
prognosis of patients with multiple injuries in the ICU.

The study will also explore the potential benefits of developing an information booklet
tailored to the specific needs of staff nurses. Such a booklet can serve as a valuable
resource, enhancing their understanding of the RTS and its clinical relevance,
ultimately improving patient care.
By investigating the knowledge gap and its consequences, this research seeks to
contribute to the advancement of trauma care in the ICU and enhance the overall
quality of healthcare services provided to patients with multiple injuries. In doing so, it
may help reduce mortality rates, minimize complications, and improve the long-term
outcomes for trauma patients.27
NEED OF THE STUDY

Trauma is a global health crisis, responsible formorethan5 million deaths annually,

and impacting nearly 1 billion people who require medical treatment for injuries each
year. India also reports more than 400,000 deaths and nearly 5 million annual injuries
due to trauma-related causes(Gupta et al., 2016). These included injuries resulting
from road accidents, occupational hazards, and various other traumatic events
.Gujarat, too like many other Indian states, witnessed a substantial burden of trauma-
related injuries. Exact numbers may vary, but it is estimated thathundreds of thousands
of people in Gujarat require medical treatment for injuries annually. This staggering
toll highlights the magnitude of the problem, with the global burden of injury
surpassing the combined fatalities of malaria, tuberculosis, and HIV/AIDS by
32%.Traumaalsostandsastheleadingcauseofdisability-adjustedlife-years

among individuals aged 5 to 45.The consequences of trauma extend beyond human

suffering, exerting significant economic burden. For instance, road traffic injuries,
which represent less than a third of all injuries worldwide, can cost a country up to 2%
of its gross national product.28
It is crucial to note that approximately 90%of injury-related deaths occur in low and
middle-income countries (LMICs). If these countries couldachieve injury fatality rates
similar to high-income countries (HICs), nearly 2 million lives could be saved
annually. India, in particular, bears a substantial burden, accounting for over 20% of
global trauma-related deaths. A significant portion of these deaths is preventable, as
demonstrated in a Delphi study on injury-related fatalities in India.
 OBJECTIVE

1. To assess the knowledge levels among ICU staff nurses regarding the Revised
Trauma score and its impact on the prognosis of patients with multiple injuries in ICU.

2. To find out association between selected demographic variables with pretest and post
test knowledge of staff nurses regarding revised trauma score & its impact on
prognosis of patients with multiple injury in ICU.

HYPOTHESES

H0: There will be positive impact on patient’s prognosis by the staff nurses working
within the ICU setting.

H1: There will be significant difference between the mean pre test and post test
knowledge regarding revised trauma score among staff nurses working in ICU in
selected hospital of surat.

ASSUMPTION

 There may be increase in knowledge of revised trauma score in ICU staffnurses.

 There may be effectiveness of booklets on survival outcomes of patients with multiple

injuries in ICU.

DELIMITATION

 The study is delimited to nurses working in ICU.

 The study is delimited to patients who are admitted in selected hospital.
 The study is delimited to the selected hospital ,in Surat.
 Thesamplesizeisdelimitedto50nurses.
 The study is delimited to nurses who were present at the time ofconducting study.
MATERIALS AND METHODS

Research design: The research design for the study is exploratory study in that
pre –test & post –test design is used .

Setting: The study will be conducted with the permission in vibrant multispecialty
hospital .surat. Gujarat, India

Population: The population of interest includes staff nurses working in the ICU of
the selected Vibrant multispecialty hospital surat.

Sampling technique: A convenience sampling technique will be employed to select

participants from the accessible population of staff nurses working in the ICU of the
selected hospital.

Data analysis: demographic variables were analysed by using descriptive measures (

frequency and percentage ) The effectiveness of knowledge regarding Revised Trama
care was analysed by using t-test. The association between the levels of knowledge by
chi – square test.

CRITERIA FOR SAMPLE SELECTION

Inclusion criteria :

Inclusion Criteria for Sample Selection:

1. Registered nurse

2. Currently employee dint he ICU of the selected hospital

3. Willingness to participating he study

Exclusion Criteria for Sampling:

1. Participants who decline to participate wile excluded from the study.

2. DEVELOPMENT OF TOOL

3. The tool acts as a best instrument to assess and collect the data from the
respondents of the study. As the study will be aimed at assess knowledge on
revised trauma score developing information booklet .was developed besd on
opinion of experts in the field of medicine,general surgeon and nursing experts and
review of literature.

DESCRIPTION OF THE TOOLS

The tool used for the study was divided as follows

Section A : Socio demographic variables

Section B : Structured questionnaire to evaluate the knowledge regarding revised

trauma score .

Section A : Demographic variables

It consisted of demographic factors such as age ,education , experience , Sources of

information, previous experience , previous knowledge .

Section B : The questionnaire will consist of multiple-choice and open- ended
questions to assess the knowledge levels of staff nurses regarding the Revised Trauma
Score. It will be divided into sections corresponding to the components of RTS,
including GCS, SBP, and RR.

SCORING ;
Based on ICU staff nurses level of knowledge score on Revised trauma score and its
impact on prognosis was graded in 3 categories. They are adequate, moderate and
inadequate knowledge.
 SR.NO LEVEL OF KNOWLEDGE ACTUAL SCORE

1 Adequate 0-14

2 Moderate 15-19

3 Inadequate 20-30

The scoring procedure on knowledge regarding Revised trauma score as follows.

There are 30 questionnaire regarding care of Revised trauma score. Maximum score is
30 and the areas are as follows:

MAJOR FINDING OF THE STUDY

Major findings of the study

Major study finding includes

A. Findings related to demographic variables of the study

1. The Majority of age groups of staff nurses were 29(48.33%) 26-30years

2. The majority of educational status of staff were 35(58.33%) B.Sc.nursing.
3. The majority of source of information were 35(58.33%) online.
4. The majority of experience of the staff were, 45(75%) more than 5 yrs.
5. The majority of Previous experience of any educational section regarding
trauma 48(80%) were no.
6. The majority of Previous experience of care given to trauma patient56(93.33%)
were No.
7. The majority of any Previous knowledge about trauma care were 50(83.33%)
were NO.
The second objective was to evaluate the effectiveness of structured teaching
program me on level of knowledge regarding revised trauma score and its impact
on prognosis of patient with multiple injury in ICU among staff nurse

The comparison of pretest and posttest level of knowledge revised trauma score and its
impact on prognosis of patient with multiple injury in ICU among staff nurse was done
by using paired’ test. The mean score was increased from. The mean score was
increased from 10.95 to 17.50 which showed a marked difference of 6.55 respectively
and the standard deviation was decreased from 5.33 to 4.35 after the administration of
structured teaching programme. The paired’ “t” test value at, 9.39 was very highly
significant at p<0.001 level

The third objective was to determine the association of pre-test levelof knowledge
regarding revised trauma score and its impact on prognosis of patient with
multiple injury in ICU among staff nurse In the pretest level of knowledge there
were five demographic variables are significantly associated with their pretest level of
knowledge score such as age, educational status of staff Experience of the staff source
of information, having previous experience of any educational section
regarding trauma, and previous experience of care given to trauma patient.

The chi square value 9.91 showed that there was a significant association of age group
of staff and pretest level of knowledge at the level of p<0.05

CONCLUSION
The main conclusion of this present study is that most of the college students had
inadequate and moderately adequate level of knowledge in pre-test and they improved
to moderately adequate and adequate knowledge in post-test. This shows the
imperative need to understand the purpose of structured teaching programme regarding
revised trauma score and its impact on prognosis of patient with multiple injury in ICU
among staff nurse.
CONTENT

SERIAL NO. CONTENT. PAGE NO.

INTRODUCTION
• Introduction
• Need for the study
• Statement of theproblem
• Operational definition
1. 25
• Objectives
• Hypothesis
• Assumption
• Delimitation
• Conceptual framework
LITRATURE REVIEW
• Studies related to knowledge
regardingrevised trauma score .
2. • Studies related accessimpact of RTS 41
on prognosis in Trauma patient
• Study related accessRTS and other
traumascore.
METHODOLOGY
• Schematic representationof
methodology • Research approach
• Research design•Variables
• Setting of the study
• Population
• Sample
• Criteria for sampleselection
• Inclusion criteria
• Exclusion criteria
3. • Sampling techniques 49
• Development of tool
• Description of tool
• Description ofintervention
• Validation of tool
• Pilot study
• Data collection
procedure
• Data analysis plan
• Protection of humanrights
• Ethical clearance

DATA ANALYSIS &

4. INTERPRETATION 60
Tables, graphs, description
 DISSCUSSION, SUMMARY,
5. CONCLUSION, & 81
RECOMMENDATIONS

6. REFERENCES 68

7. APPENDIX

LIST OF TABLES
TABLE NO. TITLE PAGE NUMBER
Frequency and Percentage
distribution according to
1 demographic variables of revised 63
trauma score among ICU staff
nurses.

Frequency and Percentage

distribution of knowledge
regarding revised trauma score in
2,3,4 pre test and effectiveness of 69
Booklet assisted teaching
programme on Revised trauma
score among ICU staff nurses

Mean, Standard Deviation and ‘t’

5 value of knowledge of revised 73
trauma score

. χ2 Association between the levels

of knowledge among ICU staff
6,7 75
nurses with their selected
demographic variables
 LIST OF FIGURES
FIGURE NO. FIGURES PAGE NO.
Frequency and percentage distribution of age
1 65
group of staffs.
Frequency and percentage distribution of
2 65
Experience of staff
Frequency and percentage distribution of
3 66
educational status of Staff
Frequency and percentage distribution of
4 66
Source of information
Frequency and percentage distribution of
5 67
educational sectionregarding trauma.

Frequency and percentage distribution of previous

6 67
experience of care given to trauma patient
Frequency and percentage distribution of previous
7 knowledge about the warning signs of suicidal 68
thoughts.
Comparative study Level of Knowledge among
8 72
staff nurses

Comparison of mean between the pretest and

9 74
posttest level of knowledge among staff nurses.
Percentage distribution of according to
10
previous knowledge about trauma care
 LIST OF APPENDIXES

APPENDIX NO. TITLE PAGE NO.

