“Effect of Video assisted teaching on knowledge of Biomedical

Waste Management among health workers of selected hospital in

Kolkata”

By

Shyamoli Dey

College of Nursing, R.G.KarMedical College & Hospital

2018

In partial fulfillment of course requirements for the degree of

Master in Nursing from the West Bengal University of Health

Sciences, Kolkata.

………………………… ……………………………..

GUIDE CO-GUIDE

Madam Aparna Ghosh Madam Sujata Mitra

Reader and Principal in charge, Senior lecturer

CNMCH ,College of nursing C.O.N.R.G.K.M.C.H.

 Abstract

The investigator conducted a study to assess the effect of video assisted teaching

program on knowledge of Biomedical Waste Management among health workers of

selected hospital in Kolkata. The objective of the study is to determine the effect of video

assisted teaching program on knowledge of Biomedical Waste Management among

health workers. Investigator adopted the pre experimental approach with one group pre

test- post test design. Data was collected from 60 health workers, selected by non

probability purposive sampling technique with the help of structured knowledge

questionnaire. The study result showed that standard deviation of Mean pre-test and post-

test knowledge score were 2.83 and 2.83 respectively and mean pre-test and post test

knowledge score is 16.35 and 26.21, mean difference (9.86) between pre-test knowledge

score (16.35) and post test knowledge score (26.21) was significant by calculating the ‘t’

in df59=22.68, p<0.05. Therefore the video assisted teaching program was an effective

method of imparting knowledge to health workers. The study has an implication on

clinical nursing practice and nursing research. This study can be repeated with a larger

sample, in another setting with other teaching strategies.

CHAPTER I
 Chapter I
Introduction
Let the waste of ‘the sick’ not contaminate the lives of ‘the healthy’.” [1]

(Park K 2005)

Background of the study

Hospital is a place of almighty a place to serve the patient. Since beginning the

hospital are known for the treatment of sick persons but we are unaware about the

environment. Now it is well established fact that there are many adverse and harmful

effects to the environment include human beings which are caused by the biomedical

waste generated during patient care .[2]

Biomedical waste means any waste which is generated during the diagnosis,

treatment or immunization of human beings or animals or in research activities

pertaining there to or in the production or testing of biological and including categories

mentioned in the schedule one of biomedical waste rules 2000 by Ministry of

environment and forest notification. [2]

According to bio-medical waste rules,1998 of India, biomedical waste means any

waste, which is generated during the diagnosis, treatment or immunization of human

beings or animals or in a research activities pertaining thereto, or in the production or

testing of biologicals, and including human anatomical waste ,animal waste,

microbiology and biotechnology waste, waste sharps, discarded medicines and

cytotoxic drugs, soiled waste, solid waste, liquid waste, incineration ash, chemicals used

in production of biological, chemicals used in disinfection, as insecticides, etc [2]

 According to a WHO report around 85% of hospital waste is non-hazardous, 10% is

infectious and the remaining 5% is non-infectious but hazardous-chemical,

pharmaceutical or radioactive. [3]

Health and safety of the nursing staff is cardinal feature of biomedical waste

management. The Medical Superintendent or head of the institute must provide training

to strengthen their skills for safety. Although biomedical waste management can't be

achieved without the cooperation of each and every worker and patient, the nursing

personnel play a significant role in this whole process. Nurses have to segregate the bio

medical waste as per the color code given by the hospital policy and also check whether

other workers are doing correctly or not. They need to be informed about current

available technology to deal biomedical wastes. The sound knowledge and safe

practices among all health care staff need to be strengthened. [3]

Biomedical waste consists of solids, liquids, sharps and laboratory waste that are

potentially infectious or dangerous and are considered bio-waste. It must be properly

managed to protect the general public, especially healthcare and sanitation workers who

are regularly exposed to biomedical waste as an occupational hazard. Hospitals and

other health care facilities generate lots of waste which can transmit infections,

particularly HIV, Hepatitis B & C and Tetanus, to the people who handle it or come in

contact with it. Until fairly recently, medical waste management was not generally

considered an issue. In the 1980s and 1990s, concerns about exposure to human

immunodeficiency virus (HIV) and hepatitis B virus (HBV) led to questions about
potential risks inherent in medical waste. Thus hospital waste generation has become a

prime concern due to its multidimensional ramifications as a risk factor to the health of

patients, hospital staff and extending beyond the boundaries of the medical

establishment to the general population.[4]

Average quantity of hospital solid waste produced in Indian hospitals have been

assessed by various workers and varied from 1kg /day /bed to 2.2kg /day /bed .In USA

this quantity was found to be above 4kg /bed /day and has been attributed mainly to

increase in use of disposables.[4]

Health personnel should serve as a spring board to renewed activities for the health

and happiness of humanity. Safe and effective management of waste is not only a legal

necessity but also a social responsibility. Lack of concern, motivation, awareness and

cost factor are some of the problems faced in the proper hospital waste management.

