http://doi.org/10.33698/NRF0191 – Kanwalpreet Kaur, Neena Vir Singh, Sandhya Ghai, Meenakshi Agnihotri
Abstract : Today the nursing has been changed from the traditional intuitive nursing to the modern cyberspace nursing, demanding a broad knowledge of science and the research generated best practices. Thus, experimenting for an effective teaching technique this comparative study was undertaken with the objectives to develop protocols on live demonstration and video assisted teaching on nasogastric tube feeding and to assess the effectiveness of live demonstration and video assisted teaching on skill development of nursing students. The study was conducted at National Institute of Nursing Education and different units of Nehru Hospital, PGIMER, Chandigarh. A sample of 79 students of B.Sc Nursing 2nd year were selected by purposive sampling technique and randomly assigned by lottery method into group I live demonstration group (39) and group II video assisted teaching group (40). Group I received live demonstration on the patients (protocol 1), while group II was shown video on nasogastric tube feeding (protocol 2). After the implementation of protocols, skill development/performance was assessed through the checklist. However, upon comparison mean score (14.46±2.79) in nasogastric tube feeding in live demonstration group was more as compared to video assisted teaching group (13.40±2.11), though the difference was not statistically significant (p=0.06 as per t-test) in the performance score between the two groups leading to conclusion that live demonstration and video assisted teaching methods were equally effective in the skill development of the nursing students. So, live demonstration can be combined with video assisted teaching to enhance better learning and skill development among nursing students.
Keywords
Live demonstration, Video assisted teaching, Nasogastric tube feeding, Skill development
Correspondence at
Neena Vir Singh
Lecturer
National Institute of Nursing Education, PGIMER, Chandigarh
Introduction
A teaching method comprises the principles and methods used for instruction.1 Commonly used teaching methods may include lecture, demonstration, video assisted teaching or combinations of these. The choice of teaching method to be used largely depends on the information or skill that is being taught, and it may also be influenced by the aptitude and enthusiasm of the students.
Different instructional techniques are used for clinical education including: Live clinical demonstration on patients by the instructors. Demonstration refers to visual presentation of the activities aiming to facilitate learning since the students directly watch the procedure being performed on actual patients and can ask questions during the procedure.2 It provides live experiences to the students. They can enhance their clinical skills and put that into their practice.3 However, live demonstration method has some drawbacks as well. For instance, a good case for demonstration may not be available and the crowd makes it difficult for all students to fully watch the procedures performed.2
Use of advanced technology such as videotapes or computers is also popular now a days. These provide new learning experience for students. Moreover, the ability to repeat some parts or the entire film is a big advantage.4 Educational films have some drawbacks as well including the production cost, time-consuming production process, difficult editing, updating etc. Another disadvantage is that videotapes do not allow bi-directional communication with the operators. Therefore, it prevents spontaneous problem solving and decision making features that are unique and valued educational aspect.5-6
There are some procedures which cannot be performed directly on the patients because of the safety as well as the privacy issues, so in that cases video teaching is more preferable. But in contrast, some procedures cannot be well understood until they are performed on live patients.
Literature has indicated these kinds of examples such as a study on the effectiveness of video teaching over lecture cum demonstration in improving knowledge and skills of B.Sc. Nursing 3rd year students on antenatal examination concluded that video teaching is an effective method of teaching the students.7 A study on 80 undergraduate nursing students using two different modalities for teaching pharmacology i.e. Active lecture cum live demonstration and Active lecture cum video revealed that the competency program using active lecture cum video proved more effective than active lecture cum live demonstration.8 Another study on the effectiveness of video assisted teaching Vs demonstration method on female urinary catheterization in terms of knowledge and practice of nursing students concluded that for improving the clinical competencies of the students, demonstration method is more effective than video assisted teaching.9
Nasogastric tube feeding is a procedure of administration of feed via a tube passed into the stomach through the nose. It is one of the common nursing procedures which can be demonstrated on live patients as well as can be shown through video to enhance the practical skills of the students. With respect to effectiveness, different researchers support the use of different type of teaching methods. In this institute, researcher has observed clinical demonstration as a contemporary method of teaching. But with the increasing number of students in the institute, emphasis should be given on the different methods of teaching so as to meet the requirements of the students.
