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January - April 2016

Volume 5 Number 1
Articles
IJSN
Factors Influencing Utilization of Immunization Services and Effectiveness of
A Guided Health Action on Utilization of Immunization Status among
Parents of Under Fives in Selected Area of Dehradun Uttarakhand 5
Chandan Kumar, Rajkumari Sylvia Devi, Atul Chaudhary, Sanchita Pugazhendi
Effectiveness of Music Therapy in Reduction of Anxiety among Patients

undergoing Dialysis 15
Vijaya M. Udumala
Challenges in Organ Transplantation: An Indian Scenario 19

Neethu Jose
Medication Errors: Don’t Let Them Happen To You 27

Neethu Jose
Nurses Role: A Vital Part in Operation Theatre 33

Vasantha Kalyani, S.K. Mohana Sundari
Guidelines for Authors 37

4
Indexing information page of Index Copernicus

http://dx.doi.org/10.21088/ijsn.2277.467X.5116.15
IJSN
Volume 5, Number 1
Factors Influencing Utilization of Immunization © Red Flower Publication Pvt.
Services and Effectiveness of A Guided Health
Action on Utilization of Immunization Status among
Parents of Under Fives in Selected Area of
Dehradun Uttarakhand
Chandan Kumar*, Rajkumari Sylvia Devi**, Atul Chaudhary***, Sanchita Pugazhendi****
Abstract
A Quasi experimental study was conducted to assess the factors influencing the utilization and non-
utilization of under five immunization services and to evaluate the effectiveness of guided health action on
utilization of immunization services among parents of under five children in a selected area of Dehradun,
Uttarakhand. Total 120 children who met the selection criteria were selected using convenient sampling and
were divided into experimental group (60) and control group (60). Pre interventional immunization status
was assessed along with the reasons of not utilizing immunization services using a structured immunization
checklist and structured questionnaire respectively in both the groups. Guided health action was given to the
experimental group through SMS, phone calls and personal contacts. Post intervention data was collected to
assess the effectiveness of the guided health action. The results showed significant reduction in the missed
vaccination doses in experimental group after intervention (43) as compared to the missed doses before
intervention (142) (χ2 = 30.732, p value <0.05). The major reasons reported by the parents for not immunizing
their children were illness of the child and unawareness regarding need to return for 2nd and 3rd dose of
immunization. The least reported reason was no faith in immunization. The findings of the present study
revealed that the guided health action was effective in improving the utilization of under-five immunization
status.
Keywords: Under Five Children; Under-Five Immunization; Utilization of Under Five Immunization
Services; Guided Health Action.
Introduction partners, more children are being immunized than

ever before – over 100 million children a year in recent
years. And more vaccines are increasingly being made
Immunization forms the major focus of child available to protect adolescents and adults [2].
survival programmes throughout the world. It is one
of the most effective, safest and efficient public health Despite of extraordinary progress in immunizing
interventions as it is estimated to save at least 3 more children over a past decade, roughly 3 million
million lives from vaccine preventable diseases [1]. children die each year of Vaccine Preventable
Since 2000, efforts have been scaled up to meet the Diseases (VPDS) with a disproportionate number of
Millennium Development Goals (MDGs) and the these children residing in developing countries [3].
supporting goals of the Global Immunization Vision Recent estimates suggest that approximately 34
and Strategy (GIVS), developed by World Health million children are not completely immunized with
Organization (WHO) and United Nations almost 98% of them residing in developing countries
International Child Emergency Fund (UNICEF). With [4]. Vaccination coverage in India is also far from
financial support from the GIVS Alliance and other complete despite the long-standing commitment to
universal coverage.
Author Affiliation: Faculties in Nursing, Himalayan
Morbidity and mortality caused by diseases that
College of Nursing,S wami Rama Himalayaan University,
Dehradun, India. are preventable by vaccine are still very high in many
developing countries across the world. 15% of deaths
Correspondance: Chandan Kumar, Faculty in Nursing, in children under-five years of age are attributed to
Himalayan College of Nursing, Swami Rama Himalayaan
these diseases [5]. Across different regions of the
University, Dehradun, India. 248016.
E-mail: chaudhary.chandan22@gmail.com developing world, the lowest recorded immunization

6 Chandan Kumar et. al. / Factors Influencing Utilization of Immunization Services and Effectiveness of A Guided
Health Action on Utilization of Immunization Status among Parents of Under Fives in Selected Area of Dehradun Uttarakhand
rates are in Sub-Saharan Africa (UNICEF, 1998; a behavioral model that provides measures to access
Boerma et al. 1990). In South Asia, 93 % of children medical care. An individual’s access to and use of
had received BCG immunization, 83% were health services is considered to be a function of three
immunized by DPT and OPV (Oral Polio Vaccine) characteristic, i.e. predisposing factors, enabling
and 77 percent were immunized against measles. factors and need factors.
(UNICEF, 1995 & 1998).
Material and Method

Need of the Study
In spite of 20 years of efforts and millions of dollars Quasi Experimental non randomized control
invested into Universal Immunization programme group design was used in the present study. The study
(UIP), the coverage rate has still not crossed the 50%. was conducted in a rural area of Dehradun,
Immunization coverage showed improvement since Uttarakhand. 120 children who fulfilled the inclusion
National Family Health Survey-1 (NFHS-1), when criteria were selected using convenient sampling. They
only 36% of children were fully vaccinated and 30% were divided into experimental and control group with
had not been vaccinated at all. But there was a very 60 samples in each group. Tool used in the present
little change in immunization coverage between study was demographic variables checklist,
NFHS-2 (42%) and NFHS-3 (44%) [6]. immunization schedule checklist and structured
In India government has made under-five questionnaire on reasons for not utilizing
immunization free of cost for all. Enormous resources immunization services. The content validity of the tool
have been spent on the immunization but it does not was ensured by submitting tool to experts from the field
reap the much hyped outcome. Various survey results of community medicine, community health nursing,
show the glaring gap between the target and child health nursing and medical surgical nursing. Pilot
achievement even after several years. study was conducted on 10 samples in selected area of
Dehradun. Reliability of the tool was established by
test retest method. Karl Pearson’s coefficient was
Problem Statement calculated which was found to be 0.8.
A study on factors influencing utilization of
immunization services and effectiveness of a guided
health action on utilization of immunization status Results and Findings
among parents of under fives in selected area of
Dehradun, Uttarakhand. Related to Socio-demographic Variables
According to table no. 1 most of the children (36.6%)
Objectives in the experimental group and (40%) in the control
group were in the age group of 1–2 years. Most of the
• To assess the factors that influence the utilization
fathers (41.7%) in the experimental group and (53.3%)
and non- utilization of under five immunization
in the control group were having secondary level of
services.
educational status. Most of the mothers (46.7%) in the
• To evaluate the effectiveness of guided health experimental group and (53.3%) in the control group
action on utilization of immunization services. were having primary level educational status. Majority
of the fathers (55%) in the experimental group and
(53.3%) in the control group were self employed. Most
Hypotheses of the mothers (46.6%) in the experimental group were
H1: The guided health action would significantly self employed and (61.7%) in the control group were
increase the utilization of immunization services in housewife. Majority of the parents (60%) in
the experimental group. experimental and (96.6%) in control group belongs to
Hindu religion. Majority of the children (68.3%) in
experimental group and (61.7%) in control group were
Conceptual Framework delivered in government hospital. Majority of the
The conceptual framework of the present study parents (66.7%) in experimental group and (53.3%) in
was based on Andersen and Newman Framework control group belongs to joint family. Source of
of Health Services Utilization (1990). The purpose of information about immunization for majority of the
this framework is to discover conditions that either parents (73.3%) in the experimental group and (66.7%)
facilitate or impede utilization. The goal is to develop in the control group were health care providers.

Chandan Kumar et. al. / Factors Influencing Utilization of Immunization Services and Effectiveness of A Guided 7
Table 1:
Sociodemographic Sample Experimental Control Total

variables characteristics group (n=60) group (n=60)
F % F % F %
Age of children 0 - 1 yrs 10 16.6 9 15 19 15.8
1 - 2 yrs 22 36.6 24 40 46 38.3
2 - 3 yrs 17 28.3 16 26.6 33 27.5
3 - 4 yrs 3 5 8 13.3 11 9.1
4 - 5 yrs 8 13.3 3 5 11 9.1
Gender of the children Male 28 46.7 30 50 58 48.3
Female 32 53.3 30 50 62 51.6
Education status of Higher 12 20.3 13 21.7 25 20.8
father education
Secondary 25 41.7 32 53.3 57 47.5
education
Primary 21 35 15 25 36 30
education
No formal 2 3.3 0 0 2 1.6
education
Education status of Higher 8 13.3 7 11.7 15 12.5
mother education
Secondary 14 23.3 21 35 35 29.1
education
Primary 28 46.7 32 53.3 60 50
education
No formal 10 11.7 0 0 10 8.3
education
Occupation of father Employed 25 41.7 27 45 52 43.3
Self-employed 33 55 32 53.3 65 54.1
Unemployed 2 3.3 1 1.7 3 2.5
Occupation of mother Employed 8 13.3 5 8.3 13 10.8
Self-employed 28 46.6 18 30 46 38.3
Unemployed 24 40 37 61.7 61 50.8
Religion Hindu 36 60 58 96.7 94 78.3
Muslim 24 40 2 3.3 26 21.6
Delivery setting Government 41 68.3 37 61.7 78 65
setup
Private setup 19 31.7 23 38.3 42 35
Type of family Joint 40 66.7 35 58.3 75 62.5
Nuclear 20 33.3 25 41.7 45 37.5
Source of information Family 14 23.3 8 13.3 22 18.3
about immunization members
Health care 44 73.3 40 66.7 84 70
providers
Media 2 3.3 12 20 14 11.6
Frequency and Percentage of Pre Intervention Missed 10% in the experimental group and 8.3% in the
dose of Immunization control group had not received DPT 3rd dose. 21.6%
Table no. 2 shows that 50% children in the in the experimental group and 41.6% in the control
experimental group and 41.6% children in the control group had not taken DPT Booster. 25% of the
group were not immunized with Hepatitis B (0 dose) children in the experimental group and 35% in the
vaccine. 6.6% children in the experimental group and control group had not received measles vaccination.
61.6% in the control group were not immunized with Only 61.6% children in the experimental group and
Hepatitis B (1 st dose). 11.6% children in the 46.6% in the control group had not received vitamin
experimental group and 21.6% children in the control A vaccination.
were not immunized with Hepatitis B (2nd dose)
vaccine. 16.6% children in the experimental group Related to Effectiveness of Guided Health Action on
and 15% in the control group had not received Utilization of Immunization Services among
Hepatitis B 3rd dose. 25% in the experimental group Experimental and Control Group
and 8.3% in the control group had not received DPT
1st dose. 8.3% in the experimental group and 11.6% Table 3 illustrates that the total pre-test missed
in the control group had not received DPT 2nd dose. doses in the experimental group were 142 and in