Clearly there is a need for education as to the hazards associated with improper waste

disposal. Lack of apathy to the concept of waste management is a major stymie to the

practice of waste disposal. An effective communication strategy is imperative keeping

in view the low awareness level among different category of staff in the health care

establishments regarding biomedical waste management.[4]

Biomedical waste is any solid, fluid or liquid waste including container and
intermediate product, generated during diagnosis and treatment in the hospitals.
Hospital waste is generated and discarded and is not intended for further use in a
hospital. It is of paramount importance that there are significant voids that need to be
addressed including efficient segregation, use of coded and colored bags, better
handling and transfer means which needs adequate training and awareness programmes
for the medical and Para medical personnel. Improper handling of solid waste in the
hospital may increase the air borne pathogenic micro organisms which could adversely
affect the hospital environment and the community as well. The current status of
employee’s awareness about biomedical waste management will help the authorities to
create strategy for improving the status in future. For proper biomedical waste
management lot of seminars, symposium and workshops are needed for the awareness
of medical and paramedical staff. [5]

At present with advancement of medical science most of the hospitals/nursing

homes are now equipped with latest instruments for diagnosis and treatment of various
diseases. One of the most important aspect associated with hospitals is the safe
management of the wastes; generated from these establishments, which contains human
anatomical wastes, blood, body fluid, disposable syringe, used bandages, surgical
gloves, blood bags, intravenous tubes etc.[4]

The Bio-medical waste generated from various sources has become a problem and

much attention is being given worldwide to find out solution of this problem. The main

concern lies with the hospital waste generated from large hospitals/nursing homes as it

may pose deleterious effects due to its hazardous nature. Bio-medical wastes, if not

handled in a proper way, is a potent source of diseases, like AIDS, Tuberculosis,

Hepatitis and other bacterial diseases causing serious threats to human health. Hence

prime attention is needed for its safe and proper disposal. A large number of out-source

Housekeeping Workers are being employed for this purpose.[4]

 Hospital is one of the complex institutions which are frequented by people from

every walk of life from society without any distinction between age, sex, race and

religion. This is over and above the normal inhabitants of hospital i.e. patients and staff.

All of them produce waste which is increasing in its amount and type due to advances in

scientific knowledge and is creating its impact. The hospital waste in addition to the risk

for patients and personnel who handle these wastes poses a threat to public health and

environment keeping in view inappropriate biomedical waste management, the ministry

of environment and forest notified the Biomedical waste management and handling

rules in July 1998.[5]

These examples gives an idea to assess the knowledge of the health workers on

biomedical waste management and Video assisted teaching method is used as a tool to

evaluate the knowledge of health workers regarding bio medical waste management .It

is a learning package system consists of planned and prepared instruction from the

beginning till end with an aim to facilitate self learning. [6]

Need of the study

Medical care is vital for our life, health and wellbeing. Inadequate Bio-Medical

waste management thus will cause environmental pollution, unpleasant smell, growth and

multiplication of vectors like insects, rodents and worms and may lead to the

transmission of diseases like typhoid, cholera, hepatitis and AIDS through injuries from

syringes and needles contaminated with human.[6]

 The nurses spend maximum time with patients in the ward than any other member of

the health team, increases their exposure and risk to the hazards present in hospital

environment, mainly biomedical waste. They need to be well equipped with latest

information, skills and practices in managing this waste besides reducing hospital-

acquired infections to protect their own health. They are also responsible for preventing

risk due to waste to the other members of health team and community at large.[7]

Awareness amongst the employees is necessary for proper management of biomedical

waste. Also, adequate knowledge of health care workers of the steps of waste

management is crucial for the success of any Health care waste management

programme.[8]

Nurses frequently get needle injuries that increase chances of infections, mainly

HIV and Hepatitis B & C. In one study it was found that there were around 700 injuries

per 1000 nursing staff per week out of which 60% were due to needles occurred during

recapping or handling but very few were due to discarded sharps. It is also found that the

present awareness among health personnel is poor regarding biomedical waste

management and imparting-training do improve their attitude and practices. Even the

Central pollution Control Board, the Ministry of Environment & Forests has

recommended that there should be a course on biomedical waste management in under

graduate nursing curriculum.[9]

Health and safety of the nursing staff is cardinal feature of biomedical waste

management. The Medical Superintendent or head of the institute must provide training

to strengthen their skills for safety. Although biomedical waste management can't be
achieved without the cooperation of each and every worker and patient, the nursing

personnel play a significant role in this whole process. They need to be informed about

current available technology to deal biomedical wastes. The sound knowledge and safe

practices among all health care staff need to be strengthened.[9]

Global figures based on statistical data of Environmental Protection Agency of

America and Japan, Ministry of Health suggested a volume of 1 to 1.5 kg/day/bed bio

medical waste for hospitals. However, waste produced has been quoted up to

5.24kg/day/bed in developed countries. The average quantity of hospital solid waste

produced in India ranges from 1.5 to 2.2kg/day/bed. As quoted by Pruthvish S. Bangalore

generates 1,32,500 kg of health care waste per day while the health care facilities

generate 5,100 kg of refuse daily.[10]