1 Letter seeking expert opinion for

content validity of the tools
2 Certificate of validation
3 Name list of experts who validated the
tool
4 Letter seeking permission to conduct
pilot study
5 Letter seeking permission to conduct
study
6 Letter seeking ethical clearance
permission
7 Statistical certificate

8 Research tool, Questionnaires (English

and Gujrati) And Answer tool
9 Content, booklet of RTS

10 Master Sheet
 INTRODUCTION

“ The greatest medicine of all is teaching people how not to need in Hippocrates

BACKGROUND OF THE STUDY

Trauma is a leading cause of mortality and morbidity worldwide, which took the lives
of 4.4 million people in 2019 and constituted 8% of all deaths, with multiple injuries
often presenting complex challenges in intensive care units (ICUs). The Revised
Trauma Score (RTS) is a vital tool used by healthcare professionals to assess the
severity of injuries and predict patient outcomes. Staff nurses play a critical role in
the care of trauma patients within the ICU, and their knowledge of the RTS can
significantly impact patient prognosis and the overall quality of care provided.

The RTS is a scoring system that evaluates three key physiological parameters:
Glasgow Coma Scale (GCS) score, systolic blood pressure (SBP), and respiratory rate
(RR). These parameters are essential in determining the severity of trauma and
guiding the course of treatment. A high RTS indicates less severe injuries, while a
low score suggests more critical conditions.1

The RTS assigns numerical values to three essential physiological parameters: the
Glasgow Coma Scale (GCS) score, systolic blood pressure (SBP), and respiratory rate
(RR). Each parameter is assessed independently, and the resulting scores are
combined to generate the RTS. The GCS evaluates a patient's level of consciousness,
SBP reflects their circulatory status, and RR indicates the adequacy of their breathing
(Boyd et al., 1987).25

The RTS quickly gained widespread acceptance and became an integral part of
trauma care protocols around the world. Healthcare providers, including emergency
medical professionals, trauma surgeons, and nurses, recognized its utility in
identifying the severity of injuries and guiding the allocation of resources and
interventions in a time-sensitive manner (Copes et al., 1988).26
Numerous studies and clinical trials have validated the RTS's effectiveness in
predicting outcomes for trauma patients. Lower RTS scores have consistently been
associated with increased mortality rates, underscoring the critical role this scoring
27
system plays in triaging and managing trauma cases.

The RTS has not remained static; it has been refined and revised over the years to
enhance its accuracy and applicability in various clinical settings. These ongoing
refinements reflect the dynamic nature of trauma care and the need for precision in
assessing patient status .25

Furthermore, the RTS has become an integral component of training programs for
healthcare professionals, especially nurses working in emergency departments and
trauma units. These programs often include specialized booklets and guidelines to
educate nurses on how to use the RTS effectively. These educational materials serve
as valuable resources for nurses, helping them develop the knowledge and skills
required to accurately assess trauma patients and contribute to improved patient
outcomes .29

In conclusion, the Revised Trauma Score (RTS) is a vital tool in the realm of trauma
care, with a history dating back to its development in Scotland in the early 1970s. Its
widespread adoption, validation through research, and integration into training
programs for healthcare professionals, including nurses, underscore its indispensable
role in the field of emergency medicine and trauma care. As we delve deeper into this
topic, we will continue to explore the components of the RTS, its clinical relevance,
and the critical role it plays in saving lives.
The scoring is as follows:

Glasgow Coma Systolic Blood Respiratory

Scale Pressure Rate

GCS Points SBP Points RR Points

15-13 4 >89 4 10-29 4

12-9 3 76-89 3 >29 3

8-6 2 50-75 2 6-9 2

5-4 1 1-49 1 1-5 1

3 0 0 0 0 0
These three scores (Glasgow Coma Scale, Systolic Blood Pressure, Respiratory Rate)
are then used to take the weighted sum by RTS = 0.9368 GCS + 0.7326 SBP +0.2908
RR. Values for the RTS are in the range 0 to 7.8408. The RTS is heavily weighted
towards the Glasgow Coma Scale to compensate for major head injury without
24
multisystem injury or major physiological changes.

Adequate knowledge of the RTS can lead to quicker and more accurate assessments,
which, in turn, can enhance patient outcomes and reduce the risk of complications.
However, there is a need to assess the level of knowledge among staff nurses
regarding the RTS and its practical application in the ICU setting. This study aims to
evaluate the extent of staff nurses' knowledge about the RTS and its impact on the
prognosis of patients with multiple injuries in the ICU.

The study will also explore the potential benefits of developing an information
booklet tailored to the specific needs of staff nurses. Such a booklet can serve as a
valuable resource, enhancing their understanding of the RTS and its clinical
relevance, ultimately improving patient care.

By investigating the knowledge gap and its consequences, this research seeks to
contribute to the advancement of trauma care in the ICU and enhance the overall
quality of healthcare services provided to patients with multiple injuries. In doing so,
it may help reduce mortality rates, minimize complications, and improve the long-
term outcomes for trauma patients.27

NEED FOR THE STUDY

Trauma is a global health crisis, responsible for more than 5 million deaths annually,
and impacting nearly 1 billion people who require medical treatment for injuries each
year. India also reports more than 400,000 deaths and nearly 5 million annual injuries
due to trauma-related causes(Gupta et al., 2016). These included injuries resulting
from road accidents, occupational hazards, and various other traumatic events
.Gujarat, too like many other Indian states, witnessed a substantial burden of trauma-
related injuries. Exact numbers may vary, but it is estimated that hundreds of
thousands of people in Gujarat require medical treatment for injuries annually. This
staggering toll highlights the magnitude of the problem, with the global burden of
injury surpassing the combined fatalities of malaria, tuberculosis, and HIV/AIDS by
32%. Trauma also stands as the leading cause of disability-adjusted life-years among
individuals aged 5 to 45. The consequences of trauma extend beyond human
suffering, exerting a significant economic burden. For instance, road traffic injuries,
which represent less than a third of all injuries worldwide, can cost a country up to
2% of its gross national product.28

It is crucial to note that approximately 90% of injury-related deaths occur in low and
middle-income countries (LMICs). If these countries could achieve injury fatality
rates similar to high-income countries (HICs), nearly 2 million lives could be saved
annually. India, in particular, bears a substantial burden, accounting for over 20% of
global trauma-related deaths. A significant portion of these deaths is preventable, as
demonstrated in a Delphi study on injury-related fatalities in India.

While advanced trauma systems have evolved in HICs, trauma research and
monitoring remain limited in LMICs. Most trauma care research is conducted in
HICs, leading to a lack of injury information and research in LMICs. This gap in
knowledge has been identified as a major obstacle to the development of global
emergency and trauma care systems. To address this issue, the Towards Improved
Trauma Care Outcomes (TITCO) data project was initiated to enhance trauma care
information systems in India and systematically gather critical injury data.

To bridge this gap in knowledge and improve trauma care outcomes, it is essential
to compare risk-adjusted trauma mortality rates between HICs and LMICs. Due to the
scarcity of detailed patient and injury data from LMICs, such comparisons have been
lacking. This study aims to fill this void by identifying independent predictors of
trauma mortality and conducting a comprehensive analysis of demographic factors,
physiological parameters, injury burden, and injury-related mortality disparities
between India and the United States. This analysis has the potential to pinpoint
specific gaps in trauma care and offer valuable insights into potential interventions to
reduce trauma-related mortality in India and other resource- constrained
environments.
In the multifaceted landscape of healthcare, where the synthesis of science, skill, and
compassion forms the core of patient care, the meticulous assessment of trauma
patients represents a critical nexus. Within the continuum of healthcare, where
timely and accurate decisions have profound implications for patient outcomes, the
art of trauma assessment assumes paramount importance. Trauma, characterized by
sudden and often life-threatening injuries, demands a swift and precise response from
healthcare providers. It is within this high-stakes environment that the Revised
Trauma Score (RTS) emerges as a beacon of guidance, offering a structured
framework to evaluate and prioritize care for
trauma patients.

THE GLOBAL IMPERATIVE:

Trauma knows no geographical boundaries;

it is an affliction that transcends borders,
affecting livesin diverse corners of the world.
The global imperative for effective trauma
assessment and management is underscored
by the sheer magnitude of trauma- related
incidents and their far- reaching
consequences. Every

year, millions of individuals experience

trauma, be it through accidents, falls,
violence, or natural disasters. The World
Health Organization (WHO) identifies
injuries resulting from road traffic accidents,
falls, and interpersonal violence as leading
causes of death and disability across the
globe. These incidents, often unforeseen
and abrupt, necessitate a robust and
standardized approach to trauma assessment
and care. It is within this global context that
the relevance of the RTS becomes evident.21
INDIA'S TRAUMA CHALLENGE:

India, with its vast and diverse population, faces a unique set of challenges in the
realm of trauma care. The country grapples with a high burden of road traffic
accidents, occupational injuries, and other forms of trauma. The Ministry of Health
and Family Welfare, Government of India, in its National Health Profile for 2021,
underscores the significant contribution of injuries to the overall disease burden in
India. The country's road safety landscape is a complex tapestry, marked by a
growing number of vehicles, diverse road conditions, and varying levels of adherence
to traffic regulations. Within this milieu, trauma-related injuries exact a toll on lives
and livelihoods.23

Within the intricate web of healthcare, staff nurses in the intensive care unit (ICU)
occupy a central position in the assessment and management of trauma patients. They
are often the first to encounter trauma patients, tasked with the pivotal responsibility
of initiating the assessment and care process. In the high-pressure environment of the
ICU, where seconds can make a difference, the proficiency and acumen of critical
care nurses are indispensable.23

GUJARAT'S TRAUMA LANDSCAPE:

The state of Gujarat, situated on the western coast of India, confronts its unique set of
challenges and opportunities in the domain of trauma care. One of India's most
industrially developed states, Gujarat boasts a robust economy, dynamic urban
centres, and a burgeoning transportation network. However, the rapid pace of
industrialization and urbanization has brought with it an increased risk of accidents
and trauma. The Gujarat State Road Transport Corporation (GSRTC) is one of the
key entities tasked with providing transportation services to the state's residents.
Unfortunately, this increased mobility has been accompanied by a notable rise in road
traffic accidents.