Due to different techniques opted by different instructors in doing same nursing procedure and in consideration of patient safety issues; video was developed as one of the teaching method to see its effectiveness as compared to live demonstration. Hence, the researcher has felt the need to identify which teaching method is more effective in developing skills among the students.
Objectives
- To develop protocols on live demonstration and video assisted teaching on nasogastric tube feeding
- To assess the effectiveness of live demonstration and video assisted teaching on skill development of nursing students
Materials and Methods
This study was conducted at National Institute of Nursing Education (NINE), PGIMER, Chandigarh and different units of Nehru Hospital, PGIMER, Chandigarh. PGIMER, Chandigarh has grown from initial bed strength of 230 to now over 1960 after adding several department and Intensive care units. The Nehru Hospital, the most vital part of the PGIMER, Chandigarh, caters to the need of the sick and has about 50,000 annual admissions. National Institute of Nursing Education (NINE) was established in 1964. It is an integral part of PGI campus and is affiliated to the PGIMER, Chandigarh. The Nursing Institute is designated as WHO class was selected because of nasogastric tube feeding procedure was in their curriculum. Ethical clearance was taken from the Institute Ethics Committee of the institution. A written permission was taken from the Principal, NINE, PGIMER, Chandigarh, Head of ENT department for video recording and Professor In-charge, Department of clinical photography, PGIMER, Chandigarh for video shooting.
The tools and protocols used for data collection were socio-demographic profile of subjects, protocol 1 for live demonstration on nasogastric tube feeding, protocol 2 for video assisted teaching on nasogastric tube feeding and observational checklist to be filled by the rater to assess the skill development of students. The scoring key of the observational checklist was made in which each correct step was scored as 1 and incorrect step was scored as
- Total 24 steps were there. So the maximum attainable score was 24. Subjects were categorized under four levels of performance scores: below 50% (<12) poor performance, 50-59% (12-14) average performance, 60-74% (15-17) good Collaborative Centre for Nursing and performance and ≥ 75% (≥ 18) excellent
Midwifery development since March 2003. Every year about 150 graduates and 30 post graduate nursing students are qualifying.
Research approach used was quantitative and research design employed was comparative research design. Target population was students of B.Sc Nursing, NINE, PGIMER, Chandigarh. Total 79 subjects were selected from B.Sc Nursing 2nd year by purposive sampling technique and randomized by lottery method into odd and even roll number. They were assigned into two experimental groups; group I live demonstration group (39) and group II video assisted teaching group (40). This performance. Tools and protocols were prepared from extensive review of literature and validated by experts from the field of nursing. The reliability of tool was checked by using inter-rater reliability method in which performance of 2 subjects was assessed by two raters on the same day and the similarity of the results were seen using the Cohen’s Kappa score (0.81) which indicated that checklist was reliable.