Health-care waste management in India is receiving greater attention due to recent

regulations (the Biomedical Wastes (Management & Handling) Rules, 1998). The

prevailing situation is analyzed covering various issues like quantities and proportion of

different constituents of wastes, handling, treatment and disposal methods in various

health-care units (HCUs). The waste generation rate ranges between 0.5 and 2.0 kg bed-1

day-1. It is estimated that annually about 0.33 million tones of waste are generated in

India. The solid waste from the hospitals consists of bandages, linen and other infectious

waste (30-35%), plastics (7-10%), disposable syringes (0.3-0.5%), glass (3-5%) and other

general wastes including food (40-45%). In general, the wastes are collected in a mixed
form, transported and disposed of along with municipal solid wastes. At many places,

authorities are failing to install appropriate systems for a variety of reasons, such as non-

availability of appropriate technologies, inadequate financial resources and absence of

professional training on waste management. Hazards associated with health-care waste

management and shortcomings in the existing system are identified.[12]

In a study conducted by WHO in 1996, revealed that more than 50,000 people die

every day from infectious diseases. One of the causes for the increase in infectious

diseases is improper waste management. Blood, body fluids, and body secretions which

are the constituents of bio medical waste harbor most of the viruses, bacterias, and

parasites that cause infection.. Human immuno deficiency virus HIV and hepatitis viruses

spearhead an extensive list of infections and diseases documented to have spread through

bio medical waste. Tuberculosis, pneumonia, diarraehoel diseases, tetanus, whooping

cough etc is other common diseases spread due to improper waste management.[11]

Anita Pandey et al, on 2016, a observational study was carried out over a period

of five months from January 2016 to May 2016 in Chhatrapati Shivaji Subharti Hospital,

Meerut by the Infection Control Team (ICT). Assessment of knowledge was carried out

by asking set of questions individually and practice regarding awareness of BMW

Management among the Health Care Personnel (HCP) was carried out by direct

observation in the workplace. Further, the total BMW generated from the present setup in

kilogram per bed per day was calculated by dividing the mean waste generated per day

by the number of occupied beds. Result though awareness (knowledge) about segregation

of BMW was seen in 90% of the Health Care Personnel , 30%-35% did not practice. Out

of the total waste generated (57912 kg.), 8686.8 kg. (15%) was infectious waste. Average
infectious waste generated was 0.341 Kg per bed per day. They concluded that the

practice of BMW Management was lacking in 30-35% Health Care Personnel which may

lead to mixing of the 15% infectious waste with the remaining non-infectious. Therefore,

training courses and awareness programs about BMW management will be carried out

every month targeting smaller groups.[10]

Mimi Lalmuanpuii et al. 2013, conducted a study to assess the effectiveness

of video assisted teaching program on biomedical waste management among staff

nurses. One group pre test post test design and evaluative approach were selected for this

study among 60 staff nurses working in Krishna Hospital and Medical Research Centre,

Karad. Pre test was conducted before administration of video assisted teaching program

and post test was conducted after 7 days. It was observed that after administering the

video assisted teaching program the mean of total knowledge score was increased to

26.033 from 17.383 that of pre test knowledge mean score. The paired ‘t’ value is 12.947

giving ‘p’ value <0.0001 which is considered to be extremely significant, indicates

significant improvement in knowledge of staff nurses regarding BMW management. [12]

Alok Sharma1, Varsha Sharma et al. “Awareness of Biomedical Waste Management

Among Health Care Personnel in Jaipur, India”. Aim of the study was to determine the

following among the workforce of the Jaipur Dental College, India, their awareness

regarding biomedical (BM) waste management policy and practices, their attitude

towards biomedical waste management, and their awareness regarding needle-stick injury

and its prevalence among different categories of health care providers. Methods was a

cross-sectional study, conducted using a questionnaire with closed-ended questions. It

was distributed to 144 dentists, nurses, laboratory technicians and Class IV employees

(cleaners and maintenance personnel) at Jaipur Dental College. The questionnaire was

used to assess their knowledge of biomedical medical waste disposal. The resulting

answers were graded and the percentage of correct and incorrect answers for each

question from all the participants was obtained. The results showed that there was a poor

level of knowledge and awareness of biomedical waste generation hazards, legislation

and management among health care personnel. It was surprising that 36% of the nurses

had an extremely poor knowledge of biomedical waste generation and legislation and just

15% of the Class IV employees had an excellent awareness of biomedical waste

management practice. It can be concluded from the present study that there are poor

levels of knowledge and awareness about BM waste generation hazards, legislation and

management among health care personnel in Jaipur Dental College. Regular monitoring

and training are required at all levels.[13]

Ananthchari K.R et al. a cross-sectional study was conducted in the month of July,