Table 2: Frequency and percentage distribution of Pre- intervention missing doses of immunization
among experimental and control group
Immunization doses Experimental group (N=60) Control group (N=60)
F % F %
Hepatitis B
0 30 50 25 41.6
1 04 6.6 10 61.6
2 07 11.6 13 21.6
3 10 16.6 09 15
DPT
1 15 25 05 8.3
2 05 8.3 07 11.6
3 06 10 05 8,3
DPTBooster 13 21.6 45 41.6
Measles 15 25 21 35
Vitamin A 37 61.6 28 46.6
Table 3: Effectiveness of guided health action on utilization of immunization services among experimental
and control group
Groups Total No. of Pre-test Total No. of post-test Total Chi- square
missed doses missed doses P value
Experimental group 142 43 185 30.732 <0.001
Control group 164 153 317
Total 306 196 502
*χ2 = 30.732, at df = 1, p value <0.001
control group were 164. After guided health action Data in Table 3.1 shows that in experimental group
total number of missed doses in the experimental there were 30 pre-test missed doses of Hepatitis- B
group was 43 and in the control group was 153. (0 dose) and in control group there were 25 missed
χ2 was 30.732 at df 1 and the p value obtained is less doses. After guided health action the post-test missed
than 0.001. Hence the researcher rejected the null Hepatitis- B (0 dose) of the experimental group was11
hypothesis and alternative hypothesis was accepted. and of thecontrol group was 23. Theχ2 value obtained
Therefore the researcher inferred that guided health was 4.165 at df 1. The p value is less than 0.001.
action was effective in increasing the utilization of Data in Table 3.2 shows that the total pre-test
under-five immunization services.
Table 3.1: Effectiveness of guided health action on utilization status of Hepatitis-B 0 dose
Group Pre test missed Post-test Total Chi square P-value
doses missed doses
Experimental group 30 11 41
Control group 25 23 48 4.165 <0.001
Total 55 34 89
missed doses of Hepatitis-B (1 st dose) in the Data in Table 3.3 shows that shows total pre-test
experimental group were 4 and in control group were missed doses of Hepatitis-B (2 nd dose) in the
6. After guided health action total number of missed experimental group were 7 and in control group were
doses in the experimental group was 0 and in the 13. After guided health action total number of missed
control group was 6. χ 2 was 3.200 at df 1 and the p doses in the experimental group was 7 and in the
value obtained was more than 0.001. control group was 13. χ 2 was 0.000 at df 1 and the p
value obtained is >0.001.
Table 3.2: Effectiveness of guided health action on utilization status of Hepatitis-B 1st dose
Group Pre-test Post-test Total Chi square P-value
missed doses missed doses
Control group 6 6 12 3.200 >0.001
Total 10 6 16
*χ 2 = 3.200, df=1, p value >0.001
Table 3.3: Effectiveness of guided health action on utilization status of Hepatitis –B 2 nd dose
Control group 13 13 26 0.000 >0.001
Total 20 20 40
*χ 2 = 0.000, df=1, p value >0.001

Data in Table 3.4 shows the total pre-test missed Data in Table 3.5 shows that total pre-test missed
doses of Hepatitis-B (3rd dose) in the experimental doses of DPT (1st dose) in the experimental group
group were 10 and in control group were 9. After were 15 and in control group were 5. After guided
guided health action total number of missed doses health action total number of missed doses in the
in the experimental group was 0 and in the control experimental group was 3 and in the control group
group was 8. χ 2 was 6.687 at df 1 and the p value was 5. χ 2 was 3.500 at df 1 and the p value obtained
obtained was less than 0.001. was less than 0.001.
Table 3.4: Effectiveness of guided health action on utilization status of Hepatitis-B 3 rd dose
Control group 9 8 17 6.687 <0.001
Total 19 8 27
*χ 2 = 6.687, df=1, p value <0.001
Table 3.5: Effectiveness of guided health action on utilization status of DPT 1 st dose
Control group 5 5 10 3.500 >0.001
Total 20 8 28
*χ 2 = 3.500, df=1, p value >0.001
Data in Table 3.6 shows that total pre-test missed Data in Table 3.7 shows that total pre-test missed
doses of DPT (2nd dose) in the experimental group doses of DPT (3rd dose) in the experimental group
were 5 and in control group were 7. After guided were 6 and in control group were 5. After guided
health action total number of missed doses in the health action total number of missed doses in the
experimental group was 0and in the control group experimental group was 0 and in the control group
was 07. χ2 was 3.958 at df 1 and the p value obtained was 1. χ 2 was 1.091 at df 1 and the p value obtained
was less than 0.001. was more than 0.001.
Table 3.6: Effectiveness of guided health action on utilization status of DPT 2 nd dose
Group Pre-test missed Post-test missed Total Chi square P-value
doses doses
Control group 7 7 14 3.958 <0.001
Total 12 7 19
*χ2 = 3.958, df=1, p value <0.001
Table 3.7: Effectiveness of guided health action on utilization status of DPT 3rd dose
doses doses
Control group 5 1 6 1.091 >0.001
Total 11 1 12
*χ2 = 1.091, df=1, p value >0.001
Data in Table 3.8 shows that total pre-test missed was 21. χ 2 was 4.532 at df 1 and the p value obtained
doses of DPT (booster) in the experimental group was less than 0.001.
were 13 and in control group were 45. After guided Data in Table 3.10 shows that total pre-test missed
health action total number of missed doses in the doses of Vitamin A in the experimental group were
experimental group was 3 and in the control group 37 and in control group were 28. After guided health
was 43. χ 2 was 4.977 at df 1 and the p value obtained action total number of missed doses in the
was less than 0.001. experimental group was 215 and in the control group
Data in Table 3.9 shows that total pre-test missed was 26. χ2 was 4.161 at df 1 and the p value obtained
doses of Measles in the experimental group were was less than 0.001.
15and in control group were 21. After guided health Figure 1 shows that majority of the respondents
action total number of missed doses in the (86%) reported illness of child was the reason for not
experimental group was 04 and in the control group utilizing under five immunization services. 60%

reported that they don’t think that immunization is immunization. 49% reported that they were unaware
important. 20% reported that they do not have any of the need to return for 2nd and 3rd dose.
source of information about immunization. 22%
reported that vaccinator was absent on the day of
Table 3.8: Effectiveness of guided health action on utilization status of DPT booster
doses doses
Control group 45 43 88 4.977 <0.001
Total 58 46 104
*χ 2 = 4.977, df=1, p value <0.001
Table 3.9: Effectiveness of guided health action on utilization status of Measles

doses doses
Control group 21 21 42 4.532 <0.001
Total 36 25 61
*χ 2 = 4.532, df=1, p value <0.001
Table 3.10: Effectiveness of guided health action on utilization status of Vitamin - A
Group Pre- test missed Post-test missed Total Chi square P-value
doses doses
Control group 28 26 54 4.161 <0.001
Total 65 41 106
*χ 2 = 4.161, df=1, p value <0.001
Fig. 1: Percentage of reasons for not utilizing immunization services in experimental

and control group

IV. Nursing Implications poliomyelitis. Who Geneva draft meeting, 2001

[cited 21. 7, 2013]; 1(1) :Available from:
The findings of the preset study can be applicable www.polioeradication.org/content/publications /
in various area of nursing like nursing practice, 20 01_tcg6.pdf.
nursing education, nursing research and nursing
2. State of world’s vaccines and immunization, Third
administration.
edition, ISBN 97924563864, 2009. [cited 21. 11, 2013];
Nurses should give more focus on factors which Available from: http://www.who.int /immunization
are more amenable to change like illiteracy and lack / sowvi/en/.
of knowledge regarding immunization. During their 3. Kane, M. Lasher, H. (2002) “the case for childhood
home visits or during visit of parents to clinics, nurses immunization”. Occasional paper, no.5. Children’s
should impart knowledge regarding various vaccine program at path. Seattle, WA. [cited 21. 5,
vaccines and importance of timely vaccination. 2013]; Available from: http://www.path.org/
Regular activities in the form of group talks, role publications/detail.php?i=339 www.ieg in dia.org/
plays, posters, pamphlets, competition can be workpap /wp2 83. pdf.
conducted by nurses in the community to ensure that 4. Frenkel, LD, Nielsen K., (2003) “Immunization
immunization will become a “felt need” of the issues for the 21st century. Ann allergy asthma
mothers in the community. Health education to Immunol’ 2003 Jun [cited 19. 10, 2013]; 90(6 Suppl
3): 45-52. Available from: http://www.ncbi.
mothers should be given at every interface with health
nlm.nih.gov/pubmed/12839113.
facility like ANC/PNC/immunization visits and in
under-five clinics. Address the issues of poor 5. World health organization, United Nations
utilization of immunization services, obstacles, and children’s fund. The state of the world’s children.
Geneva; UNICEF; 2001 [cited 11. 4, 2013]; P. 77–89.
lack of awareness to the concerned authorities.
Available from: www.unicef.org/.../SOWC_
Spec%20Ed_CRC_Main %20 Report_EN_090.
Conclusion 6. World health assembly, global eradication of
poliomyelitis by the year 2000. Resolution of the
41st world health assembly Geneva. [cited 17. 6,
It can be concluded from the results of the present 2013]; Available from:http://www.polioera
study that most of the participants were partially dication.org/Resourcelibrary/Declaration sand
immunized for age. The major reason reported by resolutions.aspx.
parents for not immunizing child was illness of child
and unawareness about need to return for 2nd and Other References
3rd doses. The guided health action was effective in
1. Bonu, S, Rani M, Baker T. “the impact of the national
improving the utilization of under-five immunization polio immunization campaign on levels and equity
services. in immunization coverage: evidence from rural
north India”. Social science medicine, 2003 [cited
21. 9, 2013]; 57: 1807-19. Available from: http://ww
Acknowledgement w. ncbi.nlm.nih.gov/pubmed/14499507.
2. Pande. R.P, Yazbeck. S. Beyond National coverage
I would like to express special thanks of gratitude for immunization in India: Income, Gender AND
to Dr. Kathleen Mckeehan, Nursing Advisor, Regional Inequalities , [cited 16. 4, 2013]; Available
Himalayan College of Nursing and Dr. Sanchita from: http://siteresources.worldbank.org/intur
Pugazhendi, Dean, Principal and HOD Community banpoverty/Resources/india-immunizatio n.pdf.
Health Nursing, Himalayan College of Nursing, 3. Chowdhury Amr, Aziz Kma, Bhuiya a. The ‘near
Swami Rama Himalayan University, for their miracle’ revisited: social science perspectives of the
cooperation and expert guidance. I would like to immunization program in Bangladesh. Amsterdam:
express gratitude to all the members of research het spinhuis, 1999: 138.
committee and all others for their support and co-
4. CDC, “Ten great public health achievement—
operation. United States, 1900–1999,” Morbidity and Mortality
Weekly Report, 1999. [cited 18. 8, 2013]; 48: pp.
241–243. Available from: http://www.cdc.gov/
References mmwr/ preview/ mmwrhtml/ mm4850 bx.htm.
5. Ministry of Health, April 2007. The National
1. Executive board room; sixth meeting of the technical Childhood Immunization Coverage Survey 2005,
consultative group on the global eradication of Ministry of Health, Wellington, New Zealand, 2007,
[cited 11. 4, 2013]; Available from: http://
www.health.govt.nz/publication/ national- 7, 2013]; Available from: http://www.indiaen