Sister-in-charge of the respective units was informed about the study. Informed consent was obtained from subjects and patients after explaining the objectives and duration of their involvement. Anonymity and confidentiality of the subjects was maintained while carrying out the study. The period of data collection was from September-October 2014. Group I with even roll number received live demonstration on the patients, while group II with odd roll
Results
Table 1 depicts the socio demographic profile of the subjects in both the groups. Age range was 18-23 years in both the groups with mean age 19.28 ± 0.99 years in video assisted teaching group and number was shown video on nasogastric 19.21 ± 0.95 years in live demonstration tube feeding. Video was shown to 40 subjects without any repetition in one sitting in NINE, PGIMER, Chandigarh. On the other hand, live demonstration was given to each group of 6-8 subjects at a time in ENT ward of Nehru hospital, PGIMER, Chandigarh. Within 5 weeks after demonstration of procedure as per two protocols, each subject was asked to perform procedure on patient and performance was assessed by researcher by using observational checklist. The data was analyzed using the descriptive and inferential statistics. Analysis was carried out with the help of Microsoft excel and Statistical Package for Social Science (SPSS version 16) program. group. Majority of the subjects in both the groups were hostlers. Day scholar in live demonstration group and video assisted teaching group were 9 (23.1%) and 7 (17.5) respectively. More than half of the subjects 23(57.5%) in video assisted teaching group were from urban locality whereas, 21(53.8%) subjects in live demonstration group were from rural locality. Looking at the academic educational background of the subjects, it was seen that all of the subjects i.e. 40 (100%) got admission after 12th whereas, one subject in live demonstration group came after doing B. Sc honors. Both the groups were found to be homogenous in nature for all the socio demographic variables (P >0.05 as per z2 test).
Table No. 1: Socio-demographic profile of the subjects in both the groups
N= 79
| Variables | Video assisted teaching group n = 40 n (%) | Live Demonstration
group n = 39 n (%) |
x2 (df) P Value |
| Present residence
Hostler Day scholar |
33 (82.5) 7 (17.5) |
30 (76.9) 9 (23.1) |
0.38(1) 0.54 |
| Habitat
Rural Urban |
17 (42.5)
23(57.5) |
21(53.8)
18(46.2) |
1.02 (1)
0.31 |
| Academic educational background
12th B.Sc |
40 (100)
– |
38 (97.4)
1 (2.6) |
– |
*Mean± SD of age in years: Video assisted teaching group19.28 ± 0.99, live demonstration group 19.21 ± 0.95
Range: 18-23 years
Table 2 depicts the performance of subjects in nasogastric tube feeding between both the study groups. 6(15.4%) subjects in live demonstration group performed excellent (≥75% score) which in video assisted teaching group was only 1(2.5%). Approximately 30% of the subjects performed good (60%-74% score) in live demonstration group as compared to 27.5% in video assisted teaching group. Total 19(47.5%) and 16(41%) subjects performed average in video assisted teaching group and live demonstration group respectively. Higher percentage of subjects (22.5%) performed poor (<50% score) in video assisted teaching group as compared to the live demonstration group (12.8%). This shows that live demonstration group performed better though no statistically significant difference was observed in the performance score of subjects (P>0.05 as per z2 test) in both the study groups.
Table no. 2: Comparison of performance of subjects in nasogastric tube feeding in both the groups
N= 79
| Performance score | Video assisted teaching group n = 40 n (%) | Live Demonstration
group n = 39 n (%) |
x2 (df) p Value |
| Excellent (≥75%) or ≥18 (18-24) | 1 (2.5) | 6 (15.4) | 4.84 |
| Good (60% – 74%) or (15-17)
Average (50% – 59%) or (12-14) Poor (<50%) or <12 |
11 (27.5)
19 (47.5) 9 (22.5) |
12 (30.8)
16 (41.0) 5 (12.8) |
0.18# |
# Fisher’s exact test Maximum attainable score: 24
Figure 1 compares the mean performance score of the subjects in nasogastric tube feeding in both the study groups. Mean score in live demonstration group was higher (14.46±2.79) as compared to video assisted teaching group (13.40±2.11), though this difference was not statistically significant
(P =0.06 as per t-test).
Figure 1: Performance score of subjects in nasogastric tube feeding in both the groups
Table 3 shows the number of subjects performed correct steps in preparation of nasogastric tube feeding procedure. Almost each subject identified the patient. More than half of the subjects checked the amount and frequency of tube feeding on patient’s chart in both the study groups. Approximately 50-60% of the total subjects explained the procedure to patient/attendant and assessed patient’s general condition, bowel movements and abdominal girth in both the study groups. 20-30% of the subjects checked that the feed is at room temperature in both the study groups. Almost 30% of the subjects positioned patient with head of bed elevated at 30-45 degree. Ninth step i.e. spread mackintosh with towel over patient’s chest was performed by 24(60%) subjects in video assisted teaching group while 16(41%) subjects have done it in live demonstration group. Significantly higher percent of subjects asked about time of last feed, time of suctioning if intubated/tracheostomized, food allergies and collected required articles at bedside in live demonstration group as compared to video assisted teaching group (p value= 0.003 and 0.03 as per z2 test) respectively.