According to the GSRTC's Annual Report for 2019-20, the organization reported a
substantial number of accidents during that period. These incidents encompassed a
range of severity, from minor injuries to major traumas, underscoring the critical need
for effective trauma care within the state. The state's healthcare infrastructure, while
continually evolving and expanding, faces the ongoing challenge of catering to the
diverse needs of its populace, including those affected by trauma. 22

This study embarks on a quest for enhancement, seeking to illuminate the landscape
of knowledge and proficiency regarding the Revised Trauma Score among staff
nurses in the ICU setting. By comprehensively assessing their knowledge levels and
practical application of the RTS, this research endeavours to contribute to the body of
evidence-based practice within the critical care domain. Moreover, it aspires to
elucidate the intricate associations between demographic variables and the proficiency
of nursing staff, shedding light on potential areas for targeted education and training.

In the pursuit of enhanced trauma care, the development of an informational booklet

emerges as a tangible intervention. This booklet, meticulously designed to convey
knowledge about the Revised Trauma Score and its profound impact on patient
prognosis, aims to be an invaluable resource for staff nurses within ICUs. Its creation
represents a commitment to knowledge dissemination and empowerment, with the
ultimate goal of improving the quality of care provided to trauma patients.

In summary, the need for this study arises from the confluence of global, national,
and local imperatives for effective trauma assessment and management. It is anchored
in the recognition of the pivotal role played by critical care nurses in this context and
the critical importance of their knowledge and proficiency in utilizing the RTS. This
research journey is marked by a commitment to enhancing the understanding and
application of the RTS among nursing staff, thereby contributing to the positive and
long-term optimization of trauma patient care and outcomes within the complex
healthcare landscape.

PROBLEM STATEMENT

A study to assess knowledge on revised trauma score and its impact on prognosis of
patient with multiple injury in ICU among staff nurse with the views to developing
information booklet in selected hospital
 OPERATIONAL DEFINITIONS
In this section, key terms and concepts essential to the study will be meticulously
defined and operationalized. Clear definitions and delineations will ensure precision
and uniformity in understanding and communication throughout the research.

 Assess: In this study ,assess refers to measurement of knowledge regarding Revised

Trauma score

 Revised Trauma Score (RTS): In this study ,RTS Sore to a composite scoring
system used to assess trauma patients, comprising the Glasgow Coma Scale (GCS)
score, systolic blood pressure (SBP), and respiratory rate (RR).

 Staff Nurses: In this study, it refers to pupil who are providing care to patient in ICU
setup.

 ICU : An intensive care unit is a special department of a hospital or health care

facility that provides intensive care medicine to patient with sever or life threatening
illnesses and injuries.

 Knowledge : In this study ,knowledge refer to The depth of understanding and

familiarity of staff nurses regarding the RTS, assessed through structured
questionnaires.

 INFORMATION BOOKLET: In this study, information booklet delivers relevant

information on a topic for a given target audience, presented in a style that is easy to
understand and visually engaging. 

OBJECTIVES

1. To assess the knowledge levels among ICU staff nurses regarding the Revised
Trauma score and its impact on the prognosis of patients with multiple injuries in
ICU.
2. To find out association between selected demographic variables with pre test and post
test knowledge of staff nurse regarding revised trauma score among staff nurses
regarding revised trauma score &its impact on prognosis of patient with multiple
injury in ICU.
 HYPOTHESES

H0: there will be positive impact on patient’s prognosis by the staff nurses working
within the ICU setting.
H1: There will be significant difference between the mean pre test and post test
knowledge regarding revised trauma score among staff nurses working in ICU in
selected hospital of surat.

ASSUMPTIONS

 There may be increase in knowledge of revised trauma score in ICU staffnurses.

 There may be effectiveness of booklets on survival outcomes of patients with
multiple injuries in ICU.

DELIMITATION

 The study is delimited to nurses working in ICU.

 The study is delimited to patients who are admitted in selected hospital.
 The study is delimited to the selected hospital, in Surat.
 The sample size is delimited to 60 nurses.
The study is delimited to nurses who were present at the time of conductingstudy
SIGNIFICANCE OF THE STUDY

The study aims to evaluate the effectiveness of an informational booklet on enhancing

knowledge regarding the Revised Trauma Score (RTS) among staff nurses. By
assessing the impact of this educational resource, the study will provide insights into
its potential to improve understanding and application of the RTS in the management
of critically injured patients in the ICU. Enhancing nursing staff knowledge on this
scoring system is crucial for better prognosis and patient outcomes, ultimately
contributing to more informed and effective trauma care practices.

CONCEPTUAL FRAMEWORK

The concept is often defined as an abstract idea or mental image of a phenomena or

reality. The conceptualization is a process of forming ideas, which when utilized
forms conceptual framework for the development of a research design. A framework
is a basic structure or outline of abstract ideas which represents reality.

Conceptual framework is a group of mental images or concepts which are related but
relationship is not explicit. The conceptual framework for the study is based on the
Pender’s Health promotion model”.

The overall purpose of conceptual framework is to provide logical, coherent,

scientific findings in meaningful and generalized manner. Conceptual framework
provides a frame of references for members of a discipline to guide their thinking,
observation and interpretation of structures through which phenomena of concept can
be understood. The proposition of a conceptual framework is abstract and general.
The overall purpose of conceptual framework is to provide logical, coherent,
scientific findings in meaningful and generalized manner. Conceptual framework
provides a frame of references for members of a discipline to guide their thinking,
observation and interpretation of structures through which phenomena of concept
can be understood. The proposition of a conceptual framework is abstract and
general.

Conceptual framework plays several inter-related roles in the progress of science. It

serves as a spring broad for the generation of research hypothesis and can provide an
 important context for scientific research. The present study is aimed at evaluating the
effectiveness of structured teaching programme on Knowledge regarding revised
trauma score among staff nurses in ICU.

The Conceptual frame work selected for this study is based on General System
Theory. IMOGENE KING state that “A conceptual model of nursing developed by
Imogene King in which individuals and groups are categorized into three interacting
systems personal, interpersonal, and social and in which the goal of nursing is to
help people remain healthy so that they can function in their social roles.

General system theory defines system as a “complex interaction” which means that
the system consists of two or more connected elements which form an organized
whole and which interact with each other. The system acts as a whole. A
dysfunctional part causes a symptoms disturbance rather than General system theory
defines system as a “complex interaction” which means that the system consists of
two or more connected elements which form an organized whole and which interact
with each other. The system acts as a whole. A dysfunctional part causes a
symptoms disturbance rather than loss of a single function. In all system, activity can
be resolved into an loss of a single function. In all system, activity can be resolved
into an aggregation of feedback circuits such as input, throughput and output. The
feedback circuit helps in the maintenance of an intact system.

SYSTEM:

It refers to a whole human being who contains articulated sets of many subcomponents and
this whole system operates or functions within the boundaries of self, family and
community and also constantly exchangesinformation, energy and matter. The
components of the systems are:

 PERCEPTION AND INTERACTION.

 COMMUNICATION.

 TRANSACTION

 FEEDBACK
PERCEPTION AND INTERACTION

King’s describes perception as a process in which data is obtained, through the sense
and from memory are organized, interaction King’s defines interaction as a process of
perception and communication between person and environment and between a
person and person or as the acts of two or more persons in mutual presence. In this
study the researcher develops the demographic variable and modified questionnaire

COMMUNICATION

King’s describe communication as a person providing information directly or

indirectly to another person. And the other person receives this information and
processes it. In this study the researcher administers of structured teaching
programme on knowledge regarding revised trauma score among staff nurses in
ICU

TRANSACTION
Transaction is defined as observable refers to goal directed human behaviors. In this
study the gaining of adequate knowledge regarding revised trauma score among
staff nurses in ICU

FEEDBACK

Feedback is the outcome of the goals desired by the interacting components. The outcome
may be either adequate or inadequate gaining . If there is inadequate gain in knowledge, it
leads to rearrangement for structured teaching programme on knowledge regarding
revised trauma score among staff nurses in ICU.

Imogene king’s conceptual framework and theory of General System provides a

useful structure for the current research by using a structured teaching programme in
educating college students regarding revised trauma score among staff nurses in
ICU.

Imogene king’s theory provides direction for nursing practice by emphasizing the
process of multidisciplinary collaboration, communication, interaction, transaction
and use of critical thinking.
Thus, the researcher adopted this model and perceived appropriate to assess the
effectiveness of structured teaching programme in educating college students
regarding revised trauma score among staff nurses in ICU.

INPUT
The input is assessing the knowledge among staff nurses working in ICU Revised
Trauma Score by using self administered questionnaire on various aspects regarding
trauma score

THROUGHPUT
This core intervention involves BOOKLET nurses on R.T.S. Program content ( NO
explicitly shown in the image) might encompass signs and symptoms of trauma ,
R.T.S steps, and practical application methods.

OUTPUT
Output is any information that leaves the system and enters the environment through
system boundaries. Output is the changes in the knowledge found among the
REVISED TRAUMA SCORE which is interpreted as inadequate knowledge,
moderate knowledge and adequate knowledge.