childhood-immunisation-coverage-survey-2005. vironmentportal.org.in/content/ 380 308/ saa rc-
6. Ministry of Health and Family Welfare Government development-goals-india-country-report-2013/.
of India, “Introduction, Child Health, Maternal 18. Sharma R, Desai VK, Kavishvar A . Assessment of
Health,” in National Family Health Survey (NFHS- Immunization status in the slums of Surat and
III). Volume I, International Institute for Population changes it has undergone in recent times, Journal
Sciences Publishers. 2005-2006 [cited 11. 4, 2013]; 9. of Community Medicine. 2009 [cited 21. 7, 2013]; 34( 2):
2, 227-232, 8. 1. 7, 204, 199, 8. 2. 1, 208, 9. 1, 225, 226, 152-155. doi: 10.4103 /0970-0218.51222. Available from:
3. 5, 70, 1. 5, 7 Available from :http:// http://www.ncbi. nlm.nih.gov/pubmed /19 966964.
www.measuredhs.com/pubs/pdf/FRIND3 /00 19. Metew J.L. Inequity in Childhood Immunization
FrontMatter00.pdf. in India: A Systemic Review, Journal of Pediatrics.
7. Joint press release-UNICEF. [cited 11. 2, 2014]; 2012 March. [cited 26. 7, 2013]; 49(3): 203 – 23.
Available from : www.unicef .org /media/ Available from: http://www.ncbi.nlm.nih.gov/
media_46751.html (accessed on October, 2008). pubmed/22484740.
8. World health organization, United Nations 20. Gupta M, Thakur J.S, Kumar R. Reproductive &
children’s fund. The state of the world’s children. Child Health Inequities in Chandigarh Union
Geneva; UNICEF. 2001[cited 11. 2. 2014]; P. 77–89 Territory of India, Journal of Urban Health. 2008
Available from: http:// www.unicef.org/gambia/ March [cited 21. 8, 2013]; 85(2): 291-9. Available from:
SOWC_report_2014.pdf. http://www.ncbi.nlm.nih.gov/pmc/ar ticles/ PMC
9. Ramalingaswami v. Importance of vaccines in child 2430117/.
survival. Rev infect dis. 1989; suppl 3: s498–502. 21. Blachew E, Deressa W. Factors associated with
[cited 11. 2. 2014]; Available from: http://www.ncbi. complete immunization coverage in children aged
nlm.nih.gov/pubmed/2669093. 12-23 months, BMC Public Health Journal. 2012 [cited
10. Peter g. Childhood immunizations. N Engl j med. 11. 6.201 3]; 12: 566. Available from: http:www.
1992; 327: 1794–800. [cited 11. 2, 2014]; Available biomedcentral.com/1471-2458/ 12/566.
from: http://www.ncbi.nlm.nih.gov/pubmed/ 22. Sanou A, Simboro S, Kouyaté B, Dugas M, Graham
1306662. J, Bibeau G. Assessment of factors associated with
11. World health organization, United Nations immunization coverage in children, BMC
children’s fund. The state of the world’s children. International Health & Human Rights. 2009[cited
Geneva: UNICEF. 1991; P.14. 11. 6, 2013]; 9(1): 510. Available from: http://www.
biomed central.com/1472-698X/9/S1/S10.
12. Global health council – child health and nutrition
[online] 1999. [cited 11. 2, 2014]; Available from: 23. Kim S.S, Kronenfeld J J, Frimpong J A, Rivers PA.
url: http:www.globalhealth.org/issues/child.html Effects of maternal & Providers Characteristics on
(accessed 26/07/2002). up-to-date immunization status of children aged
19-35 months, American Journal of Public Health.
13. Behrman RE, Kliegman RM, Arvin AM. Textbook 2007 Feburary[cited 11. 6, 2013]; 97(2): 259-266.
of pediatrics. 15th ed. Philadelphia: WB Saunders. Available from: http://connection.ebscohost.com/
1994; P. 1020. c/articles/ 239 44183/effects-maternal-provider-
14. Sylvia T. Brown, Carol Douglas and Lee Ann Plaster characteristics-up-to-date-immunization-status-
Flood, CNM Journal of prenatal Education 2001 children-aged-19-35-months.
[cited 11. 2, 2014]. Available from: www.anatomy 24. Sharma R, Bhasin SK. , A study among caretakers of
facts. com/Research/ women seval. children attending pulse polio Immunization in East
15. Philippe D, Marie J, Bele O, Dobo MG, Cherian T: Delhi, Indian Journal of Community Medicine. 2008
Global Immunization; status, progress, callanges & [cited 21. 9, 2013]; 33(1): 31-34. Available from: http:/
future, BMC International Health & Human Rights /www.ijcm.org.in /article.asp?issn=0970-0218;
Journal. 2009 [cited 11. 2, 2014]; 9 (Suppl 1): year=2008;volume= 33;issue=1;spage= 31;e page
S2Available from: http://www.biomedcent =34;aulast=Sharma.
ral.com. 25. Rosental J, Rodewald L, McCauley M, Berman S,
16. Centers for disease control & prevention, morbidity Irigoyen M, Sawyer M, Yusuf, H. et al, Immunization
& mortality weekly report (MMWR) Global routine Coverage Levels among 19-35 month old children
vaccination coverage, CDC 24/7, 2011[cited 14. 2, in 4 diverse, medically underserved areas of U.S.,
2013]; 61(43): 883 – 885. Available from: http:// Journal of Pediatrics. 2004 April [cited 11. 6, 2013];
www.cdc.gov/mmwr/preview /mmwrhtml/ 113(4) : e 296-302. Available from: http://pediatrics.
mm6143a5.htm. aap publications.org/content/ 113/4 / e296.full.
17. SAARC Development Goals India Country 26. Akesode F.A. Factors affecting the use of primary
Statistical report 2013. 29/08/ 2013 Ministry of health care clinics for children, Journal of
Statistics and Programme Implementation [cited 21. Epidemiology & Community Health. 1982
December [cited 1.11.2012 ] ; 36 (4): 310-14. Available

from: http://www.ncbi.nlm.nih.govpmc/articles / abstract.

PMC1052240/. 29. Bhuwan S, Hemant M, Velhal G.D, Immunization
27. Adeyin. D, Oladimeji O, Adeyink.F, Aimakhu C. Coverage: Role of Socio demographic Variables,
Uptake of Childhood Immunization Among Advances in Preventive Medicine. 2013 [cited 20 jan,
Mothers of Under five in Southern Western Nigeria, 2013]; Article ID 607935, Available from: http://
The Internet Journal of Epidemiology. 2008[cited www.hindawi.com/ journals/ apm /2013 /607935.
10 Dec, 2012]; 7(2): Available from: http://ispub. 30. Kar M, Reddaiah V. P, Kant S. “Primary
com /IJE/7/2/3255. immunization status of children in slum areas of
28. Payne S, Towned J, Jasseh M, Jallow YL, Kampmann South Delhi,” Indian Journal of Community
B. Acheving Comprehensive Childhood Immunization: Medicine. 2001[cited 13 jan, 2014]; 26(3): 161.
An Analysis of Obstacles & Opportunities in the Available from: http://www.indmedica.com/
Gambia, Journal of ealth Policy & Planning. 2013 journals.php? jour nalid=7&issueid=45&articleid=
[cited 20 jan, 2013]; 1: 11. Available from: http:// 559&action=article.
heapol.oxford journals.org/ content/29/2/ 193.
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15
IJSN
Volume 5, Number 1
Effectiveness of Music Therapy in Reduction of © Red Flower Publication Pvt. Ltd
Anxiety among Patients undergoing Dialysis
Vijaya M. Udumala
Abstract
A study was undertaken to evaluate the effectiveness of Music Therapy in reduction of Anxiety among
Patients undergoing Dialysis in selected Hospitals in Hyderabad, Telangana. Patients were selected by
random sampling technique. The conceptual framework of the study was based on modified Imogene King’s
Goal Attainment Model. Data were collected by using modified Zung Anxiety Rating Scale from 50 patients
undergoing Dialysis. The study revealed that majority of the patients (88%) reported moderate to severe
anxiety in pre-test, whereas (56%) reported mild to minimum anxiety level after the Music Therapy. The
statistical “t” test value was found to be significant at 0.001 level and thus it is inferred that Music Therapy
is highly effective in the reduction of Anxiety level among Patients undergoing Dialysis.
Keywords: Effectiveness; Music Therapy; Dialysis; Patients; Anxiety.
Anxiety is associated with an undefined threat to undergoing Dialysis before and after
one’s physical as well as psychological self, resulting administering Music Therapy.
in numerous physical conditions and psychiatric ii. To evaluate the effectiveness of Music Therapy
disorders. It affects the endocrine, autoimmune and in reduction of Anxiety among Patients undergoing
metabolic systems and causes toxic disorders. Dialysis in terms of gain in post-test scores.
The Patients who are undergoing dialysis may iii. To find out the association between the pre-test
develop anxiety. Anxiety, an emotion characterized scores of Patients undergoing Dialysis with
by feelings of apprehension and helplessness, most selected Demographic Variables.
patients would prefer to be relieved of.
Music is universal and connects across language
barriers. Most people can respond to music in some Hypotheses
way regardless of illness or disability. Music is H1: There is a significant reduction in Anxiety
known to reduce stress thereby producing related level among Patients undergoing Dialysis after
benefits such as lower blood pressure, improved receiving Music Therapy at 0. 05 level of
respiration, reduced heart rate, better cardiac significance.
performance and reduced tension in muscles. H2: There is a significant association between
the pre-test scores of Anxiety level among Patients
Statement of the Problem undergoing Dialysis with selected Demographic
“Effectiveness of Music Therapy in reduction of Variables at 0.05 level of significance.
Anxiety among Patients undergoing Dialysis at
selected Hospitals in Hyderabad, Telangana.”
Conceptual Framework
The Conceptual Framework adopted for this study
Objectives of the Study
was based on modified Imogene King’s Goal
i. To assess the level of Anxiety among Patients Attainment Model (1981).
Author Affiliation: Principal cum Professor, JMJ College

of Nursing, Hyderabad. Research Methodology
Correspondance: Vijaya M. Udumala, Principal cum
Professor, J.M.J. College of Nursing, St. Theresa’s Hospital
Campus, Sanathnagar, Hyderabad – 500 018.
This study used a quasi-experimental study
E-mail: vijayaud@gmail.com design.