2016 on assessment of knowledge on biomedical waste management among health care

workers of Malabar Medical College Teaching Hospital, Calicut, Kerala, India. A pre

tested semi structured questionnaire was used, 567 health care workers were

interviewed , 44.3% (251) opined correctly that biomedical waste should not stored

more than 48 hours at hospital setting, 61.6% (349) opined waste sharps should be

disposed in white/blue puncture proof containers, 89.6% (508) knew about HIV,

Hepatitis B and Hepatitis C are common infections which transmitted due to improper

biomedical waste management, 60.5% ( 345) and 61% (346) opined that human

anatomical waste and pads, cotton, dressings should be disposed in yellow bags
respectively. 70.7 % (401) were fully immunized against Hepatitis B, 29.8% (169) had

received training on biomedical waste management. [14]

Kirti Mishra et al. was conducted a study about biomedical waste management, in

the month of May, 2016. They presents an analysis study of various techniques used for

biomedical waste management along with the knowledge and attitude of people and

health care worker. Along with this the scenario of biomedical waste management in

various hospitals in India is discussed. This waste is sometimes very hazardous and can

lead to dreadful effects. So, the waste is needed to be treated using adequate treatment

method. [15]

A pre-experimental one group pre-test and post-test study was conducted in

multispecialty hospital in Hyderabad to determine the effectiveness of structured

teaching programme on biomedical waste management. Thirty housekeeping staff was

selected using multistage random technique. The findings of the study revealed that

majority of the house keeping personnel [90%] had average knowledge score in the pre-

test. The mean percentage of knowledge scores in the post-test was high [84.39%]

compared to the mean pre-test knowledge scores [50.29%]. There was significant

difference between pre-test and post-test knowledge scores [p=0.05]. It was found that

there was no significant association between pre-test knowledge scores and selected

demographic variables. The study concluded that the majority of the housekeeping

personnel [90%] had average knowledge regarding biomedical waste management in

the pre-test whereas 93.33% of housekeeping personnel had good knowledge level in

post-test hence the study indicates that the structured teaching programme shows a
noticeable improvement in knowledge and practice of housekeeping staff regarding

biomedical waste management.[16]

Vijayamma Ajmera et al. 2015, was conducted a study to assess the knowledge

regarding biomedical waste management among B.Sc. Nursing students at Udaipur,

Rajasthan. 120 samples were selected using probability sampling. The findings revealed

that high level of knowledge among respondents was 61.67%, moderate level of

knowledge among 33.33% and low level of knowledge was 5% among respondents

regarding BMW management. The investigator provided an information booklet which

will help the B.Sc Nursing students to enhance their knowledge. The study also

revealed that there is no significant association between knowledge scores and

demographic variables. [17]

Violet. N. Pinto et al, 2014, was conducted a comparative study on knowledge and

attitude regarding biomedical waste management with a preliminary intervention in an

academic hospital at Medical College in Navi, Mumbai, among specialists, resident

doctors, new medical interns and final year nursing students. Study design stage1-

descriptive, stage2-quasiexperimental , data collection tools presented, precoded self

administered questionnaire, intervention was educational training program on BMW

management. There was a statistically significant difference in the knowledge scores

between the groups as determined by a one-way ANOVA test (F (3,226)=11.098,

P<0.001. A Tukey’s post hoe test revealed that the specialists (20.82 ± 5.121)

knowledge scores were significantly higher as compaired to resident doctors (16.96 ±

5.268) medical interns (18.44 ± 4.293) and nursing group ( 15.33 ± 5.144). after the
training program in the medical interns a statistically significant increase in their

knowledge on BMW management was seen. The knowledge and attitudes between the

groups of healthcare personnel varied and was not found to be satisfactory. Training

programs with periodical sensitization sessions on BMW management are

recommended, especially focusing at the junior level. [18]

Manish Patidar et al.2014, a pre experimental study was conducted to assessing the

knowledge of Nurses regarding Biomedical Waste Management, evaluate the

effectiveness of Structure Teaching Programme on Bio-Medical Waste Management

and find out association between pre test knowledge score and selected demographic

variables. : A one group pre-test post-test pre-experimental design and evaluative

approach was adopted. The study was conducted among 60 staff nurses conveniently

selected from two hospitals of Vadodara. The content validity of the tool and teaching

plan was established. The reliability of tool was established by testing the internal

consistency by using Test -retest method. Result of study indicate that p-value = 0.000

< 0.01 , the difference between the Pre-test and Post-test scores is highly significant at

1% level of significance this shows that the Structured Teaching Programme on Bio-

Medical Waste Management is effective. This study concluded that structure teaching

program is effective tools to improve the knowledge of staff nurses regarding bio-

medical management. [19]

Suneesh Kuruvilla, Subramaniam R et al. a cross-sectional study was conducted

regarding Knowledge, attitude, and practices about biomedical waste management

among dental healthcare personnel in dental colleges in Kothamangalam, Kerala.