FEEDBACK
Feedback is the evaluation of BOK LET by using the same structured questions
Review of Literature
Section 1: A study to assess knowledge of Revised Trauma Score (RTS)
Section 2: A study to assess Impact of RTS on Prognosis in Trauma Patients
Section 3: A study to assess RTS and other trauma scores

Section 1: A study to assess knowledge of Revised Trauma Score (RTS)

Yutaka Kondo, et.al., 2019, Revised trauma scoring system to predict in-hospital
mortality in the emergency department: Glasgow Coma Scale, Age, and Systolic
Blood Pressure score. T this study was to assess whether the new Glasgow Coma
Scale, Age, and Systolic Blood Pressure (GAP) scoring system, which is a
modification of the Mechanism, Glasgow Coma Scale, Age, and Arterial Pressure
(MGAP) scoring system, better predicts in-hospital mortality and can be applied more
easily than previous trauma scores among trauma patients in the emergency
department (ED). Compared with existing instruments, our reclassification tables
show that the GAP scoring system reclassified all patients except one in the correct
direction. In most cases, the observed incidence of death in patients who were
reclassified matched what would have been predicted by the GAP scoring system.
The GAP scoring system can predict in-hospital mortality more accurately than the
previously developed trauma scoring systems.6

H Li, MD, WF Shen, et.al., 2013, The revised trauma score (RTS) was developed
more than 20 years ago. Few studies investigated its usefulness in predicting trauma
outcomes. This is especially true for the weighted version of RTS (RTS-w). The aim
of this study was to test the predicting power of RTS-w for the trauma outcomes
including mortality, admission to intensive care unit (ICU), hospital length of stay and
ICU length of stay through a comparison with Injury Severity Score (ISS).The RTS-w
is a better predictor of mortality than ISS. But its ability to predict other trauma
outcomes is not as good as ISS. More studies are needed to identify the predictive
ability of RTS-w for the outcomes other than mortality. Besides, updating the
coefficients of the formula may make RTS-w more accurate.5
Champion HR, Sacco WJ, Copes WS, et al., 1989, The Trauma Score (TS) has
been revised. The revision includes Glasgow Coma Scale (GCS), systolic blood
pressure (SBP), and respiratory rate (RR) and excludes capillary refill and respiratory
expansion, which were difficult to assess in the field. Two versions of the revised
score have been developed, one for triage (T-RTS) and another for use in outcome
evaluations and to control for injury severity (RTS). T-RTS, the sum of coded values
of GCS, SBP, and RR, demonstrated increased sensitivity and some loss in specificity
when compared with a triage criterion based on TS and GCS values. T-RTS correctly
identified more than 97% of non survivors as requiring trauma center care. The T-
RTS traige criterion does not require summing of the coded values and is more easily
implemented that the TS criterion. RTS is a weighted sum of coded variable values.
The RTS demonstrated substantially improved reliability in outcome predictions for
compared to the TS. The RTS also yielded more accurate outcome predictions for
patients with serious head injuries than the TS.13

Baker SP, O'Neill B, Haddon W Jr, Long WB, 1974, The injury severity score: a
method for describing patients with multiple injuries and evaluating emergency care.
This classic article, published in 1974, introduced the Injury Severity Score (ISS), a
fundamental tool in the field of trauma care. The ISS provided a systematic method
for describing patients with multiple injuries and assessing the quality of emergency
care they received. By assigning numerical values to specific injuries and regions
of the body, the ISS allowed healthcare professionals to quantify the severity of
trauma comprehensively. This innovation transformed trauma care by facilitating
standardized assessments, leading to improved care delivery and better patient
outcomes.38

Section 2: A study to assess Impact of RTS on Prognosis in Trauma Patients

Danielle S Wendling-Keimet.al., 2021, Trauma Scores and Their Prognostic Value

for the Outcome Following Pediatric Poly trauma. The management and prognostic
assessment of pediatric poly trauma patients can pose substantial challenges. Trauma
scores developed for adults are not universally applicable in children. An accurate
prediction of the severity of trauma and correct assessment of the necessity of
surgical procedures are important for optimal treatment. Several trauma scores are
currently available, but the advantages and drawbacks for use in pediatric patients are
unclear. This study examines the value of the trauma scores Injury Severity Score
(ISS), Paediatric Trauma Score (PTS), National Advisory Committee for Aeronautics
(NACA), and Glasgow Coma Score (GCS) for the assessment of the poly traumatized
child.3

Diwakar Verma, et.al., 2021,Comparative evaluation of revised trauma score and

injury severity score as prognosis predictor among poly trauma patients. The traumais
a major reason for various disabilities and even death around the world. Prompt
actions and appropriate management are needed to minimize the level of injuries and
mortality. An effective tool is needed to assess the prognosis of the patient in trauma.
The objective of the study was to compare the evaluation of RTS and injury severity
score (ISS) as a prognosis predictor among trauma patients. A cross- sectional
clinical observational study was conducted in the emergency department. A total of
88 samples were selected by random sampling technique. The data collection was
done using demographic and clinical tools, Glasgow Coma Scale, Revised Trauma
Score (RTS), and ISS. Data analysis was performed using SPSS
18. In the present study, the majority of the participants (79.54%) were male. The
most common mode of injury among the patients was road traffic accidents (54.54%)
with blunt trauma. The findings revealed a negative correlation (‒0.368) between
RTS and ISS scores with significant P = 0.0004. RTS (<10) and ISS (≥20) have
significant association with mortality and hospital stay. The sensitivities of ISS and
RTS with mortality were 84.2% and 89.4%, respectively. It was concluded that RTS
is a comparatively better predictor of prognosis than ISS among trauma patients.
Lower RTS and higher ISS are significantly associated with mortality and long
hospital stay. Early evaluation of the injury level can be effective in patient
management.10

Nastaran Heydari Khayat, et.al., 2012, Correlation of Revised Trauma Score with
Mortality Rate of Traumatic Patients within the First 24 hours of Hospitalization.
Trauma is a major health problem throughout the world, leading to death and
disability especially in the first four decades of victims’ life. In Iran also, accident-
related death has a critical situation with an increasing rate of 10-15% per year. The
aim of this study was to determine the relationship between revised trauma score and
mortality rate of traumatic patients within the first 24 h of hospitalization. A
prospective cross-sectional study was conducted to investigate the association
between revised trauma score and the mortality rate of traumatic patients within the
first 24 h of hospitalization on 240 traumatic patients admitted to Khatam al-Anbia
hospital. The obtained data were analyzed with SPSS software-15, using logistic
regression, chi-square, and descriptive statistics. Seventy four point tow percent of
patients were referred due to accident, of which 38.3% had multiple traumas. Fifty
point eight percent of traumatic patients died within the first 24 h of hospitalization.
The minimum and maximum revised trauma score in injured patients were 7 and
12, respectively. Also, 80% of mortality was seen in victims with a score of 9-10.
Both the χ2 test and logistic regression showed a significant relationship between the
first revised trauma score and the mortality rate of traumatic patients within the first
24 h of hospitalization (p=0.001).The results of this study indicate that the revised
trauma score can be used as a tool to predict the mortality rate of traumatic patients.7

Haas B, Stukel TA, Gomez D, et al., 2012, The mortality benefit of direct trauma
centre transport in a regional trauma system: a population-based analysis. This 2012
study focused on evaluating the mortality benefit of directly transporting trauma
patients to trauma centers within a regional trauma system. By conducting a
population-based analysis, the researchers provided crucial insights into optimizing
trauma patient outcomes. Their findings emphasized the importance of efficient
transport decisions in trauma care and highlighted the potential for reducing mortality
rates through well-coordinated systems of care.35

Demetriades D, Chan L, Velmanos GV, et al., 2001, TRISS methodology: an

inappropriate tool for comparing outcomes between trauma centers. Published in
2001, this article critically examined the limitations of the Trauma and Injury
Severity Score (TRISS) methodology for comparing outcomes between trauma
centers. The authors highlighted the challenges and inadequacies of using TRISS as a
tool for assessing trauma centre performance. Their insights underscored the need for
more suitable methods and metrics to evaluate and compare trauma care outcomes
effectively.36

Osler T, Baker SP, Long W, 1997, A modification of the Injury Severity Score that
both improves accuracy and simplifies scoring. In 1997, Osler and his team
introduced a modified version of the Injury Severity Score (ISS) that aimed to
enhance accuracy and simplify the scoring process. This modification addressed
limitations in the original ISS, resulting in a more precise tool for evaluating the
severity of injuries in trauma patients. By improving the accuracy of prognostic
assessments, this modification contributed significantly to trauma care, guiding
clinicians in making better-informed treatment decisions.37

Section 3: A study to assess RTS and other trauma scores

Radojka.et.al., 2023, Pre hospital Trauma Scoring Systems for Evaluation of

Trauma Severity and Prediction of Outcomes. Trauma scoring systems in pre hospital
settings are supposed to ensure the most appropriate in-hospital treatment of the
injured. Aim of the study: To determine the sensitivity and specificity of the CRAMS
scale (circulation, respiration, abdomen, motor and speech), RTS score (revised
trauma score), MGAP (mechanism, Glasgow Coma Scale, age, arterial pressure) and
GAP (Glasgow Coma Scale, age, arterial pressure) scoring systems in pre hospital
settings in order to evaluate trauma severity and to predict the outcome. Materials and
Methods: A prospective, observational study was conducted. For every trauma
patient, a questionnaire was initially filled in by a pre hospital doctor and these data
were subsequently collected by the hospital. Results: The study included 307 trauma
patients with an average age of 51.7 ± 20.9. Based on the ISS (injury severity score),
severe trauma was diagnosed in 50 (16.3%) patients. MGAP had the best
sensitivity/specificity ratio when the obtained values indicated severe trauma. The
sensitivity and specificity were 93.4 and 62.0%, respectively, for an MGAP value of
22. MGAP and GAP were strongly correlated with each other and were statistically
significant in predicting the outcome of treatment (OR 2.23; 95% Cl 1.06–4.70; p =
0.035). With a rise of one in the MGAP score value, the probability of survival
increases 2.2 times. Conclusion: MGAP and GAP, in pre hospital settings, had
higher sensitivity and specificity when identifying patients with a severe trauma
and predicting an un favorable outcome than other scoring systems. 31

