DEFINITION OF KEY TERMS GCS

DEFINITION OF KEY TERMS

GCS: Glasgow Coma Scale (GCS) is a neurological scale which aims to give a reliable, objective way of recording the conscious state of a person, for initial as well as subsequent assessment. A patient is assessed against the criteria of the scale, and the resulting points give a patient score between 3 (indicating deep unconsciousness), score 7 indicates coma and either 14 or 15 indicating fully awareness (Santos et al., 2016)
Consciousness: Consciousness is general awareness of oneself and the surrounding environment (Taesdale Graham et al., 2014)
Knowledge: It refers to the verbal response of Nursing students to the structured knowledge questionnaire regarding GCS assessment. It includes poor, Satisfactory, and good knowledge to assess the understanding of Nursing students.
Nursing Students: Refers to someone who is studying or training to be a nurse (Collins dictionary, 2018).
Neurological assessment: Is the assessment of sensory neuron and motor responses, especially reflexes, to determine whether the nervous system is impaired. It includes a patient physical examination and a review of the patient’s history, but not deeper investigation such as Neuroimaging (Nicholl DJ et al.,2014).
KEY TERMS
Glasgow Coma Scale, Knowledge, Neurological assessment, Nursing students, Tanzania.

TABLE OF CONTENTS
ABREVIATIONS……………………………………………………………………………………………………………………….ii
DEFINITION OF KEY TERMS. ……………………………………………………………………………………………….ii
1.0 INTRODUCTION………………………………………………………………………………………………………1
1.1 BACKGROUND ………………………………………………………………………………………………………………. 1
1.2 PROBLEM STATEMENT………………………………………………………………………….3
1.3 RESEARCH OBJECTIVES………………………………………………………………………. 4
1.3.1 Broad objectives……………………………………………………………………………………4
1.3.2 Specific objectives………………………………………………………………………………….4
1.4 RESEARCH QUESTIONS…………………………………………………………………………5
1.5 RESEARCH HYPOTHESIS…………………………………………………………………………5
1.6 CONCEPTUAL FRAMEWORK……………………………………………………………………6
2.0 LITERATURE REVIEW………………………………………………………………………….8

1.0 INTRODUCTION
1.1 BACKGROUND
Nursing is a dynamic and evolving profession, in which knowledge is central to its accountability. Nurses need to a quire a wide range of theoretical and practical knowledge in order to provide the appropriate level of care for patients. Nurses all over the world, are responsible to continuously assess patients(Al-quraan ; Aburuz, 2016). The most important assessment of neurological examination in the clinical setting is assessing level of consciousness (LoC) which is considered the first step (Jaddoua et al. 2013).
Glasgow coma scale (GCS), developed by Taesdale and Jennet in 1974 at The University of Glasgow, Scotland, UK, is employed worldwide to identify neurologic dysfunction and follow-up progress of level of consciousness, predict prognosis, and standardize communication among health professionals. This scale became an important tool to assist patient who suffered trauma, mainly BTI victims, and, posteriorly, its use extended to other neurologic conditions that can alter consciousness. The scale has three assessment parameters with total score ranging from 3 to 15 obtained by observation of spontaneous activities and use of verbal and/or painful stimulus(Santos, Vancini-Campanharo, Lopes, Okuno, ; Batista, 2016; Teasdale Graham et al., 2014).
Rapid and correct assessment will minimize the neurological complications, unnecessary and incorrect diagnostic procedures, mortality and morbidity. The basic requirements for any assessment to be effective are the availability of an objective, valid, reliable and accurate tools. (GCS)(Al-quraan ; Aburuz, 2016).
Even though the GCS is an easy, objective, reliable instrument to assess LoC; it has its own limitations(Thi ; Chae, 2011). Over the last decade, some criticism about the GCS started to appear in the literature despite plenty of advantages. GCS is considered easy to use; however, this character opens it to misinterpretation and misapplication(Al-quraan ; Aburuz, 2016; Teasdale Graham et al., 2014).
Nurses not only need to know how to assess LOC by GCS, but also they need to know how to interpret these numerical values. Previous studies(Basauhra Singh et al., 2016) showed that the nurse’s knowledge on GCS is poor in detecting deterioration of patient. Furthermore, they lack the knowledge and the self-confidence in the assessment(Al-quraan & Aburuz, 2016; Santos et al., 2016).
One of the factors that might affect the accuracy of GCS scoring is the knowledge of nurses about how to use/score GCS(Summers & McLeod, 2017). Different studies showed that higher levels of knowledge promoted the accuracy when performing GCS scoring(Scientific, 2016). The first step in such studies should be the assessment of nurses’ knowledge in performing GCS. Thereafter, if the results showed that the nurses are lacking the knowledge, then another interventional study would be recommended(Al-quraan ; Aburuz, 2016).
Therefore, the main purpose of this study is to assess MUHAS nursing students’ knowledge about GCS. There have been just a few studies on the knowledge of GCS among clinicians published in Africa, as most of the published studies were done either in Europe or North America. This study will, thus, contribute to the available body of knowledge on this subject matter in Tanzania, which is rather negligible.