Methods were cross-sectional questionnaire based survey containing 24 questions to

 assess the knowledge, attitude and practice on biomedical waste management. The

samples were the teaching faculty members and students of 3 dental colleges in

Kothamangalam, Kerala. Results were expressed as a number and percentage of

respondents for each question and Chisquare test was performed for inferential

statistical analysis. The mean knowledge, attitude and practice scores were 4.35±1.63,

4.69±1.97, 4.43±0.78 respectively with maximum scores of 9, 5 and 10. Significant

differences existed in relation to educational qualification of respondents in knowledge

and practice scores. The study revealed that although the attitude regarding biomedical

waste management among faculty members and students of the institution was high,

knowledge and practice remained low.[20]

Keeping all this in mind, education needs to be known centered for better

outcome. Continuation education program to health workers is an important aspect to

change knowledge. According to Biomedical waste management rules, WHO, On 2016,

different changes done about color coding , segregation etc. but health workers have no

knowledge about the changes written by WHO. From the above mentioned information,

personal experience from the clinical field and review of literature, the investigator

concluded that the health workers lacked knowledge regarding biomedical waste

management and felt the need to give the information regarding biomedical waste

management to health workers to enhance their knowledge through a video assisted

teaching program.
Problem Statement

“Effect of video assisted teaching on knowledge of biomedical waste management among

health workers of selected hospital in Kolkata”.

Objectives of the study

General objectives

To develop and evaluate the effect of a video assisted teaching program on knowledge
of biomedical waste management among health workers of selected hospital of Kolkata.

Specific Objectives

 To develop and validate the video assisted teaching program on knowledge of

biomedical waste management among health workers of selected hospital in
Kolkata.

 To assess the knowledge of the health workers regarding biomedical waste

management before and after the video assisted teaching program.

 To evaluate the effect of video assisted teaching among health workers on

knowledge of biomedical waste management of selected hospital in Kolkata.

 To find out the association between pre-test knowledge score on biomedical waste
management and selected demographic variables among health workers.
Variables

Independent Variable

Video assisted teaching program on biomedical waste management.

Dependent Variables

Knowledge of the health workers on biomedical waste management.

Demographic variables:

Characteristics of health workers such as designation, age, educational status, working

area, year of experienceand any special training.

Operational Definition

In this present study-

1. Knowledge: It refers to the awareness, amount of information or understanding

about bio medical waste management among health workers as measured by structured
questionnaire. Knowledge will be measured in terms of knowledge scores.

2. Effect: It refers to the extent to which the video assisted teaching delivered to
achieve the desired improvement on knowledge among health workers regarding
biomedical waste management. It will be measured by the mean difference between
the pre and post test knowledge scores.

3. Video assisted teaching: It refers to the planned and recorded activities on bio
medical waste management in hospital as an audio visual aid to provide information for
the health workers regarding biomedical waste management.

4. Health workers: A person who has successfully completed any one of the basic
nursing program and who are working in hospital and fulfill the sample selection
criteria such as nursing personnel (staff nurses and sister-in-charge, GNM and B.Sc.
Nursing).

6. Background factors: It refers to those factors which are thought to influence the
knowledge regarding bio medical waste management, such as designation, level of
general and professional education, age, working area, year of experiences and any
special training on Biomedical waste management .

7. Biomedical waste management: Systematic and scientific way of managing the

healthcare waste through a step-by-step process such as segregation, collection, storage,
transportation, and treatment. BMWM is abbreviation of biomedical waste
management.

Assumption of the study

The researcher assumes that-

o Health workers working in a selected hospital have some knowledge

about bio-medical waste management.
o Health workers have knowledge of self protection regarding bio medical
waste management in hospital.
o The health workers are willing to respond or express their knowledge
regarding bio-medical waste management.
o Responses of health workers reflects their existing knowledge about
bio-medical waste management.
o The knowledge is being influenced by the extraneous variables such as
age, qualification, experience in bio medical waste exposure
o Knowledge on bio medical waste measurable.
Hypothesis

H1: After exposure of the video assisted teaching program on biomedical

waste management, the mean post-test knowledge score is significantly higher than
the mean pre-test knowledge score of the health workers at 0.05 level of
significance.

H2: There is association between pre-test knowledge score on biomedical

waste management and selected demographic variables among health workers at 0.05

level of significance.

Delimitation

The study is delimited to

 Selected Govt. Hospital in Kolkata, West Bengal.

 Health workers who are present at the time of the study.

 Who are willing to participate.

 Health workers can read and write English.

Conceptual framework

The conceptual framework serves as a guide to research and springboard for the generation of
research hypotheses.

The present study aims at developing and evaluating the video teaching programme on biomedical
waste management among health workers with a view to educating them and to promoting their
knowledge regarding biomedical waste management, so that they should be able to perform and
maintain biomedical waste management properly as a responsible citizen.

The conceptual framework for the present study is based on the system model by Ludwig Von
Bertalanffy (1998) for development, utilization and evaluation of video teaching programme on
biomedical waste management among health workers.
 The model consists of three phases: Input, Process and Output in specific context including
evaluation of all the phases.

The conceptual framework of this study draws inspiration from the most widely used

framework for writing standards using the criteria of Input, Process and Output.

Input

Input refers to learner/ target group with their level of competence, learning needs and

interest upon entrance into the teaching programme.