16 Vijaya M. Udumala / Effectiveness of Music Therapy in Reduction of Anxiety among Patients undergoing Dialysis
Research Approach
Quantitative Approach
Research Design
Quasi Experimental One Group Pre - Test Post-Test
Design
Study Setting
Two Super Specialty Hospitals in Hyderabad
Target Population
Patients Undergoing Dialysis
Accessible Population
D ialysis Patients in Two Selected Hospitals in Hyderabad
Sample, Sample Size & Sampling Technique: 50 Patients Undergoing

Dialysis in Hospitals By
Multistage Sampling
Data Collection Tool : Modified Zung Anxiety Rating Scale Preparation of

Music Therapy : Selection and Editing
Data Collection Tool : Modified Zung Anxiety Rating Scale Preparation of

Music Therapy : Selection and Editing
Pre-test Music Therapy Post-test
Analysis of Data and Interpretation Analysis

Data Analysis and Interpretation
Conclusion and Dissemination of Research Findings
Fig. 1: Schematic representation of study

Vijaya M. Udumala / Effectiveness of Music Therapy in Reduction of Anxiety among Patients undergoing Dialysis 17
Group Pre-test Intervention Post-test between the Age group of 31-40 years. Majority
RE O1 X O2 of patients (52%) were females.
 Majority of patients (46%) were graduates and
half of them (50%) had monthly income ranging
RE: Randomly selected experimental group from Rs.5, 001-10,000.
O1: Pre-test before administration of Music therapy.  All the patients (100%) had previous experience
X: Administration of Music therapy to the patients of Dialysis and some patients (40%) had
undergoing Dialysis. Dialysis treatment three times in a week.
O2: Post-test after administration of Music therapy.  Majority of patients (86%) had not used any
relaxation techniques before this study.
Research Variables
Findings Related to the Level of Anxiety in Pre- and
• The independent variable is Music therapy. Post-Test Scores
• The dependent variable is level of anxiety among  Majority (88%) of patients had moderate to severe
patients undergoing Dialysis. level of Anxiety in pre-test, while (56%) of
patients had mild to minimum level of Anxiety
in post-test. This revealed that Music Therapy
Sample and Sampling Technique
was effective in reducing the Anxiety level of
This study used a multistage sampling. Two Super patients undergoing Dialysis.
Specialty Hospitals in Hyderabad were selected
randomly. The total study sample was 50 patients
Findings Related to Effectiveness of Music Therapy on
undergoing Dialysis, who were selected by simple
Anxiety among Patients undergoing Dialysis.
random sample.
The post-test mean Anxiety score was 64.00,
which is significantly lower than the pre-test mean
Data Collection Tool score of 71.84 with a mean anxiety reduction of
Modified Zung Anxiety Rating Scale was used to 13.82. Hence, it is inferred that the mean reduction
assess the Anxiety level of Patients undergoing in anxiety was due to music therapy.
Dialysis. The calculated t value, 5.99 was greater than the
tabulated value with 49 degrees of freedom at 0.001
level of significance. Hence it is inferred that Music
Pilot Study
therapy was effective in lessening post-test anxiety
The pilot study was conducted in February 2015. scores among Patients undergoing Dialysis.
It revealed the feasibility and practicality of the study.
Findings Related to Association Between Anxiety with
Main Study Selected Demographic Variables
The main study was conducted in March 2015. There was statistically significant association
The data collected was analyzed using descriptive between the level of Anxiety and the demographic
and inferential statistics. variables of patients such as Age, Family Monthly
income and Duration of the Disease.
Results Implications of the Study

 Nurses are obliged to provide patients with non-
Findings related to Demographic Variables pharmacological therapies to cope with altered
 The maximum number (36%) of patients was life style.
Table 1: The mean, standard deviation, standard error and

paired t-value on pre- and post-test level of anxiety scores
Test Mean SD SE t-value
Cal Value Table Value
Pre-test 71.84 7.27 1.029
*5.99 3.551
Pre-test 64.00 10.39 1.469
n=50 *Significant at 0.001 level

18 Vijaya M. Udumala / Effectiveness of Music Therapy in Reduction of Anxiety among Patients undergoing Dialysis
 Nurses need to assume roles as motivators, Conclusion

educators and researchers and counselors.
 Nurses are the key providers in promoting On the basis of study results, it is concluded that
relaxation techniques to help the overall well-being Renal Disease and its ensuring treatments negatively
of the patient in hospital and other care settings. affect the patients’ quality of life. Music Therapy has
 The administration should enable the nursing the potential to be a cost effective, safe, non-
personnel to develop newer skills through pharmacological tool for lowering anxiety among
continuing education programs. Patients undergoing Dialysis.
 Nursing research is the means to develop
advanced patient education interventions and References
there by contribute to the development of Nursing
Profession.
1. Sikendar, K. Anxiety level among patients
undergoing haemodialysis. Nightingale Nursing
Recommendations Times. Jan 2012; 9(10): 42-44.
 A similar study can be undertaken on large 2. Modi, GK. The incidence of end-stage renal disease
samples, so that results can be generalized. in India: A population-based study. Kidney
International Journal. 2006; 70(2): 2131-3.
 A comparative study can be carried out between
Music Therapy and other relaxation techniques 3. Jennifer, F. John, V. Nica, J. The Psychosocial
Experience of Patients with End-Stage Renal Disease
like Yoga and meditation.
and Its Impact on Quality of Life: Findings from a
 A descriptive study can be conducted to assess Needs Assessment to Shape a Service. ISRN
the anxiety level among End Stage Renal Disease Nephrology, July 2013.
patients. 4. Appachan, B. A study to assess and compare the
effect of acupressure and music therapy in
reduction of fatigue and depression of patients with
Limitations of the Study End Stage Renal Disease in selected hospitals at
 The sample in this study was small and had no Mangalore. Nightingale Nursing times. June 2013;
8(3): 54-56.
control group, hence generalization was not
possible. 5. Balasubramanian. Effect of music therapy on quality
of sleep during post operative period among CABG
 Study results were confined only to selected patients. Nightingale Nursing Times. Aug (2011);
Hospitals in Hyderabad among patients 10(5): 13-14.
undergoing Dialysis which possibly would
decrease the credibility of the study.

19
IJSN
Volume 5, Number 1
Challenges in Organ Transplantation -An © Red Flower Publication Pvt. Ltd
Indian Scenario
Neethu Jose
Abstract
Until recently, financial incentive was the prime motivation in transplantation of kidneys from nonrelated
living donors in India. Prior to the Human Organ Transplantation Act of 1994, it was legal in all states of
India to purchase and merchandise organs, eliminating the opportunity for black markets currently created
by the enormous demand for organs. Despite the Transplantation of Human Organ Act passed in Indian
Parliament in 1994, cadaver liver and/or kidney transplant are infrequently performed (in a few private
hospitals) in our country compared to living donor liver or kidney transplant. The need for performing more
cadaver liver and/or kidney transplants in private and public hospitals is obvious. Immediate measures
which should be taken to facilitate more cadaver organ transplant both in private and public hospitals are
suggested. This article reveals attitudes and beliefs about organ donation in India from the perspectives of
the public. Mistrust of the medical profession and concerns about illegal buying and selling of organs were
some major issues in organ donation. Additional issues were the need for public education, advertisement,
and role models to promote organ donation in India.
Keywords: Organ Donation; Challenges; Public Education; Brain Death; Organ Transplantation.
Introduction country, out of which not less than 2% are from

cadaver donors with sporadic reports of
transplantation of other organs. There is a large pool
Organ transplantation has achieved a state of of cadaver donors available in our country and if
preferred therapeutic option for patients with end- this is mobilized, there will not be any need to
stage organ failure, in the western world. Cadaver undertake living organ donation. This alone will
donors form the largest pool of organs, approaching stop unethical transplants involving commerce.
95% and 70% in Europe and USA, respectively.
However, the predominant limitation to broader
application of clinical transplantation is the Challenges in Organ Transplantation –Indian Scenario
inadequate number of donor organs available. [2,7]
In a developing country like ours, slow growth of
organ transplantation is due to high costs involved, Systemic Issues
lack of facilities in government hospitals, non-
availability of a suitable donor from the family and  In spite of periodic amendments to the Organ
lack of well-developed cadaver programme. Since Transplant Act in the recent past, there has not
the passage of THO (Transplantation of Human been a significant change or increase in the
Organ) Act by the Indian parliament in 1994, cadaver overall donation numbers or to the establishment
organ transplants have been performed so far, with of a donation system within the country (apart
acceptable results. It is estimated that every year, 3500 from a few states).
kidney transplants are being performed in our  In the case of living organ donations (from a
living donor to a recipient), if the donor is not
Author Affiliation: Assistant Professor, Department of related to the patient, the transplant needs to be
Medical Surgical Nursing, Jubilee Mission College of Nursing, approved by a state-level committee or hospital
Thrissur, Kerala 680005. committee, including government officials.
Naturally these requirements lead to delays in
Corre sponda nce : Ne ethu Jose , A ssi sta nt Professor,
Department of Medical Surgical Nursing, Jubilee Mission the whole process.
College of Nursing, Thrissur, Kerala 680005.  In the case of deceased organ donations, few
E-mail: agnesfeb9@gmail.com
hospitals declare brain deaths and people are

20 Neethu Jose / Challenges in Organ Transplantation -An Indian Scenario
not in place to counsel families, both of which by people is detrimental to the improvement of
lead to a poor conversion rate. Brain death as a the organ transplant scenario in India.
form of death is not widely understood or An assurance about the system that these organs
recognized by the public. Also there is hesitation will be utilized for good and not be a
on the part of the medical fraternity to certify commoditized in the organ market may
brain death. This has to change if the organ encourage organ pledges. The idea of a
donation rates have to be increased. commodity and charity are viewed as distinct
and the donor/donors family would not want
Infrastructural and Skilled Personnel Problems their charity to be a monetary gain for someone
else.
Few hospitals are equipped in terms of the required
personnel (qualified doctors and trained transplant
coordinators) and equipment to conduct a successful Lack of a Centralized Registry for Organ Donation
transplant. Unlike Other Countries
Ventilators for maintaining brain dead persons India does not have any centralized system in
are not available everywhere. Limited facilities place to enable/assist donors or medical institutions.
for transport of donated organs aggravate the There is no centralized list of potential recipients
situation. Very few specialized private hospitals being available to different hospitals so that organs
can boast of standard infrastructure for carrying could reach the right people in time. Apart from a
out a smooth organ transplant process. The few states, there is no sharing protocol in place in
situation worsens in case of public hospitals, the rest of India. This leads to unethical and
which account for witnessing majority of such unhealthy practices. Further, it leads to wastage of
cases. organs which is a shame when a family has taken
Lack of training for intensive-care unit personnel this courageous decision to donate.
to maintain brain dead person, is also a constraint
according to a number of doctors surveyed in Expectation of the Possibility of Organ Rejection
our study.
Certain studies reveal that technically there is
A big percentage of medical professionals are always a possibility that the patient might face a
unaware of the process as a whole and about rejection, wherein the body fights off the newly
the idea of brain death since it is not part of their implanted organ even if the surgery goes well.
formal education curriculum. Rejection is harmful to transplant success because the
body fights off the new organ as if it were a virus or
bacteria akin to any other harmful foreign invader.
Lack of Awareness, Religious and Other Issues
The immune system makes proteins called anti-bodies
Lack of awareness remains one of the leading that go to the transplanted organ and try to kill it.
reasons for such low organ donation rates in
In order to hold back the antibodies that threaten
India. There are no structured/focused
the new organ, transplant patients have to take
awareness initiatives or drives to help people
powerful additional immunosuppressant drugs to
understand the what, why or how of organ
keep the level of antibodies down, low enough to
donation. While some NGO’s are making efforts,
allow for the organ to integrate into the body.
these are at best – drops in the ocean.
In India where health services are seemingly
It is a usual refrain that people in India do not
expensive for the average person, the ability to afford
sign up for organ donation, but in reality there
a transplant operation is beyond the common man’s
are hardly any platforms available for ‘sign up’.
means, especially at a private hospital. The added
Most people have never been offered this
risk that the organ may not benefit the patient is a
opportunity in their life time. Many don’t know
negative add-on. Therefore, a majority of patient and
where to go even if they are aware and willing.
patient parties back out due to the uncertainty quotient
Religious beliefs also may be a reason why clubbed with the amount of financial drain out it
families do not agree to deceased organ donation. leads to. This is also in certain ways connected to the
The idea of charity and perceptions about fact that health insurance in India still does not have
donation varies from one community to another. a good enough reach. Most people are not even aware
The religious mindset together with the of how they could arrange funds. Cumulatively, it
unpleasant experiences in the health sector faced leads to discouragements in a number of ways.