Table no.3: Performance of correct steps by subjects during preparation of nasogastric tube feeding procedure
N= 79
| Activities under evaluation during preparation of procedure | No. of subjects performed correct steps | x2 (df) p Value | |
| Video assisted teaching group n = 40 n (%) | Live Demonstration
group n = 39 n (%) |
||
| Identify patient | 38 (95.0) | 38 (97.4) | – |
| Check the amount and frequency of tube feeding on patient’s chart | 27(67.5) | 28(71.8) | 0.17 (1)
0.69 |
| Explain procedure to patient/attendant | 22(55.0) | 20 (51.3) | 0.11 (1)
0.74 |
| Assess patient’s general condition, bowel movements and abdominal girth | 20 (50.0) | 24 (61.5) | 1.06 (1)
0.30 |
| Ask about time of last feed, time of suctioning if intubated/ tracheostomized and food allergies | 2( 5.0) | 12 (30.8) | 8.99 (1)
0.003 |
| Collect required articles at bedside | 6 (15.0) | 14 (35.9) | 4.56 (1)
0.03 |
| Check that the feed is at room temperature | 11(27.5) | 8 (20.5) | 0.53 (1)
0.47 |
| Position patient with head of bed elevated at 30-45 degree | 12(30.0) | 13(33.3) | 0.10 (1)
0.75 |
| Spread mackintosh with towel over patient’s chest. | 24 (60.0) | 16(41.0) | 2.844(1)
0.09 |
Table 4 describes the number of subjects performed correct steps during the procedure. Fifty percent of the subjects performed hand hygiene in video assisted teaching group and 41% of the subjects in live demonstration group did the same task. Almost all subjects aspirated gastric contents with syringe in both the groups. Pinching the feeding tube was performed in high percentage by subjects in video assisted teaching group i.e. 33(82.5%) as added water into the syringe when feeding was almost complete in both the groups. Approximately fifty percent of the subjects fixed the feeding tube on the forehead or behind the ear in both the groups. Statistically higher percentage of subjects checked placement by pushing 5-10 ml of air and auscultate over the stomach; and dip lower end of nasogastric tube in bowl of clean water in live demonstration group as compared to video assisted teaching group compared to live demonstration group 26(66.7%). All subjects administered prescribed feed. Majority of the subjects (p value 0.02 and 0.002 as per z2 respectively. test)
Table no.4: Performance of correct steps by subjects during the nasogastric tube feeding procedure
N= 79
| Activities under evaluation during the procedure | No. of subjects performed correct steps | x2 (df) p Value | |
| Video assisted teaching group n = 40 n (%) | Live Demonstration
group n = 39 n (%) |
||
| Perform hand hygiene. | 20(50.0) | 16(41.0) | 0.64 (1)
0.42 |
| Aspirate gastric contents with syringe. Proceed with the feeding if amount of feeding does not exceed 100ml or policy agency. | 38(95.0) | 38(97.4) | – |
| Check placement by pushing 5-10 ml of air and auscultate over the stomach | 22(55.0) | 31(79.5) | 5.36 (1)
0.02 |
| Dip lower end of nasogastric tube in bowl of clean water | 18(45.0) | 31(79.5) | 9.97 (1)
0.002 |
| Pinch the feeding tube and attach barrel of feeding syringe to tube | 33(82.5) | 26(66.7) | 2.62 (1)
0.11 |
| Administer prescribed feed | 40(100) | 39(100) | – |
| Add 30-50 ml of water for irrigation into the syringe when feeding
is almost completed |
37(92.5) | 33(84.6) | 0.56 (1)
0.45* |
| Close end of feeding tube and fix it on the forehead or behind the ear | 16(40.0) | 20(51.3) | 1.01 (1)
0.31 |