In the present study, Input involves the resources used to provide knowledge and the

manner in which they are organized. The researcher focused on the background

characteristics of the health workers such as designation, age, general qualification,

professional qualification, working area, working experience and any special training on

biomedical waste management.

Process

Process refers to the deferent operational aspects of the development and

implementation of the video teaching programme. Process was the way in which the

professionals used the resources and the manner in which work was done. It aimed at

finding out whether the activities of the health workers were carried out properly.

In the present study, Process referred to different activities that facilitate the

investigator to acquire information about knowledge of health workers and proceed

accordingly. It includes;
  Subjects exposure to pre test on biomedical waste management.

 Administration of the video assisted teaching program on biomedical waste

management.

 Subject exposure to post test on biomedical waste management.

Output

Output refers to the evaluation of performance of the target group, exposed to video

teaching programme to find out the evidenced of desired changes in relation to the set

objectives. Output was the end product of a system.

In the present study, output referred to the evaluation of performance of the health

worker after exposure to the video assisted teaching program. It also referred to changes

in knowledge of health workers on subject exposure to pre test on biomedical waste

management.

Feedback

Feedback was the process through which the output was returned to the system. Here

feedback was not under study.

Summary

This chapter deals with the background of the study, need of the study, statement of

the problem, purpose of the study, objectives, hypotheses, operational definitions,

assumptions, delimitations and conceptual framework of the study.

CHAPTER II
 Chapter II

Literature review

REVIEW OF LITERATURE:

A review of literature is an essential aspect and the key step of scientific research. It helps

the investigators to establish support for the need for the study, select research design,

developing tools and data collection technique.

A Review of literature on the research topic makes the researcher familiar with existing

studies & provides information, which helps to focus on a particular problem, laid a foundation

upon which to base new knowledge. It creates accurate picture of the information found on the

subject.

Polit & Hungler 2000. [21]

The literature review has been organized under the following headings;

 Literature related to biomedical waste management.

 Literature related to consequences of inadequate biomedical waste management.

 Literature related to knowledge of health workers on biomedical waste management.

 Literature related to effectiveness of video assisted teaching program.

 Part -A

Literature related to biomedical waste management.

Sheikh Javed Ahmad et al.2017, a pre experimental study was conducted to evaluate the

effectiveness of Structured Teaching Programme (STP) On Knowledge Regarding Bio Medical

Waste Management among Staff Nurses working in selected Hospitals of Indore, MP. The

research design was pre experimental one group pre test post test design. Non probability

convenient sampling method was used for the selection of samples. The instrument for the data

collection was a structured questionnaire. Total 30 staff nurses were participated from Index

Hospital, Indore, MP. Results was the mean post-test level of Knowledge is significantly higher

than the mean pre test Knowledge scores that is 73.22% post test and 55.22% pre test with paired

t=16.26 .[22]

Ananthchari K.R et al. a cross-sectional study was conducted in the month of July, 2016 on

assessment of knowledge on biomedical waste management among health care workers of

Malabar Medical College Teaching Hospital, Calicut, Kerala, India. A pre tested semi structured

questionnaire was used, 567 health care workers were interviewed , 44.3% (251) opined

correctly that biomedical waste should not stored more than 48 hours at hospital setting, 61.6%

(349) opined waste sharps should be disposed in white/blue puncture proof containers, 89.6%

(508) knew about HIV, Hepatitis B and Hepatitis C are common infections which transmitted

due to improper biomedical waste management, 60.5% ( 345) and 61% (346) opined that human

anatomical waste and pads, cotton, dressings should be disposed in yellow bags respectively.
70.7 % (401) were fully immunized against Hepatitis B, 29.8% (169) had received training on

biomedical waste management. [23]

Kirti Mishra et al. was conducted a study about biomedical waste management, in the

month of May, 2016. They presents an analysis study of various techniques used for biomedical

waste management along with the knowledge and attitude of people and health care worker.

Along with this the scenario of biomedical waste management in various hospitals in India is

discussed. This waste is sometimes very hazardous and can lead to dreadful effects. So, the waste

is needed to be treated using adequate treatment method. [24]

Anita Pandey et al, on January 2016 to May 2 016, a observational study was carried out

over a period of five months from January 2016 to May 2016 in Chhatrapati Shivaji Subharti

Hospital, Meerut by the Infection Control Team (ICT). Assessment of knowledge was carried

out by asking set of questions individually and practice regarding awareness of BMW

Management among the Health Care Personnel (HCP) was carried out by direct observation in

the workplace. Further, the total BMW generated from the present setup in kilogram per bed per

day was calculated by dividing the mean waste generated per day by the number of occupied

beds. Result though awareness (knowledge) about segregation of BMW was seen in 90% of the

Health Care Personnel , 30%-35% did not practice. Out of the total waste generated (57912 kg.),

8686.8 kg. (15%) was infectious waste. Average infectious waste generated was 0.341 Kg per

bed per day. They concluded that the practice of BMW Management was lacking in 30-35%

Health Care Personnel which may lead to mixing of the 15% infectious waste with the remaining

non-infectious. Therefore, training courses and awareness programs about BMW management

will be carried out every month targeting smaller groups.[25]

 Mrs. Nice Joseph et al. 2016, was conducted an evaluative approach with one group pre-

test post-test design in District Hospital, Karwar, U.K, to evaluate the effectiveness of structured

teaching program on biomedical waste management. Twenty samples are selected by purposive

sampling method. Data was collected by the structured questionnaire. After the administration of

pretest and post test was conducted after six days. The findings revealed that structured teaching

program was effective, post test score was highest than pre test scores of knowledge and attitude.