Neethu Jose / Challenges in Organ Transplantation -An Indian Scenario 21
Organ Wastage in India Nadu in 2012, according to Tamil Nadu organ

Medical Science has made tremendous progress transplant registry Convener Dr. J.
in recent times in the field of transplant surgeries Amalorpavanathan. The registry received organs
and operations, with organ donation from one person from 306 brain dead patients and allotted them to
after brain death capable of saving up to 9 lives and different hospitals based on a waiting list. While 280
improving the lives of many others. livers and 563 kidneys were retrieved for transplant,
only 52 hearts and 13 lungs were harvested. The
However, due to the prevalence of myths reason for the same was poor coordination among
surrounding brain death and the lack of awareness transplant surgeons causing delay in retrieval.
in India, majority of people do not take up this noble
cause for the benefit of others.
According to medical practitioners, kidney, a part Government Bodies Involved in Organ Donation and
of the lung, a part of the liver, blood and bone marrow Transplantation Policies
can easily be transplanted while the person is alive. According to the Indian law, Organ
But in deceased organ donations (after brain death), Transplantation is a State subject and is under the
more organs and tissues such as the heart, pancreas direct control of the respective State Governments.
and cornea can be transplanted if the patient is on However, the Union Health Ministry is responsible
the ventilator till the organs are extracted. for making amendments to the Transplantation of
Human Organs Act, so that the organ transplantation
system in the country runs effectively.
Following Statistics are Alarming in the Indian Context [8]
 The total number of brain deaths due to
accidents is nearly 1.5 lakhs annually. Other Central Government
causes of brain death such as sub-arachnoids’ In case of the Central Government, the Ministry of
hemorrhage and brain tumors would potentially Health and Family Welfare is the body looking at
add more numbers. decisions related to the organ transplantation
 There is a need of 2 lakh kidneys, 50,000 hearts processes in the country. The Ministry comprises of
and 50,000 livers for transplantation every year. four departments, each headed by a Secretary, out of
Even if 5-10% of all brain deaths are harvested which the Department of Health & Family Welfare
properly for organ donation, technically there is responsible for taking actions related to organ
would be no requirement for a living person to donation and transplantation. In addition, there is
donate organs. the Directorate General of Health Services (DGHS)
which is the attached office of DH&FW. It renders
 One person dies of kidney failure every 5 technical advice on all medical and public health
minutes. This amount to roughly 290 deaths matters and is involved in implementation of various
every day due to kidney failure. These numbers health services. The ministry as reported has been
suggest that with adequate systems in place, contemplating on measures such as 50% discount
people succumbing to accident-prone injuries on second class railway tickets, provision of lifelong
could meet a major portion of the demand. free medical test and care in the hospital where the
In light of the number of brain deaths that probably organ has been donated.
take place every year; the number of donations in
comparison are abysmally low. This is because most
brain death cases go unrecognized and therefore Role of Non-Government Organizations & Other
uncertified. This wastage could be prevented by Groups [2]
mandating certification of brain death. In addition,
hospitals need to have well-trained personnel who MOHAN Foundation
can effectively identify, certify and maintain brain
dead patients for organ retrieval to take place. MOHAN (Multi Organ Harvesting Aid Network)
Trained transplant coordinators are an absolute must is one of the front-running NGOs promoting and
to counsel families in grief and help them to think taking up the cause of organ donation in India,
about organ donation to save other peoples’ lives. especially in the case of deceased donors. The
organization believes that the shortage of organs can
The situation of organ wastage is the most severe be overcome if the plans are executed properly.
in case of hearts. In a recent study[1] conducted in
January 2013, it was found that only 17% of hearts MOHAN foundation has taken up state-by-state
received were used by surgeons in the state of Tamil implementation of the organ transplant awareness

initiatives, starting with the southern parts of the 2. Kidneys were transported by air from New Delhi
country. The organization has had significant to Mumbai, Pune, Lucknow and Bangalore.
success because of the wide-scale awareness created AORTA argued that the previously held
by the organization. They were responsible for concerns about social and religious beliefs as a
distribution of donor cards and MOHAN foundation cause for lack of organ donation in India were
has sent its recommendations to both the central and found to be untrue contrary to what the existing
the state governments. These recommendations are argument is.
as follows:
3. ORBO (Organ Retrieval Banking Organization)
1. Making it compulsory for the hospital staff to by AIIMS
ask for organs in case of brain death.
ORBO has been setup by the All India Institute of
2. Provide an Organ donation clause in the driver’s Medical Sciences (AIIMS) Delhi with the purpose of
license cards. encouraging organ donations across the country. It
3. Conducting Post-Mortem Examination during aims to achieve fair and equitable distribution and
the same time as Organ Retrieval Surgery to utilization of organs. ORBO is concerned with the
avoid unnecessary delays. following primary activities:
4. To reduce the hassle of transporting the donors a. Maintaining donor registration
from hospitals where organs can be retrieved to b. Coordination from procurement of organs to
hospitals where they can be transplanted. transplantation
5. Making it compulsory to appoint Transplant c. Dissemination of information to all the
Coordinators in the ICUs of hospitals. concerned hospitals in the network
d. Creating awareness about organ donation and
AORTA (Armed Forces Organ Retrieval and transplantation
Transplantation Authority)
e. Organizing promotional activities directed
AORTA or the Armed Forces Organ Retrieval and towards helping the cause of organ donation
Transplantation Authority have been actively
ORBO has established a network of 20 hospitals
pursuing the cause of Organ Donation, Retrieval and
(8 Government and 12 Private) in the NCR(National
Transplantation in the country. They had organized
Capital Region) region and is now moving towards
an extensive drive to promote deceased organ
expansion of the same, with both national and
donation in India. During the drive, information was
international groups on the agenda. Each of the
disseminated on brain death and organ donation
participating hospitals has the infrastructural support
through various lectures, posters, billboards and
from ORBO. An officer from the hospital is also
extensive coverage via local and national
nominated as a nodal officer to coordinate with ORBO.
newspapers and periodicals in the country. Some of
the steps taken up by AORTA are as follows:
1. Establishing organ donor registry at the hospitals Recommendations – Future Strategy & Action Plan [1,3]
2. Issuing donor cards to the individuals to help Large-Scale Awareness Building
them pledge organs in case of brain death It is only through awareness programmes that the
3. Conducting organ pledging ceremonies number of deceased donations can be increased.
involving prominent personalities (including What is needed is a large scale campaign which only
movie stars and athletes) the government can undertake or fund. Clear
messaging by the government will also add
4. Honoring families of organ donors to spread the
credibility to the cause. In fact all messaging in public
message of organ donation
places and hospitals in the form of standees, video
spots etc. have to have the government logo along
Many Firsts have been Achieved through the Initiatives with that hospital in order to increase people’s trust.
Taken by AORTA Large-scale advertising campaigns should aim to
1. For the first time in India, a liver was flown from educate people about benefits of organ donation,
New Delhi in the north to Hyderabad in the clearing all prevalent myths and misconceptions.
south and transplanted, thereby diminishing The concept of brain death needs to be adequately
geographical boundaries with regards to organ dealt with so that organs of the deceased which can
transplantation. be retrieved and utilized and do not go waste.

Positive Messaging on Organ Donation Can Be Done in the entire process of organ donation and
Using The Following Mediums transplantation. It is only when that the hospital is
 Advertising campaigns across all media (TV, able to establish a personal rapport with the patient
Print, Radio, In-cinema ads) and the patient’s relatives, can they create a
precondition necessary to establish talk regarding
 Social Media organ donation later on. The role of the Transplant
 Celebrity endorsements Coordinator is to reach out to potential donor families
and explain to them the need and importance of the
 Theater & Street Plays Events to promote organ
act of donation. His/her task would be to facilitate
donation (Marathons, Concerts etc.)
and enable the retrieval of the organ from the deceased
 On-ground awareness drives at Schools, patient’s body in a smooth and quick manner so the
Colleges, Corporate offices, Clubs etc. organ does not go waste.
An increased number of Transplant Coordinators
Setting Up of A National Registry and A Centrally would help in creating awareness and also help in
Managed Organ Donor-Recipient Network counseling the relatives to manage the system of organ
donation. Higher numbers of Transplant
A central organ sharing registry or a recipient
Coordinators are required in a public set-up as the
registry is an absolute must, so that donated organs
amount of patients there are significantly higher.
can be shared in a fair and transparent manner. This
has already been initiated in the Transplantation of
Human Organs Act, which has made a provision for Improve Infrastructure within Public Hospitals for
the same. However there is no such system yet. Apart Transplantation
from a few states, there are no sharing protocols in
Transplantation as a service should be readily
place. This leads to unethical and unhealthy
available in all Government hospitals as the majority
practices. Further, it leads to wastage of organs which
of patients go there for treatment and many cannot
is a shame when a family has taken a courageous
afford treatment at private hospitals. The
decision to donate. The sharing of cost between
Government also needs to take the necessary steps to
hospitals also has to be clearly defined.
improve the infrastructural set-up at all public
This system however will not work in the current hospitals to store/transport organs and train the
scenario with seemingly unhealthy and negative hospital staff/personnel for organ transplantation
attitudes amongst the various stakeholders. There procedures and on the subject of brain death, and
needs to be a spirit of cooperation, sharing and the how to increase awareness regarding the same.
willingness to adopt from successful practices in
other parts of the country. The concerned agencies
would be recommended to look into the practices Non-Transplant Hospitals Need to Be Involved in
and policy measures undertaken by the states such Organ Retrieval
as Tamil Nadu and Maharashtra. This could enable These medical centers (which have ICU’s but are
them to build a model that could be implemented in not transplant centers) are crucial because a lot of
other parts of the country as well. accident victims are brought here for treatment. They
should be geared up for brain death declaration. They
need to be given an incentive to be participants in
Make Brain Death Declaration Mandatory organ retrieval, and a system has to be worked out
Making the declaration of brain death mandatory wherein they are compensated adequately for their
will increase instances of organ donation. It will help active involvement in the Organ Donation programme.
facilitate a discussion between the doctor/physicians The government will have to provide all the
and the relatives about brain death and organ facilities (or monetary incentives) to ensure that brain
donations. It would help Transplant Coordinators deaths are identified in these hospitals and organs
and personnel from other Departments to intervene retrieved.
and convince the relatives about organ donation.
Sensitizing Police Personnel and Forensic Experts