Table 5 depicts the number of subjects performed correct steps during termination of nasogastric tube feeding procedure. More than half of the subjects removed mackintosh with towel in video assisted teaching group while, in case of live demonstration group was 41%. In both the groups, less than half of the subjects made the patient comfortable by communicating with him/her. Very few subjects asked the patient to remain in upright or left lateral position for at least 30-60 minutes after feeding i.e. only 2(5%) subjects in video assisted teaching group and 6(15.4%) subjects in live demonstration group. Most of the subjects washed equipments with warm water and dried them in both the groups. More than 90% of subjects performed hand hygiene after the procedure in both the study groups. Majority of the subjects had documented type, amount, time of feed and amount of water given. Last step i.e. document patient’s general condition, bowel movements and abdominal girth was performed by more number of subjects 11(28.2) in live demonstration group as compared to video assisted teaching group 7(17.5). No statistically significant difference (P >0.05 as per z2 test) was found in any of the steps performed by subjects while terminating the procedure in both the study groups.
Table no. 5: Performance of correct steps by subjects while terminating the nasogastric tube feeding procedure
N= 79
| Activities under evaluation during the procedure | No. of subjects performed correct steps | x2 (df) P Value | |
| Video assisted teaching group n = 40 n (%) | Live Demonstration
group n = 39 n (%) |
||
| Remove mackintosh with towel | 21(52.5) | 16(41.0) | 1.04 (1)
0.31 |
| Make the patient comfortable by communicating with him/her. | 14(35.0) | 16(41.0) | 0.30 (1)
0.58 |
| Ask patient to remain in upright or
left lateral position for at least 30-60 minutes after feeding. |
2(5.0) | 6(15.4) | 1.34 (1)
0.25* |
| Wash equipment with warm water and dry | 34(85.0) | 35(89.7) | 0.09 (1)
0.77* |
| Perform hand hygiene | 36(90.0) | 36(92.3) | – |
| Document type, amount, time of feed and amount of water given | 36(90.0) | 37(94.9) | 0.15 (1)
0.69* |
| Document patient’s general condition, bowel movements and abdominal girth. | 7(17.5) | 11(28.2) | 1.29 (1)
0.26 |
As shown in table 6, mean score of the subjects while preparing, during and terminating the procedure of nasogastric tube feeding in live demonstration group was higher than video assisted teaching group, though this difference was not statistically significant (P >0.05 as per t- test).
Table no. 6: Comparison of mean score of the subjects while preparing, during and terminating the procedure of nasogastric tube feeding in both groups
N= 79
| Steps of procedure | Mean performance score | t (df) p Value | |||
| Video assisted teaching group
n = 40 |
Live Demonstration
group n = 39 |
||||
| Mean±SD | Range | Mean±SD | Range | ||
| Preparation of procedure | 4.0±1.28 | 1-7 | 4.4±1.33 | 2-8 | 1.48(77) |
| (Maximum attainable score = 9) | 0.14 | ||||
| During the procedure | 5.65±1.21 | 3-8 | 6.0±1.57 | 3-8 | 1.11 (77) |
| (Maximum attainable score = 8) | 0.27 | ||||
| Termination of procedure | 3.75±0.93 | 2-5 | 4.0±1.11 | 2-6 | 1.19 (77) |
| (Maximum attainable score = 7) | 0.23 | ||||
Discussion
Teaching methods utilizes the principles and methods of education. These serve as stimulation, guidance, direction and encouragement for learning. New methods and materials of instruction are evolving every day. Commonly used teaching methods may include lecture, clinical demonstration, video assisted teaching or combinations of these. Nurses being the first line managers are challenged with patient management and it calls the importance of updated and skillful nursing. Hence, teaching programmes become extremely important to close the gap between theory and practice.