Calculated ‘t’ value was 7.14 and 6.99 of knowledge and attitude respectively. The mean

knowledge pre test score was 28.65 and attitude pre test score was 43.35. The mean post test

knowledge score was 37.2 and the attitude post test score was 52.15. [26]

Vijayamma Ajmera et al. 2015, was conducted a study to assess the knowledge regarding

biomedical waste management among B.Sc. Nursing students at Udaipur, Rajasthan. 120

samples were selected using probability sampling. The findings revealed that high level of

knowledge among respondents was 61.67%, moderate level of knowledge among 33.33% and

low level of knowledge was 5% among respondents regarding BMW management. The

investigator provided an information booklet which will help the B.Sc Nursing students to

enhance their knowledge. The study also revealed that there is no significant association between

knowledge scores and demographic variables. [27]

Violet. N. Pinto et al, 2014, was conducted a comparative study on knowledge and attitude

regarding biomedical waste management with a preliminary intervention in an academic hospital

at Medical College in Navi, Mumbai, among specialists, resident doctors, new medical interns

and final year nursing students. Study design stage1-descriptive, stage2-quasiexperimental , data
collection tools presented, precoded self administered questionnaire, intervention was

educational training program on BMW management. There was a statistically significant

difference in the knowledge scores between the groups as determined by a one-way ANOVA

test (F (3,226)=11.098, P<0.001. A Tukey’s post hoe test revealed that the specialists (20.82 ±

5.121) knowledge scores were significantly higher as compaired to resident doctors (16.96 ±

5.268) medical interns (18.44 ± 4.293) and nursing group ( 15.33 ± 5.144). after the training

program in the medical interns a statistically significant increase in their knowledge on BMW

management was seen. The knowledge and attitudes between the groups of healthcare personnel

varied and was not found to be satisfactory. Training programs with periodical sensitization

sessions on BMW management are recommended, especially focusing at the junior level. [28]

Mimi Lalmuanpuii et al. 2013, conducted a study to assess the effectiveness of video

assisted teaching program on biomedical waste management among staff nurses. One group pre

test post test design and evaluative approach were selected for this study among 60 staff nurses

working in Krishna Hospital and Medical Research Centre, Karad. Pre test was conducted before

administration of video assisted teaching program and post test was conducted after 7 days. It

was observed that after administering the video assisted teaching program the mean of total

knowledge score was increased to 26.033 from 17.383 that of pre test knowledge mean score.

The paired ‘t’ value is 12.947 giving ‘p’ value <0.0001 which is considered to be extremely

significant, indicates significant improvement in knowledge of staff nurses regarding BMW

management. [12]

Alok Sharma et al, on 2013, a cross sectional study was conducted regarding awareness of

Biomedical Waste Management among Health Care Personnel in Jaipur, India, using a

questionnaire with closed-ended questions. It was distributed to 144 dentists, nurses, laboratory
technicians and Class IV employees (cleaners and maintenance personnel) at Jaipur Dental

College. The questionnaire was used to assess their knowledge of biomedical medical waste

disposal. The resulting answers were graded and the percentage of correct and incorrect answers

for each question from all the participants was obtained. Result was for the 144 questionnaires,

140 were returned and the answers graded. The results showed that there was a poor level of

knowledge and awareness of biomedical waste generation hazards, legislation and management

among health care personnel. It was surprising that 36% of the nurses had an extremely poor

knowledge of biomedical waste generation and legislation and just 15% of the Class IV

employees had an excellent awareness of biomedical waste management practice. It can be

concluded that there are poor levels of knowledge and awareness about BM waste generation

hazards, legislation and management among health care personnel in Jaipur Dental College.

Regular monitoring and training are required at all levels.[29]

Manoj Bansal.et.al. (2011) conducted a cross sectional study on biomedical waste

management awareness and practices in the districts of Madhya Pradesh. The aim was to assess

the awareness and existing practices regarding biomedical waste and its management. It was

carried out both rural and urban health care facilities of smaller district from January to June

2008. Medical, paramedical, non medical personnel working at the current position for at least 6

months were included the study participants to assess the awareness. The results showed that

awareness regarding biomedical waste management was highest among doctors followed by

paramedical staff and least among non medical staff. The study concluded that regular

orientation and reorientation training programs should be organized for hospital staff and strict

implementation of guidelines of biomedical waste management to protect themselves and

hospital visitors [30]

 Shalini Sharma, Senior member IACSIT. 2010, Awareness about Bio-Medical Waste

Management among Health Care Personnel of Some Important Medical Centers in Agra. .