Recognizing the Pivotal Role of the Transplant Sensitization of police personnel and the forensic
Coordinator in the Organ Donation/Transplant Process experts has to be taken up on a war footing to make
It is imperative to understand and acknowledge all medico-legal cases smooth. Most brain death cases
the pivotal role that the Transplant coordinator plays are accident cases and therefore medico legal cases.
They usually are difficult to handle as they do not Student/College Initiatives towards Creating Awareness
get cooperation from these quarters. We can  More than 1,500 students of Shivaji College, Delhi
recognize and highlight some police people who University, organized a walk around their
have been cooperative. campus in early September, 2013, creating
awareness about importance of organ donation
Provision of More Opportunities for Donor Pledges by holding placards and banners[3].
Provide the public with organ donor intent forms  Faculty members of BMS department of Western
and brochures while issuing driving licenses, College in Mumbai set an example for the
Aadhar cards and college ID cards, so they can choose students by donating their organs and initiating
to express their intent on the cards. the same leading to 150 students coming
forward for the cause in August, 2013[4].
Increasing involvement of National Media in
Emulate Successful Practices from Other States awareness campaigns Times of India ran a campaign
States such as Tamil Nadu for instance have on organ donation, garnering more than 50,000
recorded an 80% conversion rate when it comes to organ donation pledges in August, 2013. This
donating the organs of one kin. Through a motivated included 1,000 CRPF Jawans, a large number of
network of doctors who declare brain death, students and elderly people[5].
personnel who maintain the deceased on life
support, and transplant coordinators who convince
Pledging Donation through Driving Licenses
the near relatives of the patient, the state has a record
organ donation which is 15 times the national The Road Transport and Highways Ministry[6] is
average. An important step in this direction was the formulating a norm to include the provision of
creation of a network of hospitals for sharing organs. pledging organs through application forms used for
obtaining a driver’s license. This drive has already
The Maharashtra government made it compulsory
been implemented in cities like Bangalore, Mumbai
for all non-transplant hospitals equipped with an
and Pune; and other cities will follow soon.
ICU and operation theatre to retrieve organs for
harvesting and made it mandatory for them to The success of the program can be judged by the
officially identify brain dead patients. fact that organ donation pledging went up by 40 times
in the first ten months of its launch in the pilot cities,
thereby accomplishing the dual goals of creating
Recent Initiatives for Creating Awareness about Organ awareness and increasing the number of potential
Donation in India organ donations. This initiative has now been taken
up by the Central Road Transport and Highways
Promotion and Awareness by Famous Personalities/ Ministry for implementation across the country.
Ambassadors
 Actress and Former Miss World Aishwarya Rai Conclusion
Bachchan has promoted eye donation for a long
time through various channels including print
media, television advertisements and through In recent years, transplantation has assumed an
events organized by the medical fraternity. important role in the treatment of patients with end-
stage organ failure. With the passage of
 Actors Aamir Khan and his wife Kiran Rao have Transplantation of Human Organ Act by the Indian
pledged to donate his organs. Priyanka Chopra parliament, transplantation of organs from brain
has also pledged to donate her organs. dead donors has become a reality. Although there
 Sports celebrities like Kapil Dev and Gautam are many issues in success of cadaver programme,
Gambhir have also pledged their organs. the following measures can help in solving non-
medical problems in organ transplantation in India:
Considering the fact that public figures have the
potential to attract media coverage, social causes 1. Reducing the shortage of organs by promoting
when promoted by celebrities have proven to have deceased organ donation with presumed consent
greater reach than a regular event. The personalities and by educating the public.
themselves hold immense brand value and the cause 2. Reducing the problem of finances by bringing in
he/she upholds also becomes an attribute of their insurance, roping in philanthropists, getting
overall value. some government help and requesting
pharmaceutical companies to reduce the cost of sharing. foundation,www.mohanfoundation.org

medicines. 3. Times News Network, 1,500 walk to collect organ
3. Strict policing for illegal transplants and woes. Times of India (print edition). Sep 5, 2013.
punishment of all the persons involved. It is time 4. Munshi, SameeraKapoor, TNN, Organ donation, a
that the medical fraternity took a strong stand cause taken seriously by group of BMS students.
on this issue and started promoting the concepts Times of India (online edition). Aug 29, 2013.
of brain death and deceased organ donation 5. Times News Network, Campaign on organ donation
garners 50,000 plus pledges. Times of India (print
edition). Aug 7, 2013.
Reference 6. World News, Pledge for organ donation in the form
of driving license. www.wn.com. Jul 23, 2012.
1. Narayan, Pushpa, TNN, Hearts meant for transplant 7. Organ Retrieval Banking Organization (AIIMS).
end up in trash. Times of India (online edition). Jan www.aiims.edu/aiims/orbo.
18, 2013. 8. Indian Transplant Registry, Indian Society of Organ
2. MOHAN foundation, creating a network for Organ Transplantation. www.transplantindia.com.
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IJSN
Volume 5, Number 1
Medication Errors: Don’t Let Them Happen To You © Red Flower Publication Pvt. Ltd
Neethu Jose
Abstract
Advancements in human healthcare are on an all time high. The treatment system is becoming hi-tech and
sophisticated and vulnerable to errors at the same time. Various disasters have occurred due to medication
errors at different levels of healthcare delivery. Ongoing quality improvement programs for monitoring
medication errors are needed. Medication errors should be identified and documented and their causes
studied in order to develop systems that minimize recurrence. Patient education and participation in their
own healthcare decisions should be encouraged. Thus, it is the need of the hour to give a wake-up call and
all those concerned should join hands to solve this gigantic problem. However, if a little bit of extra caution
is observed by the various stakeholders these can be prevented largely.
Keywords: Medication Errors; Healthcare Delivery; Malpractice Litigation; Word Error; Failure in
Communication.
Mistakes can occur in any setting, at any step of identified 10 key elements with the greatest influence
the drug administration continuum. Here’s how to on medication use, noting that weaknesses in these
prevent them. can lead to medication errors. They are:
Patient information
Introduction Drug information
Adequate communication
Medication administration is a complex multistep Drug packaging, labeling, and nomenclature
process that encompasses prescribing, transcribing, Medication storage, stock, standardization, and
dispensing, and administering drugs and distribution
monitoring patient response. An error can happen
at any step. Although many errors arise at the Drug device acquisition, use, and monitoring
prescribing stage, some are intercepted by Environmental factors
pharmacists, nurses, or other staff. Staff education and competency
Administration errors account for 26% to 32% of
Patient education
total medication errors—and nurses administer most
medications. Unfortunately, most administration errors Quality processes and risk management.
aren’t intercepted. Recent technological advances have
focused on reducing errors during administration
Patient Information
Accurate demographic information (the “right
Ten Key Elements of Medication Use [1,2] patient”) is the first of the “five rights” of medication
Many factors can lead to medication errors. The administration. Required patient information
Institute for Safe Medication Practices (ISMP) has includes name, age, birth date, weight, allergies,
diagnosis, current lab results, and vital signs.
Author Affiliation: Assistant Professor, Department of
Barcode scanning [4] of the patient’s armband to
Medical Surgical Nursing, Jubilee Mission College of Nursing,
Thrissur, Kerala 680005. confirm identity can reduce medication errors related
to patient information. But initially, barcode
Corre sponda nce : Ne ethu Jose , A ssi sta nt Professor, technology increases medication administration
Department of Medical Surgical Nursing, Jubilee Mission
times, which may lead nursing staff to use potentially
College of Nursing, Thrissur, Kerala 680005.
E-mail: agnesfeb9@gmail.com dangerous “workarounds” that bypass this safety
system. Also, the barcode method isn’t fail proof;
28 Neethu Jose / Medication Errors: Don’t Let Them Happen To You
the patient’s armband may be missing or may fail to distinguish differing drug dosages.
scan, or the scanner’s battery may fail. Look-alike or sound-alike medications—products
that can be confused because their names look alike
Drug Information or sound alike—also are a source of errors. The JC
requires healthcare institutions to identify look-alike
Accurate and current drug information must be and sound-alike drugs each year and have a process
readily available to all caregivers. This information in place to help ensure related errors don’t occur.
can come from protocols, text references, order sets,
computerized drug information systems, medication
administration records, and patient profiles. Medication Storage, Stock, Standardization, and
Distribution
Adequate Communication Many experienced nurses remember when critical

care units kept a medication “stash,” which
Many medication errors stem from miscommunication frequently caused duplication errors. Potentially,
among physicians, pharmacists, and nurses. many errors could be prevented by decreasing
Communication barriers should be eliminated and availability of floor-stock medications, restricting
drug information should always be verified. One way access to high-alert drugs, and distributing new
to promote effective communication among team medications from the pharmacy in a timely manner.
members is to use the “SBAR” method (situation, Also, hospitals can use commercially available
background, assessment, and recommendations). products to decrease the need for I.V. compounding
Poor communication accounts for more than 60% of medications and I.V. admixing. Use of preprinted
the root causes of sentinel events reported to the Joint order sets and standardized formularies can reduce
Commission (JC). errors, too.
A case for example, a patient died after labetalol, The Institute for Healthcare Improvement
hydralazine, and extended-release nifedipine were recommends standardized order sets and preprinted
crushed and given by NG tube. (Crushing extended- protocols for 75% of the drugs healthcare facilities
release medications allows immediate absorption of use. These orders and protocols help clinicians
the entire dosage.) As a result, the patient experienced promptly select correct dosing regimens, routes, and
profound bradycardia and hypotension leading to parameters while eliminating ambiguous
cardiac arrest. Although she was successfully abbreviations and the risk of misreading a
resuscitated, she received the drugs the same way prescriber’s handwriting. However, errors can occur
the next day. Clinicians had failed to communicate even when automated dispensing cabinets are
to other team members that her initial cardiac arrest stocked by technicians. Errors can happen when a
had occurred shortly after she’d received the technician filled an automated dispensing cabinet
medications improperly. with the wrong concentration such as premixed
potassium chloride I.V. solution.
Drug Packaging, Labeling, and Nomenclature
Healthcare organizations should ensure that all Drug Device Acquisition, Use, and Monitoring
medications are provided in clearly labeled unit-dose Improper acquisition, use, and monitoring of drug
packages for institutional use. Packaging for many
delivery devices may lead to medication errors. Some
drugs looks similar. A tragic case stemming from
delivery systems have inherent flaws that increase
such similarity occurred with heparin (one of the
the error risk. For example, at one time, I.V.
drugs on the JC’s “high-alert” list, meaning it has a
medication tubing continued to flow or infuse when
high potential for causing patient harm). A few years
removed from the pump. Thus, patients could receive
ago, several pediatric patients received massive
heparin overdoses due to misleading packaging and boluses of medications or I.V. solutions, which
labeling; three infants died. As a result, the Food sometimes had deleterious outcomes. During the
and Drug Administration and Baxter Healthcare (the admission process, for instance, a patient receiving
heparin manufacturer) issued a letter via the nitroprusside could receive a large infusion of this
MedWatch program alerting clinicians to the danger drug when the I.V. tubing was removed from the
posed by similarly packaged drugs. Baxter has since pump and the patient was transferred from one bed to
enhanced the labels on heparin and some other high- another. This design flaw has since been resolved.
alert drugs; it now uses a 20% larger font size, tear- In addition, syringes for administering oral
off cautionary labels, and different colors to medications should not be compatible with I.V. tubing.

Neethu Jose / Medication Errors: Don’t Let Them Happen To You 29
Environmental Factors vigilant for unusual events or processes.

