CHAPTER II

REVIEW OF LITERATURE
This chapter represent review of selected literature relevant to the present study, review
of literature is an important step in the development research project and broad cleaning the
understanding and developing and insight in to the problem area. It further helps in developing
the broad conceptual content in which the problem fix methodology and construction of tool and
analysis of data.
Literature relevant for this study where reviewed and has been organized in following sequence.
1. Studies related to knowledge regarding Glasgow coma scale.
2. Studies related to effectiveness of structured teaching program.
Rostam Jalali and Mansor Rezaei (2014) conducted a prospective study among 104
neurologic patients, 23 (22.15%)females and 81(77.9%)males, with mean age of (from17-86
years)were studied. Agreement between Glasgow coma scale and patients outcome was 30%.
IshanMattar and Sok Ying Liaw and Moon Faichan conducted correlational
observational study conducted in one acute care hospital in Singapore. The participants were
registered nurses involving in bed side nursing care a self administered questionnaire was
provided to the participants via ward manager. The quantitative responses were collected and
analyzed using statistical package for social science(SPSS)16.0 nurses in the neonatal intensive
care unit scored the highest mean scores(12.7),where as nurses from the general medicine wards
scored the lowest mean scores (9.7). Nurses who worked in a neuroscience setting for 6 years or
more scored higher mean score(11.9).On the knowledge scale where as nurses who worked in a
neuroscience setting for less than a year scored lower mean score(10.0).
Grotes,Bicker.W,Mutchler

W,Bourllon

B,Lefering

conducted

correlational

observational study conducted in patients with severe multiple injuries may have other reasons
for unconsciousness, traumatic defined by the Glasgow coma scale the record of 18,002 severely
injured adult( 15.5 greater than 16) patients from the coma register of the german society for
trauma surgery were analyzed and initial Glasgow coma scale and abbreviated injury scales were
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recorded. A severe TBI was defined by an AIS (head) greater than 3 on other hand,
unconsciousness was defined by an initial Glasgow coma scale greater than 8.By this
criteria,6546 patients(36.3 percentage)were unconscious and 8746 patients (48.6 percentage) had
severe TBI. Our study indicates that the Glasgow coma scale in unconsciousness patient with
multiple injured shows only a moderate correlation with the diagnosis of severe TBI
`

Zafonte Rdi,Hammond FM,Mann NR,Wood DL Black.KL,Millis SR conducted

descriptive study used to multicentre national institute on disability and rehabilitation research
TBI model systems data base of 501 patients who had received acute medical care and inpatient
rehabilitation with in a co ordinate neuro trauma program for treatment of TBI. The relationship
between initial and lowest Glasgow coma scale scores and outcomes variables. Initial and lowest
Glasgow coma scale score comparison with outcome demonstrated the following correlation
coefficient. Admission disability rating scale is 0.25 and 0.28; discharge disability rating scale
0.24 and 0.24,admission levels of cognitive functioning scale 0.31 and 0.33,discharge levels of
cognitive e functioning scale 0.27 and 0.25.admission functional independence measures 0.31
and 0.31 and in discharge period 0.25 and 0.21.the Glasgow coma scale as a single variable may
have limited value as a predictor of functional out come.
Coma is a state of prolonged unconsciousness in which the patient cannot be aroused
even with painful stimuli. Coma in children is categorized into traumatic and non-traumatic
(NTC). A proper neurological assessment using Pediatric Glasgow Coma Scale (PGCS) is the
essential part of nursing care. Aims of the study were: to assess knowledge of PICUs nurses
about coma and PGCS, to assess skills of PICUs nurses about coma and PGCS and to assess
effect of instructional guidelines about coma and PGCS on knowledge and skills of nurses.
Research design a quasi-experimental research design was utilized. Setting: the current study
was conducted in PICUs of 2 of Educational Pediatric Hospitals, Cairo University. Sample: a
convenient sample of 50 PICUs nurses and a convenient sample of 50 preschool children with
NTC were included. Tools: there were 3 tools utilized which were: 1- a structured sociodemographic questionnaire for: a- PICUs nurses and b- preschool children in PICUs. 2- a
structured nurses knowledge questionnaires.3- An observational checklist on PGCS. Results:
results of the current study revealed that the mean age of children was 3.780.7637 years; the
mean age of nurses was 23.122.855 years. The present study indicated that nurses knowledge
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about coma and PGCS in pretest was unsatisfactory but their knowledge in posttest improved
after provision of instructional guidelines and there was a statistically significant difference
between mean scores of nurses knowledge in pretest and posttest. There was a statistically
significant difference between mean scores of nurses skills before and after application of
instructional guidelines about coma and PGCS. Conclusion: There was a positive effect of
instructional guidelines in improving knowledge and skills of PICUs nurses regarding coma and
PGCS and achieved aims of the study. Recommendations: the current study recommended that
PICUs should provide training courses for nurses about coma and application of PGCS and
adequate supervision and follow up should be available by head nurses in PICUs for staff nurses
during assessment of coma and application of PGCS.