Zeinab Mohammed,et.al., 2022, Evaluation of the Revised Trauma Score, MGAP,

and GAP scoring systems in predicting mortality of adult trauma patients in a low-
resource setting. Numerous trauma scoring systems have been developed in an
attempt to accurately and efficiently predict the prognosis of emergent trauma cases.
However, it has been questioned as to whether the accuracy and pragmatism of such
systems still hold in lower-resource settings that exist in many hospitals in lower- and
middle-income countries (LMICs). In this study, it was hypothesized that the
physiologically-based Revised Trauma Score (RTS), Mechanism/Glasgow Coma
Scale/Age/Pressure (MGAP) score, and Glasgow Coma Scale/Age/Pressure (GAP)
score would be effective at predicting mortality outcomes using clinical data at
presentation in a representative LMIC hospital in Upper Egypt.. The RTS, MGAP,
and GAP all showed good discriminatory capabilities per AUROC. Given the relative
simplicity and potentially added clinical benefit in capturing critically ill patients, the
MGAP score should be further studied for stratifying risk of incoming trauma
patients to the emergency department, allowing for more efficacious triage of
patients in lower-resource healthcare settings.8

Prastia, AchsanuddinHanafie,et.al., 2019,Correlation of the Revised Trauma Score

(RTS) and National Early Warning Score (News) on the Prognosis of Trauma
Patients in the Emergency Department of the Hajji Adam Malik Hospital Medan.
Trauma is one of the main health problems in every country regardless of the level
of socio-economic development. It continues to be a significant health problem that
increases mortality and morbidity rates due to developments in technology, accidents
and incidents of violence. Scoring systems for trauma patients have been used and
these systems are constantly being improved in order to manage the diagnosis and
treatment of trauma patients more efficiently.9

Glance LG, Osler TM, Mukamel DB, Dick AW, 2012, Impact of trauma center
designation on outcomes: is there a difference between Level I and Level II trauma
centers In 2012, Glance and colleagues investigated the impact of trauma center
designation, specifically comparing Level I and Level II trauma centers. Their
research provided valuable insights into trauma care disparities, addressing the
question of whether Level I centers offered significantly better outcomes than their
Level II counterparts. This study's findings contributed to the ongoing discussion
surrounding trauma centre designations and their implications for patient care. 32

Haider AH, Chang DC, Efron DT, et al., 2008, Race and insurance status as risk
factors for trauma mortality. Published in 2008, this study explored the significant
factors of race and insurance status as potential risk factors influencing trauma
mortality rates. By analyzing a large dataset, the researchers aimed to uncover
disparities in trauma outcomes related to these demographic variables. This research
highlighted the importance of addressing healthcare disparities and ensuring equitable
access to trauma care for all patients, regardless of their racial or insurancestatus.33

Teixeira PGR, Inaba K, Hadjizacharia P, et al., 2007, Preventable or potentially

preventable mortality at a mature trauma centre. This study, conducted in 2007,
delved into the concept of preventable or potentially preventable mortality within a
mature trauma centre. By identifying cases where mortality could have been avoided
or mitigated with different interventions, the research shed light on areas for
improvement in trauma care. It emphasized the importance of ongoing quality
improvement efforts to enhance patient outcomes further.34

Boyd CR, Tolson MA, Copes WS, 1987, Evaluating trauma care: the TRISSmethod.
In 1987, Boyd and colleagues introduced the Trauma Injury Severity Score (TRISS)
method, revolutionizing the assessment of trauma care. This systematic approach to
evaluating the severity of injuries and predicting patient outcomes addressed a crucial
need in the field. By considering demographic and physiological variables, the TRISS
method allowed healthcare providers to make more accurate prognostic assessments.
It became an indispensable tool for improving trauma care protocols, enabling better
resource allocation and ultimately enhancing patient survival rates.25
METHODOLOGY

RESEARCH METHODOLOGY IS ONE OF THE VITAL SECTION OF A

RESEARCH, SINCE THE SUCCESS OF ANY RESEARCH IS MOSTLY DEPENDS

UPON THE METHODOLOGICAL ISSUES THAT ARE FOLLOWED IN THE
EXECUTION OF THE RESEARCH WORK. THE ROLE OF METHODOLOGY
CONSISTS OF PROCEDURES AND TECHNIQUES FOR CONCLUDING THE
STUDY.

THIS CHAPTER DEALS WITH THE METHODOLOGICAL APPROACH

ADOPTED FOR THE STUDY. IT INCLUDES DESCRIPTION OF THE RESEARCH

APPROACH, RESEARCH DESIGN, SETTING OF THE STUDY, POPULATION,

SAMPLE, CRITERIA FOR SAMPLE SELECTION, SAMPLING TECHNIQUE,

DEVELOPMENT OF TOOL, SCORING PROCEDURE, PILOT STUDY, DATA

COLLECTION PROCEDURE AND PLAN FOR DATA ANALYSIS
 RESEARCH APPROACH : Quantitative Approach

RESEARCH DESIGN: exploratory study

TARGET POPULATION: ICU STAFF NURESE SELECTED HOSPTAL SURAT.

ASSESSIBLE POPULATION: ICU staff nurses at surat hospital.

SAMPLING TECHNIQUE: Non probability purposive Sampling Techniques.

SAMPLING SIZE: The sample size in this study will be 60 ICU staff nurses.

DATA COLLECTION PROCEDUR: Pre test variables structured, information

booklet, post test demographic variables, structured questionnaire

Assess the level of knowledge staff nurses on revised trauma score

Explore on Knowledge regarding revised trauma score among ICU staff nurses

DATA ANALYSIS: Descriptive Statistics

CRITERION MEASURE: knowledge regarding revised trauma score among ICU staff nurses
RESEARCH APPROACH

A: Quantitative approach was used for assessing the knowledge regarding revised
Trauma Score

RESEARCH DESIGN
Exploratory one group pre –test and post –test research design is used .

The diagrammatic representation of research design is given below.

Group Pre -test intervention Post-test

ICU STAFF URSES 01 X 02

Duration 1 day 3 day 7 day

Keys:
O1:- Pre- test assessment of revised trauma score in hospital.X:- Intervention
O2:- Post- test assessment Of icu staff nurses

VARIABLES:

Independent Variable: Information booklet on knowledge regarding revised trauma

score

Dependent Variable: Knowledge regarding revised trauma score working in ICU

staff nurses

SETTING:

Setting is the physical location and condition in which data collection takes place
The study was conducted with the permission of higher authority of vibrant hospital
of Surat The population selected from this setting was ICU staff nurses of The
hospital is situated near budia rod
POPULATION:

The population of interest includes staff nurses working in the ICU of the selected
hospital.

Accessible Population: The accessible population for this study comprises staff
nurses who are available and willing to participate in the research within the ICU of
the selected hospital.

Target Population: The target population is staff nurses working in ICUs across
hospitals in Gujarat.

Sample: A sample of 50 staff nurses working in the ICU of the selected hospital
will be included in this study.

CRITERIA FOR SAMPLE SELECTION

Inclusion Criteria for Sample Selection:

1. Registered nurse

2. Currently employed in the ICU of the selected hospital

3. Willingness to participate in the study

Exclusion Criteria for Sampling:

1. Participants who decline to participate will be excluded from the study.

SAMPLE TECHNIQUES

A convenience sampling technique will be employed to select participants from the

accessible population of staff nurses working in the ICU of the selected hospital.

DEVELOPMENT OF TOOL

SECTION A: A structured questionnaire will be developed to assess the knowledge

levels of staff nurses regarding the Revised Trauma Score. The questionnaire will
include items related to the components of RTS, its calculation, and its clinical
significance.
SECTION B: An informational booklet on the Revised Trauma Score will be
developed, containing detailed information about RTS, its components, interpretation,
and its impact on patient prognosis.

DESCRIPTION OF TOOL

The tool used for the study was divided as follows,

Section A: Socio Demographic variable

Section B: Structured questionnaire to evaluate the knowledge regarding revised

trauma score

SECTION A: DEMOGRAPHIC VARIABLES

It consisted of demographic factors such as age, education, experience, source of

information, previous experience, previous experience of any educational section,
previous experience of care of trauma patient, previous knowledge.

SECTION B: STRUCTURED QUESTIONNAIRES

It consisted of items seeking knowledge regarding care of revised trauma score and
each correct response carries 1 score and wrong response carries 0 score.

SCORING;
Based on ICU staff nurses level of knowledge score on Revised trauma score and its
impact on prognosis was graded in 3 categories. They are adequate, moderate

and inadequate knowledge. The scoring procedure on knowledge regarding Revised

trauma score as follows. There are 30 questionnaire regarding care of Revised trauma
score. Maximum score is 30 and the areas are as follows:
DESCRIPTION OF INTERVENTION

The pre-test of knowledge regarding revised trauma score its

SR.NO LEVEL OF KNOWLEDGE ACTUAL SCORE

1 Adequate 0-14

2 Moderate 15-19

3 Inadequate 20-30

implication, assessed by the use of questionnaires and pre test scores were noticed. As
a part of intervention, booklet (Planned Teaching Program) on knowledge regarding
revised trauma score, and its implication was conducted for 30-40 minutes. After
giving booklet a gain in the level of knowledge was assessed by the use of
questionnaire with the help of post test score.

PILOT STUDY

Before conducting pilot study formal permission was obtain from the prannath
hospital dean in order to test feasibility, relevance and practicability of the study. 10%
of population is planned for pilot study. Informed consent was taken from the
subjects. 10% of population is planned for pilot study. Intervention was on individual
basis for 1 to 7 days.

‘’revised trauma score and its application and the pre-test scores will be noticed. The
interventional program will be conducted after 7day and Deliver the PTP to the
nurses. Administer the knowledge questionnaire to the nurses again to assess their
knowledge after participating in the PTP. Analyze the data to compare the nurses'
knowledge scores before and after the PTP.”
VALIDITY: The content validity of the questionnaire and informational booklet
will be established by seeking expert opinions from 2 experienced nursing educators
and 3 clinicians.