Environmental factors that can promote
medication errors include inadequate lighting, The Fatigue Factor [3]3
cluttered work environments, increased patient
acuity, distractions during drug preparation or Recent research high lights the role of care giver
administration, and caregiver fatigue (The fatigue fatigue in medication errors. Nurses who responded
factor). Distractions and interruptions can disrupt to a 2008 medication safety survey reported that
the clinician’s focus, leading to serious mistakes. fatigue, stress, and under staffing increased the risk
Heavier workloads also are associated with of making a medication error. Fatigue and sleep
medication errors. The nursing shortage has deprivation are linked to decreases in vigilance,
increased workloads by increasing the number of memory, information processing, reaction time, and
patients for which a nurse is responsible. Also, decision making. A person who works about12-hour
nurses perform many tasks that take them away from shift and has a long commute may need to stay awake
the patient’s bedside, such as answering the for up to 18 consecutive hours. According to U.S.
telephone, cleaning patients’ rooms, and delivering Army studies, staying awake for 17 hours is
meal trays. Absence of nurses from the bedside is equivalent to a blood alcohol level of 0.05%; staying
directly linked to compromised patient care. awake for 24 hours equates to a blood alcohol level
of 0.10%.
Nurses who work a16 hour shift may be awake
Staff Education and Competency for up to 19 or 20 hours, especially if they have a long
Continuing education of the nursing staff can help commute. Loss of even one night’s sleep can lead to
reduce medication errors. Medications that are new short-term memory deficits and omission errors and
to the facility should receive high teaching priority. giving the wrong drug are common medication
Staff should receive updates on both internal and errors. Fatigue and sleep loss also may diminish a
external medication errors, as an error that has nurse’s ability to recognize subtle patient changes.
occurred at one facility is likely to occur at another. As a result, the nurse may not notice an adverse
As medication-related policies, procedures, and reaction to a drug quickly enough to avoid a
protocols are updated, this information should be devastating outcome.
made readily available to staff members. Also, nurses
can attend pharmacy grand rounds. Some facilities
now use nursing grand rounds as a way to keep Near-Misses
staff members competent. Suppose a physician writes an order on the wrong
chart, but you catch the error before the patient is
harmed. A 2006 study found 350 such near-misses
Patient Education were reported, with drug administration implicated
Caregivers should teach patients, the name of each in 28.2%. Due to decreased vigilance and reduced
medication they’re taking, how to take it, the dosage, information-processing ability, a severely fatigued
potential adverse effects and interactions, what it nurse may not notice a potential problem that could
looks like, and what it’s being used to treat. make the difference between a near-miss and a
medication error. Near-miss medication error
reporting can be used to reduce medication errors.
Quality Processes and Risk Management Failure to recognize and report near-misses impedes
A final strategy for reducing medication errors is efforts to improve medication safety.
to establish adequate quality processes and risk
management strategies. Every facility should have a
culture of safety that encourages discussion of Inattentional “Blindness”
medication errors and near-misses (errors that don’t Another case of a fatigue-related error involved
reach a patient) in a non punitive fashion. Only then misreading of drug labels. A nurse nearing the end
can effective systems-based solutions be identified of a 16-hour shift reached into the medication supply
and used. Simple redundancies, such as using an cabinet to obtain furosemide I.V. She thought she
independent double-check system when giving high- was grabbing a furosemide vial, but picked up a vial
alert drugs, can catch and correct errors before they of potassium chloride instead. The vial was correctly
reach patients. According to the Institute of labeled, and the nurse even read the label before
Medicine, organizations with a strong culture of administering the drug (which caused a fatal
safety are those that encourage all employees to stay arrhythmia). The furosemide and potassium chloride
30 Neethu Jose / Medication Errors: Don’t Let Them Happen To You
labels had similar colors and printing. The nurse  Asking a colleague to double check your
was expecting to see “furosemide” on the label, so medications when giving high-alert drugs
her brain processed what she expected to see. Such  Using an oral syringe to administer oral or NG
inattentional “blindness” occurs when the brain fails medications
to distinguish something that should be easy to
discern. To prevent information over load, the brain  Assessing patients for drug allergies before
“searches and sweeps” until something grabs its giving new medications
attention. It’s adept at filling in gaps when  Becoming familiar with your facility’s “do not
information is missing, compiling a comprehensive use” list of abbreviations.
picture based on incomplete information. Thus, the
In 2004, the JC (Joint Commission) published a list
nurse saw what she expected to see.
of abbreviations that shouldn’t be used because they
can contribute to medication errors. For instance, in
Consequences for the Nurse [5] one documented case, a “naked” decimal point (one
For a nurse who makes a medication error, without a leading zero) led to a fatal tenfold overdose
consequences may include disciplinary action by the of morphine in a 9 month old infant. The dosage was
state board of nursing, job dismissal, mental anguish, written as “.5 mg” and interpreted as “5 mg.”
and possible civil or criminal charges. In one study of
fatal medication errors made by healthcare providers, Reading Back Medication Orders
the providers reported they felt immobilized, nervous,
fearful, guilty, and anxious. Many experienced The Joint Commission recommends care givers
insomnia and loss of self-confidence. read back and verify all medication orders given
verbally or over the telephone. Keep these tips in mind:
How to Avoid Medication Errors? [1,3,5]  Have the patient’s chart available when calling
the prescriber, and write down the order while
How can you safeguard your practice from
you’re still on the phone.
medication errors? For starters, be conscientious about
performing the “five rights” of medication administration  Verify the patient’s name.
every time— right patient (using two identifiers), right  Read back and confirm the medication. If you’re
drug, right dosage, right time, and right route. Some unfamiliar with the drug, ask the prescriber to
experts have expanded this list to include: spell the drug name.
 Right reason for the drug  Confirm the medication dosage by stating each
 Right documentation number individually.
 Right to refuse medication  To help prevent sound-a like errors, verify with
the prescriber the condition that the medication
 Right evaluation and monitoring.
is being used to treat. For example, Actos is used
 Right to know about the medication for diabetes mellitus, where as the similar-
Be sure to use the safety resources available at your sounding Actonel Is used to treat osteoporosis.
facility. Don’t use workarounds to bypass safety
systems. In a 2008 study, one-third of nurses reported
Eliminating Medication Errors
they sometimes bypass safety systems. Nurses
working in critical care and pediatrics were more Avoiding medication errors requires vigilance and
likely to do this; yet medication errors in these the use of appropriate technology to help ensure
settings can be particularly devastating. Where proper procedures are followed. Computerized
nurses routinely bypass safety systems and create physician order entry reduces errors by identifying
workarounds, the employer must conduct a root- and alerting physicians to patient allergies or drug
cause analysis to identify the reason for the interactions, eliminating poorly handwritten
workaround, and take action to correct the situation prescriptions, and giving decision support regarding
and prevent recurrences. standardized dosing regimens.
Additional Steps you can Take to Promote Safe Conclusion

Medication use Include
 Reading back and verifying medication orders Medicines cure, but they can also kill or cause
given verbally or over the phone. severe adverse reactions if a wrong medicine is
Neethu Jose / Medication Errors: Don’t Let Them Happen To You 31
administered or if the dosage is wrong. Many errors:Don’t let them happen to you. American
disasters have occurred due to the medication errors. Nurse Today. March 2010 : 23 -27.
Errors occur at all levels of the medication use system, 2. Institute for Safe Medication Practices. ISMP
from prescriber to the consumer through many Medication Safety Alert! Nurse Advise-ERR
intermediate levels. These errors are not usually due [Newsletter]. http://www.ismp.org/Newsletters/
to incompetence but due to mostly preventable nursing/default.asp. Accessed February 1, 2010.
reasons. Be sure to use the safety practices already in 3. Rogers A, Hwang W, Scott L, Aiken L, Dinges D.
place in your facility. Eliminate distractions while The working hours of hospital staff nurses and
preparing and administering medications. Learn as patient safety. Health Aff (Millwood). 2004; 23 (4):
much as you can about the medications you administer 202-212.
and ways to avoid mistakes. Finally, be aware of the 4. Sakowski J, Newman J, Dozier K. Severity of
role fatigue can play in medication errors. medication administration errors detected by a bar-
code medication administration system. Am J
Health Syst Pharm. 2008; 65(17): 1661-1666.
Reference 5. Malhotra K ,Goyal M,Walia R, Aslam S. Medication
Errors: A Preventable Problem: Indian Journal o f
Clinical Practice. June 2012; 23(1): 17-21.
1. Pamela Anderson, TerriTownsend, Medication
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33
IJSN
Volume 5, Number 1
Nurses Role: A Vital Part in Operation Theatre © Red Flower Publication Pvt. Ltd
Vasantha Kalyani*, S.K. Mohana Sundari**
Abstract
Nurses responsibility is the vital part in health services which has the two major disciplines as medical
and surgical. On the account of surgery nurses play a crictal and important role in maintain the quality of
nursing care. The nursing care depends in the OT as the need of patients such as either diagnostic purpose
or treatment with the standard safety measures in the prevention of infection .
Keywords: Nurses Role; Operation Theatre; Role of Nurse; Infection Control; Duties of Nurse.
Introduction nurse. Communication provides a basis for

judgements that are supported by a social network
of nurses, surgeons, anaesthesiologists, technicians,
Nurses play an important role in maintaining the and auxiliary staff. The OR charge nurse then
health and well-being of patients. One type of nurse becomes a conduit for information flow, receiving,
in particular is the perioperative nurse, which is processing, and communicating this information to
commonly referred to as the operating room nurse. others for the coordination of patient care. The
They are registered nurses who take care of patients purpose of OR charge nurse communication is to
before, after and during surgery. OT nurse is coordinate the activities of the operating
responsible to the Medical Coordinator, who is in room. Coordination of staffing is usually face-to-face
charge of the management and organisation of patient and with OR nurses.
care.
Charge nurses are experienced registered nurses
who have displayed leadership, management and Duties and Responsibilities of OT Charge Nurse
communication skills. They are responsible for
managing, supervising and assisting the nursing
staff, providing administrative support and patient
care. A hospital, clinic or health care facility may
have several charge nurses, each responsible for a
different shift, department or specialized unit.
OT in charge nurse is acting as a coordinator and
their main goal is to provide, safe, and effective care
of surgical patients. The charge nurse is integrally
involved in insuring that staff, patients, and
equipment come together seamlessly to move patients
through the surgical process. It essential to
understanding operating room coordination is an
examination of the communication of the OR charge
Author Affiliation: *Assist Professor, **Nursing Tutor,

College of Nursing, AIIMS, Rishikesh.
All emergency personnel are expected to know
Correspondance: Vasantha Kalyani, Assist Professor, and follow the hospital admissions criteria, guide
College of Nursing, AIIMS, Virbhadra Road, Rishikesh, lines, protocols, and the diagnosis and treatment
Uttarakhand 249201
standards in use in the Centre, and to ensure the
E-mail: vasantharaj2003@gmail.com
34 Vasantha Kalyani & S.K. Mohanasundari / Nurses Role: A Vital Part in Operation Theatre
correct compilation of clinical records and statistics 2. Preparation of the theatre for operations and
in both computer and paper formats. organisation of the work of the national team in
theatre;
The Main Duties and Responsibilities of the OT in 3. Direct participation in surgical procedures;
Charge is 4. To assist with clinical research and record
1. Management and supervision of sterilisation keeping as required by the scientific programmes
services; of the specialist sector of the Medical Division of
emergency.
The Areas in which OT Charge Nurse may be Required  Chemical sterilisation using formaldehyde,
to work are: glutaraldehyde...;
 Sterilisation  Quality control of the sterilisation processes in
 Operating theatres use, via the appropriate tests (Bowie-Dick,
biological and chemical tests).
 Training programmes
 Administrative duties Management and Orders of Stocks and Supplies
The workload and rota are variable, depending The OT in charge is responsible for checking that
on the needs and organisational set-up of the levels of supplies of materials and equipment are always
hospital; usually have at least one day off a week, adequate in terms of quantity and quality, and for
with on-call 24/7 in case of surgical emergency.. informing the Medical Coordinator of any requirements.
Sterilisation Services Management and Training of Local Personnel