1.2 PROBLEM STATEMENT
Four decades after its introduction, the GCS has gained worldwide acceptance It is now employed in more than 80 countries, has been translated into more than 60 languages and there are more than 18,000 references to its use (Middleton, 2012). Unfortunately, this widespread use has been accompanied by: Increasing variations in the way it is used; and Decreasing reliability of assessment and communication(Middleton, 2012; Teasdale Graham et al., 2014).
It seems that knowledge about GCS scale is a global problem (Al-quraan & Aburuz, 2016). For many years, a variety of studies were developed to evaluate the precision and reliability of GCS (Magyar MI(1), Mitchell VG, Ladson AR, 2015). Studies shown low adherence of GCS use, difficulties in its application and fails of professionals related to conscience evaluation such as lack of standards and poor knowledge about the scale(Santos et al., 2016).
In Africa, the study done in Nigeria by (Emejulu et al., 2014) shows a high percentage of clinicians who are not in emergency or neurological services, after their formal graduate training, progressively lose touch with this life?saving tool, and this could negatively impact on the optimal care of patients. This impact on care could range from lack of knowledge on when to institute resuscitative measures to the lack of awareness of when to refer such patients for specialist neurological treatment. Also the study done by (Basauhra Singh et al., 2016), found that only 2.96% of nurses have good knowledge in GCS.
Even in Tanzania, Nurses in our hospitals get problems in assessment of patient using GCS and therefore doubting their knowledge acquired during their study years. Therefore, there is a lot of issues leading to be poor knowledge among nursing students that need to be identified by this study.

1.3 RESEARCH OBJECTIVES
1.3.1 Broad objective
To examine knowledge about Glasgow Coma Scale among Nursing Students at MUHAS, from January to February, 2018.
1.3.2 Specific objectives
i) To assess knowledge of nursing students on the components of Glasgow Coma Scale.
ii) To assess knowledge of nursing students on scores of each GCS components.
iii) To find out the association between the level of knowledge about Glasgow Coma Scale among nursing students with their selected socio demographic variables
iv) To find out the relationship between year of study and knowledge about GCS.

1.4 SPECIFIC RESEARCH QUESTIONS
i) What is the knowledge of nursing students on the components and scores of Glasgow coma scale?
ii) What is the association between the level of knowledge about GCS among nursing students with their selected socio demographic variables?
iii) What is the relationship between year of study and knowledge about GCS?

1.5 RESEARCH HYPOTHESIS
Nursing students in final year of study will have more knowledge about GCS than those in other years of study.
VARIABLES
INDEPENDENT VARIABLE DEPENDENT VARIABLE
Year of study Knowledge

1.6 CONCEPTUAL FRAMEWORK
Conceptual framework is the way ideas are organized to achieve a research project’s purpose. Research frameworks are connected to purpose/Aim of the research study. In addition, it identifies the variables required in the investigation and show how the variables in the study are connected to each other. It serves as the “map” that guide the researcher towards realizing the objectives or intent of the study (Polit ; Beck, 2003).
In this study of assessment of Nursing students about GCS there are many Independent variables which influence one dependent variables. Independent variables are, Year of study (I, II, III, IV year), Curriculum formulation, Time available for attending Clinical areas (i.e. Number of days per week), Students attendance in class sessions and clinical areas, Lecturers commitment in teaching and supervising students in clinical areas
All these independent variables, influence the knowledge of students about GCS. However, there are some independent variables which are connected to each other. For example, Curriculum formulation may dictate time available for attending Clinical areas.
The conceptual framework for this study is shown in the following page:

INDEPENDENT VARIABLE

DEPENDENT VARIABLE

2.0 LITERATURE REVIEW
Results of the several studies indicated that all items related nurses’ knowledge and practice concerning Glasgow coma scale were inadequate and the authors of those studies recommended that it is crucial need to education the nurse and to employ more qualified and knowledgeable and skillful nurses with high standards oriented competencies to apply through neurological assessment particularly Glasgow coma scale in neurosurgical wards (Scientific, 2016). Also, studied nurses had statistically significant lacking in the basic knowledge and practice about GCS and their knowledge during school study years might be insufficient for such a specialized service or for gotten (Scientific, 2016; Summers & McLeod, 2017). Jordanian nurses as well have inadequate knowledge to perform GCS (Al-quraan & Aburuz, 2016)
These results were supported by (Thi & Chae, 2011) who found the gap between the theoretical knowledge and performance of GCS in the Vietnamese nurses. Although most Vietnamese nurses had suitable theoretical knowledge of the GCS, they were not able to apply it to analyze a clinical situation. Furthermore, their basic knowledge of GCS was not enough to ensure accurate performance of GCS scoring. Therefore, the study suggested that a well-developed GCS training program should be delivered to the nurses to contain accuracy of assessment of the consciousness level using GCS, which ultimately results in improving the quality of nursing care. In addition, (Summers & McLeod, 2017), also identified uncertainty with painful stimuli with majority of 3rd year nursing students within their study unable to answer a question regarding the localization of pain correctly.
Result of the study done by Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia showed that among 135 studied nurses, 55.56% of nurses had poor knowledge followed by 41.48% and 2.96% with satisfactory knowledge and good knowledge, respectively.(Basauhra Singh et al., 2016).
(Summers & McLeod, 2017), assessed level of knowledge and found that 14 of the 39 (36%) third year nursing students answered the majority of the questions correctly and, of these, 10 had undertaken placements in neurological wards. When asked how confident they felt about their theoretical knowledge and practical skills in the GCS, majority of them reported having little confidence.
The study study done by (Santos et al., 2016) showed that, some professionals had poor knowledge about the scale. This fact corroborates with finding of an international study in which participants showed poor knowledge in some parameters of the scale, which indicated the need of continuous training in order to guarantee standard and reliable use of GCS.
Also the result of study done by (Thi & Chae, 2011), involving 94 Vietnamese nurses, showed that the vast majority of the nurses (>90%) responded correctly to questions regarding their GCS basic knowledge; however, 52.1% of the nurses answered incorrectly questions related to clinical scenarios requiring the application of the basic knowledge. Regarding the GCS performance, the nurses demonstrated acceptable accuracy rates for each component of GCS, but those who scored well in all three components accounted for only 42.6% of the subject group. These findings indicate that the Vietnamese nurses are not able to integrate their GCS knowledge into actual practice as measured by the accuracy of GCS scoring.
However, from different source I did not find article in Tanzania which assessed the knowledge of nursing students about Glasgow coma scale. In many hospitals, knowledge on GCS is not well understood by Nurses and still pose a great challenge, necessitating the need for more training in nursing schools

REFERENCES
Al-quraan, H., & Aburuz, M. E. (2016). Assessment Of Jordanian Nurses ‘ Knowledge To Perform Glasgow Coma Scale, 12(27), 208–217. https://doi.org/10.19044/esj.2016.v12n27p208
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Emejulu, J. K. C., Nkwerem, S. P. U., ; Ekweogwu, O. C. (2014). Assessment of physicians’ knowledge of Glasgow coma score. Nigerian Journal of Clinical Practice, 17(6), 729–734. https://doi.org/10.4103/1119-3077.144386
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