There has been a considerable amount of efforts expanded over the past several years to identify the most effective teaching method. Based upon the reported literature, researcher wanted to evaluate whether video assisted teaching that serve as easy reference has more impact on performance of students or live demonstration. Live demonstration on patients plays important role in learning as it provides live experiences to the students. Hence, the present study was undertaken. Results indicated that video assisted teaching and live demonstration methods were equally effective in the skill development of nursing students though live demonstration group’s performance score was higher than video assisted teaching group.
Similar kinds of findings are also depicted in various other studies. A study conducted by Maria et al concluded that video assisted teaching (VAT) and self instructional module (SIM) were equally effective in improving the practices of the nurses regarding care of patients on on forehead and remove mackintosh but rest of the subjects skip by finding it as not ventilator.10 Similar study conducted by important. Assessment is first step to do Hosseininasab D concluded that computer assisted instruction as an independent teaching method, can improve learning in cognitive domain as same as demonstration method.11
However, in the study conducted by Karimi, video and demonstration methods on learning of clinical skills were compared. The scores of the students in the cognitive domain of hand washing by the demonstration were more (16.20±1.5) as compared to video method (15.25±1). Similarly, scores of the students in psychomotor domain of hand washing by the demonstration were more (16.85±1.4) as compared to video method (15.94±1.4). The results revealed that demonstration method was more effective in the student’s learning.12
Contradictory findings revealed that the competency program on drug administration using active lecture cum video (ALV) was proved to be more effective than active lecture cum live demonstration before any procedure but only 2(5%) subjects asked about time of last feed, time of suctioning and food allergies in video assisted teaching group as compared to 12(30.8%) in live demonstration group. The reason may be because of their little attention while watching the video and no interaction with the researcher.
Higher number of subjects collected required articles at bedside in live demonstration group as compared to video assisted teaching group because of their live experience during the demonstration. Similarly, more number of subjects checked placement by pushing 5-10 ml of air and auscultate over the stomach and dip lower end of nasogastric tube in bowl of clean water in live demonstration group as compared to video assisted teaching group because of their attention and interaction in attending live demonstration. Very few subjects (20-30%) checked that the feed is at room temperature in both the groups as they do not emphasize on this step rather (ALLD) in teaching pharmacology.8 In they just focus on administering feed. More another study done by Scaria TM, Valsaraj PB showed the effectiveness of video teaching over lecture cum demonstration in improving knowledge and skills of nursing students on antenatal examination.7
In present study, performance of correct steps by subjects indicated that most of the subjects (90-100%) identified patient, aspirate gastric contents with syringe and performed hand hygiene after the procedure by considering these are important steps to do in a procedure. Approximately half of the subjects explained procedure to patient/attendant, performed hand hygiene during the procedure, fix tube number of subjects spread mackintosh over patient’s chest and pinch the feeding tube in video assisted teaching group in contrast to live demonstration group; the reason may be more clear visualization of these steps in the video. All of the subjects administered feed.
Documentation is the last but important step after every procedure. 90- 95% of the subjects document type, amount and time of feed but most of the subjects skip to document the patient’s general condition, bowel movements and abdominal girth as they do not consider it as important one.
Results of various studies support the use of different type of teaching methods. In the present study, mean score of the subjects in live demonstration group was more in comparison to video assisted teaching group. However, no statistically significant difference was observed. Hence, live demonstration and video assisted teaching methods were equally effective in the skill development of nursing students.
Hence, it is recommended that combination of teaching methods can be adopted to enhance the skill development of the students. Live demonstration is a traditional and preferred method but video can also be used as statistically both are equally effective. Whichever method is used for teaching but it is essential to emphasize the importance of performing each step as steps of procedure are important for skill development. Future studies can be extended to other nursing procedures also.
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