DATA COLLECTION PROCEDURE

A formal prior permission was obtained from the head of the department vibrant
hospital of surat. Data was collected after getting permission from the concerned
authority of selected hospitals by explaining the purpose of the study. The
investigator was introduce to participants. The objectives of the study was explained
to the participants and formal written consent was taken from the subject. After 7
days a mean post-test was conducted by using questionnaire

Permission from the concerned authority:

Prior to collection of data, permission was obtained from the hospital, at Surat
Period of data collection:

The data collection period was 1week.

Pre-test:
Pre-test was conducted on icu staff nurses in selected hospital by using questionnaire
on knowledge items on revised trauma score

Implementation of planned teaching program:

1week after pre-test, the booklet was administered regarding revised trauma score .

Evaluation of planned teaching program:

The same structured questionnaire on knowledge items was used among staff nurses
after 7 days. It was used to collect the post-test knowledge.
DATA COLLECTION PROCEDURE

A formal prior permission was obtained from the head of the department vibrant
hospital of Surat. Data was collected after getting permission from the concerned
authority of selected hospitals by explaining the purpose of the study. The
investigator was introduce her to participants. The objectives of the study were
explained to the participants and formal written consent was taken from the
subject. Then the tool is administered and after 20 minutes the questionnaire was
collected

Descriptive statistics:

SR.NO METHODS REMARKS

1. Numbers, Percentage ,Mean Describes demographic variables

andStandard Deviation. and assess the knowledge of pre-
test andpost-test.

1. Paired ‘t’ test To analyzing the effectiveness

of book let on knowledge
regarding revised trauma sore

2. Chi-square test To know association between

selected demographic
variables and pre-test
knowledge on revised trauma
score selected hospital.
PROTECTION OF HUMAN RIGHTS

In this study all the subjects as a human being will be protected.

ETHICAL CLEARANCE

Ethical clearance for this study will be sought from the institutional ethics
committee of the selected hospital.

PROTECTION OF HUMAN RIGHTS

The study was conducted after the approval of research committee in the college. The
nature and purpose of the study was explained to the participants. The written consent

was obtained from the study participants to gain full co-operation. assurance was
given to the study samples that the anonymity of each individual would be
maintained strictly.

ETHICAL CLEARANCE

Ethical consideration was taken for the purpose of the study to assess knowledge
on Revised trauma score and its impact on prognosis of patient with multiple injury in
ICU among staff nurses with the views to developing information booklet in selected
hospital successive training period. Explanation regarding revised trauma score of
nurses, thus the ethical issue and confidentiality was ensured in this study.

Ethical clearance was obtained from research committee of Shri Anand Institute of
Nursing.

Inform consent was taken from the hospitals where the data was collected.

In this study all the rights of the subjects as human being has been protected. Ethical
consideration was taken into account for the study to assess the effectiveness of
booklet on knowledge regarding revised trauma score among ICU staff nurses
selected hospitals at surat city.
 CHAPTER – IV

DATA ANALYSIS AND INTERPRETATION

“All meanings, we know depend on the key of
Interpretation.”

-George Eliot
The process of evaluating data using analytical and logical reasoning to examine each
component of the data provided. This form of analysis is just one of the many steps
that must be completed when conducting a research experiment. Data from various
sources is gathered, reviewed, and hence analysis method, some of which include
data mining, text analytics, business intelligence and data visualizations.

The statistical analysis is method of rendering quantitative information meaningfully

and intelligently. Statistical procedure enables the research to reduce, summarize,
organize, evaluate, interpret & communicate numerical information.
This information deals with the analysis and interpretation of the collected data from
the samples in hospital. Polit and Beck (2004), has donated data analysis as the
systemic organization, synthesis of research data and the testing of research
hypothesis using those data. The analysis was done based on the objectives and
hypothesis of the study.

ORGANIZATION OF DATA:

Section A: Frequency and percentage distribution of demographic variables

regarding revised trauma score and its impact on prognosis of patient
with multiple injury in ICU among staff nurse.
Section B: Frequency and percentage distribution of pretest level of knowledge
regarding revised trauma score and its impact on prognosis of patient
with multiple injury in ICU among staff nurse.

Section C: Frequency and percentage distribution of posttest level of knowledge

regarding revised trauma score and its impact on prognosis of patient
with multiple injury in ICU among staff nurse.

Section D: Comparison between pretest and posttest level of knowledge

 regarding revised trauma score and its impact on prognosis of patient
with multiple injury in ICU among staff nurse

Section E: Comparison of mean and standard deviation of pretest and posttest

level of knowledge regarding revised trauma score and its impact on
prognosis of patient with multiple injury in ICU among staff nurse.

Section F: Association of pretest level of knowledge regarding revised trauma

score and its impact on prognosis of patient with multiple injury in
ICU among staff nurse
Section G: Association of posttest level of knowledge regarding revised trauma score
and its impact on prognosis of patient with multiple injury in ICU among staff
nurse
 SECTION –A

TABLE: 4. 1 Frequency and percentage distribution of demographic and variables

regarding revised trauma score and its impact on prognosis of patient with
multiple injury in ICU among staff nurse.

N=60

SrNo Demographic variables Frequency Percentage

(f) (%)
1 Age Group of staff nurses
22-25 Years 6 10%
26-30 Years 29 48.33%
30 Above 25 41.67%

2 Education status of staff

GNM B.SC. POST B.SCM.SC 3 5%
35 58.33%
15 25%
7 11.67%
3 Experience of the staff
1-2years3-4years 5 8.33%
More than 5years 10 16.67%
45 75%

4 Source of information
10 16.67%
Books Online Mass Media 35 58.33%
None 13 21.67%
2 3.33%

5 Previous experience of any

educational section regarding 12 20%
trauma 48 80%
Yes
No
6 Previous experience of care
given to trauma patient? 4 6.67%
YesNo 56 93.33%

7 Previous knowledge about

trauma care. 10 16.67%
YesNo 50 83.33%
Regarding the age group of staff nurses, 6 (10%) 22-25years, 29 (48.33%) 26-
30years, 24 (41.67%) were in 30 above age group. Regarding Education status of
staff nurses, 3 (5%) staffs were GNM,
35 (58.33%) of staffs were B.SC., 15 (25%) were post B.Sc., 7 (11.67%) were M.SC.
Regarding the experience of the staff, 34 (56.67%) were 1-2years, 21 (35%) were 3-
4years, 5 (8.33%) were more than 5years.Regarding source of information 10
(16.67%) were from book, 35 (58.33%) were from online, 13 (21.67%) were from
mass media, 2 (3.33%) were from none. Regarding previous experience of any
educational section regarding trauma 12 (20%) were yes, and previous experience of
any educational section regarding trauma 48 (80%) were No. Regarding any previous
experience of care given to trauma patient 4 (6.67%) were yes, and any previous
experience of care given to trauma patient 56 (93.33%) were No. Regarding any
previous knowledge about trauma care 10 (16.67%) were yes, 50 (83.33%) were NO.
 AGE GROUP
35

30
29

25
25

20

15

10

5 6

0 0 0 0 0 0
0
22-25years 26-30years above 30 year

Figure 4.1: Frequency and percentage distribution of agegroup of staffs.

EXPERIENCE OF STAFF

0%

3-4YEARS
MORE THAN
17%
Other 5YEARS
75% 75%
1-2YEARS
8%

Figure 4.2: Frequency and percentage distribution ofExperience of staff.

 35
15

GNM
B.SC
POST B.SC
M.SC

Figure4.3: Frequency and percentage distribution ofeducational status of

Staff.

SOURCE OF INFORMATTION
NONE
3%

MASS MEDIA
BOOK 17%
22%

ONLINE
58%

Figure4.4: Frequency and percentage distribution ofSource of

information
 EDUCATIONAL SECTION REGARDING TRAUMA

60
50
40 EDU SECTION
30 EDU SECTION2
20
10

YES Axis Title NO

Figure 4.5: Frequency and percentage distribution ofeducational

section regarding trauma

EXPERIENCE OF CARE
YES NO

40

20

EXPERIENCE OF CARE

EXPERIENCE OF CARE

Figure4. 6: Frequency and percentage distribution ofprevious experience

of care given to trauma patient
 PREVIOUS KNOWLEDGE
90

80

70

60

NO, 83
50

40

30

20
YES, 17
10

0
PREVIOUS KNOWLEDGE.

Figure4. 7: Frequency and percentage distribution of previous

knowledge about the warning signs of suicidalthoughts.
 SECTION – B

TABLE: 4.2 Frequency and percentage distribution of pretest level of knowledge

regarding revised trauma score and its impact on prognosis of patient with
multiple injury in ICU among staff nurse.

N=60

Level of knowledge Frequency(f)) Percentage(%)

Inadequate 36 60%

Moderate 21 35%

Adequate 3 5%

Table: 4.2 Frequency and percentage distribution of pre test level of knowledge
revised trauma score and its impact on prognosis of patient with multiple injury in
ICU among staff nurse. In pretest 36 (60%) of staff had inadequate knowledge and 21
(35%) of them had moderate knowledge and only 3 (5%) of them had adequate
knowledge.
 SECTION – C

TABLE: 4. 3 Frequency and percentage distribution of posttest level of

knowledge regarding revised trauma score and its impact on prognosis of patient
with multiple injury in ICU among staff nurse.

N= 60

Level Frequency(f)) Percentage(%)

Of knowledge

Inadequate 5 8.33%

Moderate 10 16.67%

Adequate 45 75%

Table: 4.3 Frequency and percentage distribution of posttest level of knowledge

revised trauma score and its impact on prognosis of patient with multiple injury in
ICU among staff nurse in post test 5 (8.33%) of staffs had inadequate knowledge and
10 (16.67%) of staffs had moderate knowledge and 45 (75%) of them had adequate
knowledge.
 SECTION – D

TABLE: 4.4 Frequency and percentage distribution of pretest and posttest level of
knowledge regarding revised trauma score and its impact on prognosis of patient
with multiple injury in ICU among staff nurse.