Each Centre is equipped to carry out the following Clinical activities and patient care are always
procedures: carried out alongside and in collaboration with local
 Steam sterilisation via autoclave, including very personnel, who thus benefit from training in the field.
basic models; There is also provision for more specific teaching
Vasantha Kalyani & S.K. Mohanasundari / Nurses Role: A Vital Part in Operation Theatre 35
activities, managed by the international specialists, Staff Appraisal

in accordance with the individual needs of each In charge nurses document the performance of
hospital. As there is a high turnover of nursing staff, nurses, perform evaluations and counsel nurses on
there will be a particular need to provide training to unsatisfactory performance. In addition, they meet
these personnel. with upper management to discuss personnel and
administrative issues and address and solve
Administrative Duties and Responsibilities problems among staff.
In charge nurses perform administrative duties

including creating schedules, maintaining adequate Roles and Responsibilities of Perioperative Nurse
supplies and informing staff of changes to protocol.
A perioperative nurse is a registered nurse who, promote the sterility of the operating room. They
using the nursing process, develops a nursing care inform operating room staff of anything that may
plan, and coordinates and delivers care to patients cause contamination. They are also responsible for
undergoing operative or other invasive procedures. opening autoclaved packages, which are packages
” Perioperative nurses work closely with surgeons, that hold sterile objects, so that the operating room
anaesthesiologists, nurse anaesthetists, surgeon’s staff may easily access the sterile equipment.
assistants, surgical technologists, and nurse practitioners.
Preoperative nurses assume many roles within the Scrub Nurses
operating room that involve both sterile and unsterile
Scrub nurses remain in the sterile field of the
activities. Perioperative nurses can be divided into
operating room and follow the designated scrub
three main groups according to their roles and
procedure, wear gloves, a mask and gown. Scrub nurses
responsibilities within the operating room. The three
aid surgeons by handing them equipment, sponges and
main groups are circulating nurses, scrub nurses,
other necessary instruments needed during the
and registered nurse first assistants.
operation. They also help the surgeon by monitoring
the patient’s condition during the procedure.
Registered Nurse First Assistant (RNFA)

RNFA nurses have had additional education and
training in surgical care. These nurses have more
responsibilities within the operating room and work
directly with surgeons. Their job is to help surgeons
by controlling patient bleeding, use instruments and
medical devices during the operation, perform
invasive procedures such as cutting tissue, and
suture the patient when the operation has finished.
Circulating Nurses Practice Settings
In the operating room, circulating nurses remain Perioperative registered nurses work in a wide
in the unsterile field .These nurses are not scrubbed, array of urban and rural settings, such as:
and do not wear gloves or a gown. Their role is to • Hospital surgical departments
monitor and document the procedures taken during • Ambulatory surgery centres (also known as
the operation. Circulating nurses also function to Day Surgery units)

36 Vasantha Kalyani & S.K. Mohanasundari / Nurses Role: A Vital Part in Operation Theatre
• Clinics Career Opportunities

• Physicians’ offices Perioperative registered nurses also may work as
an O.R. Director, managing budgets, staffing, and
Education other business aspects of the operating room. Some
perioperative registered nurses may later consider a
RN license with a Bachelor’s of Science degree in career in business as a management consultant, clinical
nursing (BSN), associate degree in nursing (ADN), educator, researcher, or medical sales professional.
or hospital diploma.
Reference
Personal Qualification
Generally, registered nurses obtain general
1. Association of periOperative Registered Nurses.
nursing experience before entering the specialty area
(2009). Retrieved December 2, 2009.
of Perioperative Nursing. Two areas that can provide
applicable experience are critical care and emergency 2. Israel Institute for Occupational Safety and Hygene.
(2000). Retieved.
room care. They are fast-paced, sometimes stressful
environments where life-saving decisions that make 3. Lewis, S.M., Heitkemper, M.M., & Dirksen, S.R.
a difference in a patient’s life are routinely made. (2006). Medical Surgical Nursing in Canada.
Toronto, MO: Mosby.
Perioperative registered nurses must be able to
4. Nurses for a healthier tomorrow. (n.d.). Retrieved
interact well with all kinds of people in difficult
November 25, 2009.
situations. They need emotional stability to cope with
human suffering and frequent emergencies. They 5. Operating Room Nurses Association of Canada.
(n.d.). Retrieved December 2, 2009.
must be able to accept responsibility, provide
direction to others, coordinate a patient’s health care 6. Smith, S.E.(2009). What is a Circulating Nurse?.
plan, and collaborate with other health care Retrieved December 2, 2009 from.
professionals.

37
Guidelines for Authors
Manuscripts must be prepared in accordance with 22754205, E-mail: redflowerppl@vsnl.net. Website:

“Uniform requirements for Manuscripts submitted www.rfppl.co.in
to Biomedical Journal” developed by international
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Review articles: Up to 2500 words excluding Do not make subheadings in these sections.
references and abstract and up to 10 references.
Case reports: Up to 1000 words excluding Title Page
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identity should be here. use text/rtf/doc/PDF files. (Last name, First name and initials of middle
Do not zip the files. name), with his or her highest academic degree(s)
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articles submitted online, should be sent to the words for case reports, brief reports and 250 words
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Publication Pvt. Ltd., 48/41-42, DSIDC, Pocket-II, Settings and Design, Methods and Materials,
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38 Guidelines for Authors
Introduction mechanisms, clinical research). Do not repeat in

State the background of the study and purpose of detail data or other material given in the Introduction
the study and summarize the rationale for the study or the Results section.
or observation.
References
Methods List references in alphabetical order. Each listed
The methods section should include only reference should be cited in text (not in alphabetic
information that was available at the time the plan order), and each text citation should be listed in the
or protocol for the study was written such as study References section. Identify references in text, tables,
approach, design, type of sample, sample size, and legends by Arabic numerals in square bracket
sampling technique, setting of the study, description (e.g. [10]). Please refer to ICMJE Guidelines
of data collection tools and methods; all information (h t t p: //w ww . n lm. ni h. gov /b sd /un if or m_
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the Results section.
Reports of randomized clinical trials should be Standard journal article
based on the CONSORT Statement (http://www. [1] Flink H, Tegelberg Å, Thörn M, Lagerlöf F. Effect
consort-statement. org). When reporting experiments of oral iron supplementation on unstimulated
on human subjects, indicate whether the procedures salivary flow rate: A randomized, double-blind,
followed were in accordance with the ethical placebo-controlled trial. J Oral Pathol Med 2006; 35:
standards of the responsible committee on human 540-7.
experimentation (institutional or regional) and with
the Helsinki Declaration of 1975, as revised in 2000 [2] Twetman S, Axelsson S, Dahlgren H, Holm AK,
(available at http://www.wma.net/e/policy/l 7- Källestål C, Lagerlöf F, et al. Caries-preventive effect
c_e.html). of fluoride toothpaste: A systematic review. Acta
Odontol Scand 2003; 61: 347-55.
Results
Article in supplement or special issue
Present your results in logical sequence in the text,
tables, and illustrations, giving the main or most [3] Fleischer W, Reimer K. Povidone iodine antisepsis.
important findings first. Do not repeat in the text all State of the art. Dermatology 1997; 195 Suppl 2: 3-9.
the data in the tables or illustrations; emphasize or
summarize only important observations. Extra or
Corporate (collective) author
supplementary materials and technical details can
be placed in an appendix where it will be accessible [4] American Academy of Periodontology. Sonic
but will not interrupt the flow of the text; alternatively, and ultrasonic scalers in periodontics. J Periodontol
it can be published only in the electronic version of 2000; 71: 1792-801.
the journal.
Unpublished article
Discussion [5] Garoushi S, Lassila LV, Tezvergil A, Vallittu
Include summary of key findings (primary PK. Static and fatigue compression test for particulate
outcome measures, secondary outcome measures, filler composite resin with fiber-reinforced composite
results as they relate to a prior hypothesis); Strengths substructure. Dent Mater 2006.
and limitations of the study (study question, study
design, data collection, analysis and interpretation);
Personal author(s)
Interpretation and implications in the context of the
totality of evidence (is there a systematic review to [6] Hosmer D, Lemeshow S. Applied logistic
refer to, if not, could one be reasonably done here regression, 2nd edn. New York: Wiley-Interscience; 2000.
and now?, What this study adds to the available
evidence, effects on patient care and health policy,
possible mechanisms)? Controversies raised by this Chapter in book
study; and Future research directions (for this [7] Nauntofte B, Tenovuo J, Lagerlöf F. Secretion and
particular research collaboration, underlying composition of saliva. In: Fejerskov O, Kidd EAM,

Guidelines for Authors 39
editors. Dental caries: The disease and its clinical Type or print out legends (maximum 40 words,
management. Oxford: Blackwell Munksgaard; 2003. p. 7-27. excluding the credit line) for illustrations using
double spacing, with Arabic numerals
corresponding to the illustrations.
No author given
[8] World Health Organization. Oral health
surveys - basic methods, 4th edn. Geneva: World Sending a revised manuscript
Health Organization; 1997. While submitting a revised manuscript,
contributors are requested to include, along with
single copy of the final revised manuscript, a
Reference from electronic media photocopy of the revised manuscript with the
[9] National Statistics Online—Trends in suicide changes underlined in red and copy of the comments
by method in England and Wales, 1979-2001. with the point to point clarification to each comment.
www.statistics.gov.uk/downloads/theme_health/ The manuscript number should be written on each
HSQ 20.pdf (accessed Jan 24, 2005): 7-18. Only of these documents. If the manuscript is submitted
verified references against the original documents online, the contributors’ form and copyright transfer
should be cited. Authors are responsible for the form has to be submitted in original with the
accuracy and completeness of their references and signatures of all the contributors within two weeks
for correct text citation. The number of reference of submission. Hard copies of images should be sent
should be kept limited to 20 in case of major to the office of the journal. There is no need to send
communications and 10 for short communications. printed manuscript for articles submitted online.
More information about other reference types is
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40 Guidelines for Authors
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Challenges in Organ Transplantation -An Indian Scenario

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Effectiveness of Music Therapy in Reduction of Anxiety among Patients

Challenges in Organ Transplantation: An Indian Scenario 19

Medication Errors: Don’t Let Them Happen To You 27

Nurses Role: A Vital Part in Operation Theatre 33

Guidelines for Authors 37

Indian Journal of Surgical Nursing / Volume 5 Number 1 / January - April 2016

Indexing information page of Index Copernicus

Indian Journal of Surgical Nursing / Volume 5 Number 1 / January - April 2016

Introduction partners, more children are being immunized than

Indian Journal of Surgical Nursing / Volume 5 Number 1 / January - April 2016

Material and Method

Indian Journal of Surgical Nursing / Volume 5 Number 1 / January - April 2016

Sociodemographic Sample Experimental Control Total

Indian Journal of Surgical Nursing / Volume 5 Number 1 / January - April 2016

Indian Journal of Surgical Nursing / Volume 5 Number 1 / January - April 2016

Indian Journal of Surgical Nursing / Volume 5 Number 1 / January - April 2016

Table 3.9: Effectiveness of guided health action on utilization status of Measles

Fig. 1: Percentage of reasons for not utilizing immunization services in experimental

Indian Journal of Surgical Nursing / Volume 5 Number 1 / January - April 2016

IV. Nursing Implications poliomyelitis. Who Geneva draft meeting, 2001

www.health.govt.nz/publication/ national- 7, 2013]; Available from: http://www.indiaen

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Sample, Sample Size & Sampling Technique: 50 Patients Undergoing

Data Collection Tool : Modified Zung Anxiety Rating Scale Preparation of

Data Collection Tool : Modified Zung Anxiety Rating Scale Preparation of

Pre-test Music Therapy Post-test

Analysis of Data and Interpretation Analysis

Conclusion and Dissemination of Research Findings

Fig. 1: Schematic representation of study