N=60

Level of Pre test Post test

knowledge
Frequency(f) Percent Frequency(f) Percent(%)
(%)

36 60% 5 8.33%
Inadequate

21 35% 10 16.67%
Moderate

3 5% 45 75%
Adequate

Table: 4.4 Represents Frequency and percentage distribution of pretest and posttest
level of knowledge revised trauma score and its impact on prognosis of patient with
multiple injury in ICU among staff nurse. With respect to the pretest level of
knowledge 36 (60%) of staffs had inadequate knowledge 21 (35%) of them had
moderate knowledge 3 (5%) of them had adequate knowledge, whereas in post test
only 5 (8.33%) of staffs had knowledge and 10 (16.67%) of them had moderate
knowledge, 45 (75%) of them had adequate knowledge.
 LEVEL OF KNOWLEDGE

45
40
35
30
25 Inadequate
20 Moderate
15 Adequate

10

Pre test Post test

Axis Title

Figure4.8: Comparative study Level of Knowledge

 SECTION – E

Table: 4.5 Comparison of mean and standard deviation of pretest and posttest
level of knowledge regarding revised trauma score and its impact on prognosis of
patient with multiple injury in ICU among staff nurse.

N=60

Assessment Mean StandardDeviation Paired ‘t’

value

Pre test 10.9 5.33

9.39***
Post test 17.5 4.35

***P<0.001

Table: 4.5 the comparison of mean and standard deviation between pretest and
posttest level knowledge regarding revised trauma score and its impact on prognosis
of patient with multiple injury in ICU among staff nurse. The mean score was
increased from 10.95 to 17.50 which showed a marked difference of 6.55
respectively and the standard deviation was decreased from 5.33 to 4.35 after the
administration of structured teaching programme. The paired’ “t” test value at,9.39
was very highly significant at p<0.001 level. It indicates the effectiveness of
structured teaching programme on increasing the level of knowledge regarding
revised trauma score and its impact on prognosis of patient with multiple injury in
ICU among staff nurse.
 20
COMPARITIVE STUDY OF MEAN & SD
18

16

14

12

10 pretest
post test

PRE TEST POST TEST

Figure 4.9: Comparison of mean between the pretest and posttest level of
knowledge among staff nurses.
 SECTION – F

Table 4.6: Association of pretest level of knowledge regarding revised trauma

score and its impact on prognosis of patient with multiple injury in ICU among
staff nurses

Sr Pretest level of knowledge Chi

No DEMOGRA Square
PHIC 2
VARIABL
Inadequate Moderate Adequate
ES
n % n % n %

1 Age Group of 2= 9.91

staff nurses 30% 3.33% 1 1.66%
18 2 Df = 4
15% 15% 1 1.66%
18-19 Years 9 9 16.67% 1 1.66% p= 9.49
20-21 Years 9 15% 10
22 Above p=<0.05

s*
2 Educational 2=13.57
status of staff 1.67%
11 18.33% 1 0 0% Df =6
nurses. 25%
GNMB.Sc. 11 18.33% 15 5% 1 1.66% P=12.59
post B.Sc.M.Sc. 10 16.67% 3 3.33% 2 3.33%
4 2 0 0% P=<0.05
6.67%
S*

3 Experience 2=8.21
of the staff. 13 21.67% 1.66%
2 3.33% 1 Df =
1-2yrs.3- 6 10% 10 1 1.66%
16.67%
17 28.33% 9 1 1.66% 4
4yrs more 15%
than 5yrs. p=9.
49
p=>0.05
NS

4 Source of 2=3.28
information 11.67%
7 3 5% 1 1.67% Df =6
Books 30%
18 14 23.33% 1 1.67%
Online 9 15% 3 5% 1 1.67% P=12.59
Mass 2 3.33% 1 1.67% 0 0%
P=<0.05
Media
None
 NS

5 Previous 2=8.71
experience of
any educational DF=2
section 4 6.67% 8 13.33% 2 3.33% P= 5.99
regarding 32 53.33% 13 21.67% 1 1.6%
trauma. P=<0.05
Yes S*
No
6 Previous 2=3.61
experience of Df=2
care given to
trauma 13.33% P=5.99
8 8 13.33% 2 3.33%
patient?Yes 46.67%
28 13 21.67% 1.6% P=<0.05 NS
1
No
7 Previous 2=3.05
knowledge Df =2
about trauma
care 15 25% 1 1.6%
35%
4 6.67% p-5.99 p=<0.05
Yes 21 17 28.33% 2 3.33%
No
NS

Table: 4.6 showed the association of pretest level of knowledge regarding revised
trauma score and its impact on prognosis of patient with multiple injury in ICU
among staff nurse and their demographic variables.

Three demographic variables are significantly associated with their pretest level of
knowledge score such as age group of staff, educational status of staff nurses, previous
experience of any educational section regarding trauma. The chi square value 9.91
showed that there was a significant association of age group and pretest level of
knowledge at the level of p<0.05.

With regard to the educational status of staff nurse’s chi square value of 13.57 was
significant at the interval of p<0.05. In concern with previous experience of any
educational section regarding trauma. 8.71 was significance at the interval of p<0.05.
 SECTION – G

Table 4.7: Association of post-test level of knowledge regarding revised trauma

score and its impact on prognosis of injury in ICU

Sr. Demographic Post test level of knowledge Chi

No Square
Variables
2
Inadequate Moderate Adequate
n % n % n %

1 Age Group of 2=12.59

staff nurses 10% Df=4
2 4 6.67% 6
3.33% 6.67% 8.33%
1 1.67% 4 5 P=9.49
22-25Years 3.33% 56.67%
2 3.33% 2 34
26-30 Years P=<0.05
Above 30 S*
years

2 Education 2=17.51
status of Df=6
staff nurse 8 P=12.59
1 1.67% 1 13.33%
1.67% 2
GNM 1 1.67% 4 3.33% P=<0.05
6.67% 30
1 1.67% 2 50%
B.SC 3.33% 5 S*
2 3.33% 3 8.33%
POST B.SC 5%
M.SC.

3 Experience 2=10.52
of the staff 8.33% 6.67% Df=4
1 1.67% 5 4
1-2yrs. 5% 38.33%
3 5% 3 23 P=9.49
3-4yrs. 3.33% 30%
1 1.67% 2 18
More than 5 P=<0.05
yrs. S*

4 Source of 2=7.61
information 13.33% 30% Df=6
Books 1 1.67% 8 18
1.67% 20%
2 3.33% 1 12 P=12.59
Online 0% 16.67%
1 1.67% 0 10
Mass 1.67% 8.33% P=<0.05
1 1.67% 1 5
Media NS
None
 5 Previous 2=8.
experience of 80
Df=2
any P=5.99
educational
section 11.67% 16.67% P<0.0
2 3.33 7 10
regarding 5% 58.33% 5
3 % 3 35
trauma 5% S*
Yes
No
6 Previous 2=7.87
experience of Df=2
care given to
P=5.99
trauma
patient 3 5% 8 13.33% 15 25% P<0.05
Yes 2 3.33 2 3.33% 30 50% S*
No %

7 Previous 2=9.23
knowledge Df=2
about trauma
P=5.99
care.
3 5% 9 15% 17 28.33% P<0.05
YesNo 2 3.33 1 1.66% 28 46.67% S*
%

TableTable: 4.7 showed the association of post-test level of knowledge regarding

revised trauma score and its impact on prognosis of patient with multiple injury in
ICU among staff nurse and their demographic variables. 6 demographic variables are
significantly associated with their posttest level knowledge score.

The chi square value 12.59 showed that there was a significant association of age and
post test level of knowledge after structure teaching programme at the level of
p<0.05. With regard to the educational status of staff nurse’s chi square value of 10.52
was significant at the interval of p< 0.05. In concern with Experience of the staff chi
square value of 17.51 was significant at the interval of p< 0.05.
The chi square value 7.61 showed that there was significant association of ‘any source
of information’ and post test level of knowledge after structural teaching programme
at the level of p<0.05.

The chi square value 8.80 showed that there was significant association of ‘previous
experience of any educational’ section regarding trauma and post test level of
knowledge after structural teaching programme at the level of p< 0.05. The chi
square value 7.87 showed that there was significant association of frequency of
previous experience of care given to trauma patient and posttest level knowledge after
structure teachingprogramme at the level of p< 0.05.

The chi square value 9.23 showed that there was a significant association of duration
of previous knowledge about trauma care and posttest level of knowledge at the level
of p<0.05.
 CHAPTER–V

DISCUSSION, SUMMARY, CONCLUSION,RECOMMENDATION

This chapter with discussion summary, conclusion, limitation, and recommendations

of the study. Further is includes implication of nursing practice, nursing education,
nursing administration and recommendation for further nursing research.

DISCUSSION
This study was conducted to assess the effectiveness of ‘planned teaching
programme’ on improving the knowledge regarding revised trauma score and its
impact on prognosis of patient with multiple injury in ICU among staff nurses the
first essential step for appropriate and timely referral. The finding of this study has
provided insight information on improving the knowledge revised trauma score and
its impact on prognosis of patient with multiple injury in ICU among staff nurse in
the study area, which could help in designing appropriate intervention and as a base
for further wide scale studies in other part of the country.

The study aimed to assess the effectiveness of structured teaching programme on

knowledge regarding revised trauma score and its impact on prognosis of patient with
multiple injury in ICU among staff nurse. The review of literature included related
researches which provide a strong foundation for the study including the basis for
conceptual framework and formation of tool.
The conceptual framework of this study was developed based on king’s conceptual
framework and theory of General System. This framework includes three
components such as Input, Output, and Feedback. This involves interaction between
the researcher and the college students.

The study was conducted by adopting a pre-experimental one group pre test post test
design. The study was carried out with 60 staff nurses who fulfilled the inclusion
criteria. Purposive sampling technique was used to select the sample. The
investigator introduced her to college student and explained the purpose of the study
to ensure better cooperation. Written consent was obtained from the staffs.
At the first day when they conducted the section the investigator collected data from
60 staffs to assess the level of knowledge regarding revised trauma score and its
impact on prognosis of patient with multiple injury in ICU among staff nurse. A
structured questionnaire was distributed to the staff nurses.

Assess the pretest level knowledge regarding revised trauma score and its impact on
prognosis of patient with multiple injury in ICU among staff nurse. Then followed by
a structured teaching programme on revised trauma score and its impact on prognosis
of patient with multiple injury in ICU among staff nurse. Post test was conducted to
assess the level of knowledge with the same questionnaire provided in the pre test.

The frequency and percentage distribution of demographic variables, revealed that

majority, 5 (8.33%) were in the experience of staff, 10 (16.67%) 1-2years, 45 (75%)
3-4years. With respect to the age group of staff, 0 (0%) were in the age group 22-25
Years, 50 (83.33%) 26-30 years, 10 (16.67%) 22 above. Regarding Education
status of staffs, 3 (5%) staff were GNM, 35 (58.33%) of staffs were
b.sc, 15 (25%) post b.sc, 7 (11.67%) M.S.c nursing Regarding source
of information10 (16.67%) were books, 35 (58.33%) of online, 13 (21.67mass media, 2
(3.33%) were none. Regarding any previous experience of any educational section
regarding trauma 12 (20%) were yes, and previous experience of any educational
section regarding trauma48(80%) were no. previous experience of care given to trauma
patient 4 (6.67%) were yes, and previous knowledge about trauma care
56 (93.33%) were No. Regarding any previous knowledge about trauma care 10
(16.67%) were yes, 50 (83.33%) were NO. The result of the study was discussed
based on the objectives stated for the study.

MAJOR FINDING OF THE STUDY

Major study findings include,

Findings related to demographic variables of the study

1. The Majority age groups of staff nurses were 26 to 30 years

2. The majority of educational status of staff were 35(58.33%) B.Sc.

3. The majority of source of information were35(58.33%) online.

4. The majority experience of staff were 45(75%) more than 5 yrs.

5. The majority of Previous experience of any educational section regarding trauma
48(80%) were no.
6. The majority did not have Previous experience of trauma care
7. The majority of Previous knowledge about trauma care were no 50(83.33%)

The first objective was to assess the level of knowledge level regarding revised
trauma score and its impact on prognosis of patient with multiple injury in ICU
among staff nurse. Study shows that pre-test level of knowledge among selected
60 sample of staff
nurses studying in selected areas. Inpretest 36 (60%) of staff nurses had inadequate
knowledge and 21 (35%) of them had moderate knowledge only. 3 (5%) of them had
adequate knowledge.

The second objective was to evaluate the effectiveness of structured teaching

programme on level of knowledge regarding revised trauma score and its impact
on prognosis of patient with multiple injury in ICU among staff nurse

The comparison of pretest and posttest level of knowledge revised trauma score and
its impact on prognosis of patient with multiple injury in ICU among staff nurse was
done by using paired’ test. The mean score was increased from. The mean score was
increased from
10.95 to 17.50 which showed a marked difference of 6.55 respectively and
the standard deviation was decreased from 5.33 to 4.35 after the administration of
structured teaching programme. The paired’ “t” test value at, 9.39 was very highly
significant at p<0.001 level. It indicates the effectiveness of structured teaching
programme on increasing the level of knowledge regarding revised trauma score and
its impact on prognosis of patient with multiple injury in ICU among staff nurses
Thus stated hypothesis H1 is accepted which shows there is significant change in the
level of knowledge in post test score than pre-test score regarding revised trauma
score and its impact on prognosis of patient with multiple injury in ICU among staff
nurse.
The third objective was to determine the association of pre-test level of
knowledge regarding revised trauma score and its impact on prognosis of patient
with multiple injury in ICU among staff nurse
In the pretest level of knowledge there were five demographic variables are
significantly associated with their pretest level of knowledge score such as age,
educational status of staff Experience ofthe staff source of information, having previous
experience of any educational section regarding trauma, and previous experience of care
given to trauma patient.

The chi square value 9.91 showed that there was a significant association of age
group of staff and pretest level of knowledge at the level of p<0.05

With regard to the educational status of staff’s chi square value of

13.57 was significant at the interval of p<0.05. In concern with previous experience of
care given to trauma patient8.71 was significant at the interval of p<0.05.

There was no significant association was found with other demographic variables
such as educational status’ education, staffs occupation, any medical professionals in
family, previous experience of any educational section regarding trauma., any previous
knowledge about trauma care

There are six demographic variables are significantly associated with their posttest
level knowledge score. The chi square value 12.59showed that there was a significant
association of age and posttest level of knowledge after structure teaching programme
at the level of p<0.05. With regard to the religion of college student’s chi square
value of 10.52 was significant at the interval of p< 0.05. In concern with educational
status of parent’s chi square value of 17.51 was significant at the interval of p< 0.05.
The chi square value 8.80 showed that was significant association of any medical
professional in the family and posttest level of knowledge after structural teaching
programme at the level of p< 0.05. The chi square value 7.87showed that there was
significant association of frequency of previous experience of care given to trauma
patient and posttest level knowledge after structure teaching programme at the level of
p< 0.05. The chi square value 9.23showed that there was a significant association of
duration of previous knowledge about trauma care and posttest level knowledge at the
level of p<0.05.
SUMMARY, CONCLUSION AND RECOMMENDATIONS

This chapter deals with the summary conclusion, limitations, suggestion and
recommendations of the study. Further it includes implications for nursing practice,
nursing education, nursing administration and recommendations for further nursing
research.

SUMMARY

The present study was to assess the effectiveness of ‘planned teaching programme’ on
improving the knowledge regarding revised trauma score and its impact on prognosis
of patient with multiple injury in ICU among staff nurse
Objective of the study was to assess the effectiveness of ‘planned teaching
programme’ on improving the knowledge regarding revised trauma score and its
impact on prognosis of patient with multiple injury in ICU among staff nurse

A pre–experimental one group pre-test post-test design was chosen for this study
without randomization. The samples were selected for this study by adopting non
probability purposive sampling technique. The sample selected for the present study
was decided to be 60. The data collected by structured knowledge questionnaire using
knowledge score to assess the level of knowledge.

The tool was used to collect the data, which consisted of two parts. Part I consisted of
Demographic variables, Part II consisted of structured knowledge questionnaire. The
contents of the questionnaire were checked and evaluated by five experts.

Data was collected in one month in areas of surat district. The data collected were
analyzed through descriptive statistics (frequency and percentage) and inferential
statistics (‘t’ test and Chi- square) to test the hypothesis
CONCLUSION

The main conclusion of this present study is that most of the college students had
inadequate and moderately adequate level of knowledge in pre-test and they
improved to moderately adequate and adequate knowledge in post-test. This shows
the imperative need to understand the purpose of structured teaching programme
regarding revised trauma score and its impact on prognosis of patient with multiple
injury in ICU among staff nurse

IMPLICATIONS OF THE STUDY

The implication of the findings has been discussed in relation to nursing practice, nursing
education, nursing administration and nursing research
NURSING PRACTICE
 Health is the quality of life that enables the individual to live the most and
serve the best.

 Nursing personnel, as a member of health care team, have an important roleto

play in improving the general health, wellbeing and quality of life of people.

 Nurses play a vital role in hospital setting. They can be perceptive and
sensitive in the process of identifying and validating any immediate and
longterm, concern or problem and can respond to these by appropriate
intervention. Nursing professional who provides knowledge revised trauma score
and its impact on prognosis of patient with multiple injury in ICU among staff
nurse

NURSING EDUCATION:

 Students may be given chances to provide health education regarding recognition

of trauma care

 Health education programmes can be organized by the studies in the college

settings.

 Continuing nursing education programme can be organized on this aspect.

 This study emphasizes the significance of short-term courses, in service education

for nurses to acquire advanced knowledge regarding the recognition of trauma
care.

 Nurse educator, should plan with an ample opportunity for the students to educate
the staff nurses about recognition of trauma care.
NURSING RESEARCH

Professional organizations in nursing are convinced of the importance of nursing

research as a major contribution to meeting the health and welfare needs of the people.
One of the aims of nursing research is to expand and broaden the scope of nursing.
The expanded role of a professional nurse emphasizes those activities which promote
health maintenance behavior among the people.

The present study helps nurse researcher to develop appropriate teaching learning
tools for Nurses in order to improve their knowledge and skills revised trauma score
and its impact on prognosis of patient with multiple injury in ICU among staff nurse
There is a need for extended and intensive research in this area, especially among staff
nurses This study can be baseline for future study.

NURSING ADMINISTRATION
 In the event of ever-changing disease manifestations, knowledge, explosion,
technology, and ever-growing challenges of nursing, the administration has a
responsibility to provide staff nurses with substantial continuing educational
opportunities.
 Necessary administration support should be provided for the development of such
educational material.
 Nursing personnel should be motivated to devote their time for the development of
educational material.
 In-service education, continuing nursing programmes and trainings should be
arranged for nursing personnel to update their knowledge and skills on revised
trauma score and its impact on prognosis of patient with multiple injury in ICU
among staff nurse
 The student administrators should explore their potentials and encourage
innovative ideas in the preparation of appropriate information modalities.
LIMITATIONS

1. Data collection period is limited to 4 weeks.

2. The study is limited to the staff nurses.

3. The sample size is limited to 60 sample. The small number of samples limits
generalization of the study.

4. The study did not use control group. The investigator had no control over the
events that took place between pre-test and post-test.

5. Only the knowledge aspect is considered in the present study

RECOMMENDATIONS
Based on the findings of the present study recommendations offered for the
future study are:
1. A similar study can be replicated on a larger scale to generalize the findings.

2. An experimental study can be undertaken with control group for effective

comparison.

3. The comparative study may be conducted to evaluate the effectiveness of various

teaching strategies like Self Instructional Module, Information booklets and
educational pamphlets on the same topic.

4. A similar study can be conducted on the staffs

5. A comparative study can be conducted with staff nurses.

6. A similar study can be conducted to assess the practice.

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