Random sampling technique is adopted at all the four different strata mentioned above to have a

representative sample. After random sampling technique, total fourteen health care facilities

from all strata are taken up. Periodical visits were made to analyze awareness about bio-medical

waste management among health care personnel of all the fourteen health care facilities. a

written appraisal tool in the form of different questionnaires was prepared for various categories

of working personnel in the hospital/nursing home. The results obtained pointed towards lack of

knowledge and awareness towards legislations on bio-medical waste management even among

qualified hospital personnel. As a consequence there is inappropriate practice of BMW handling

and management, thus exposing themselves and general public to health and environment

hazards.[31]

PART-B

 Literature related to consequences of inadequate biomedical waste management.

Bhavesh R. Bariya, Grishma D. Chauhan. et al. 2017.a cross sectional study was carried

out to observe and assess the BMW management Practices among staff nurses in a teaching

hospital of Vadodara district using BMW Checklist. Observation was the predominant method

for data collection. Results were Segregation of BMW at the site of generation was found in

72.73%. Sharp and non-sharp infectious waste was correctly segregated in 72.73% and 100% of

areas respectively. Bio medical Waste was found covered in bins, but overfilled in 81.82%. In 6

out of 11, BMW was kept beyond 48 hours. IV set, bottles, syringes, latex gloves, catheters etc.
were cut by scissors before disinfection in 45.45%. Staff nurses were using gloves while

handling syringe and needles in 10 out of 11 places. They Concluded that Staff nurses were

knowledgeable about segregation of BMW, but storage and pretreatment of BMW before its

final disposal needs to be improved. An orientation programme about newer guidelines may

improve the current practice.[ 32]

Tigist Birku .et al 2015, a cross sectional study was conducted regarding Prevalence

of hepatitis B and C viruses infection in a total of 403 military personnel . Socio-demographic

characteristics and risk factors were collected through face to face interview using structured

questionnaire. HBV and HCV infection was determined using HBsAg and anti-HCV antibody

rapid tests. Logistic regression analysis was employed to assess possible risk factors for HBV

and HCV infections. Results were the sero-prevalence of HBV and HCV infection were 4.2 and

0.2 %, respectively. None of the study subjects were co-infected with HBV and HCV. Higher

prevalence of HBV infection (11.3 %) was observed in the age group of 40 and above. Being at

the age of 40 years and above (COR 7.6; 95 % CI 2.0–29.0, p = 0.003), history of nose piercing

(COA 5.9; 95 % CI 1.2–29.9, p = 0.033) and sexually transmitted infection (COR 4.3; 95 % CI

1.1–16.4, p = 0.03) were significantly associated with these viral hepatitis infections. They

concluded that intermediate prevalence of HBV and low prevalence of HCV were observed

among military personnel. Strengthening HBV screening strategies among military personal may

further reduce these viral diseases.[33]

Rajesh K Chudasama, Associate Professor, Ankit Sheth. et. al.2014. “Awareness

and Practice of Biomedical Waste Management Among Different Health Care Personnel
at Tertiary Care Centre, Rajkot, India.” Objective of this study was to know the

awareness and practice of biomedical waste management (BMW) among health care

personnel working at a tertiary care centre. The study was conducted from January 2013

to June 2013. It was a descriptive observational hospital based cross sectional study.

Study participants included the resident and intern doctors, nursing staff, laboratory

technicians, sanitary staff (ward boys, aya and sweepers) working in the P D U

Government Medical College and Civil Hospital, Rajkot who are dealing with BMW.

The study was conducted by using pretested, semi-structured pro forma. Results was total

282 health care personnel participated, including 123 resident and intern doctors, 92

nursing personnel, 13 laboratory technicians and 54 sanitary staff. Only 44.3% study

participants received training for bio medical waste management. Except for doctors

(98.4%), awareness regarding identification and use of color coded bags as per BMW act,

was very poor among health care personnel. Record keeping for injuries related to

biomedical waste was very poor for all health care personnel. Significant number of

paramedics maintained record of BMW at work place, practiced disinfection and

segregation of BMW at work place, used personal protective measures while handling

BMW. Significant number of resident and intern doctors practiced correct method for

collecting sharps and needles than paramedical staff. They concluded that Intensive

training program at regular time interval and a system of monitoring and surveillance

about practice of day to day BMW management should be evolved.[34]

 Praveen Mathur, et al. 2012, a study related to current Bio-medical waste

management in many hospitals is that the implementation of Bio-Waste regulation is

unsatisfactory as some hospitals are disposing of waste in a haphazard, improper and

indiscriminate manner. Lack of segregation practices, results in mixing of hospital wastes

with general waste making the whole waste stream hazardous. Inappropriate segregation

ultimately results in an incorrect method of waste disposal. Inadequate Bio-Medical

waste management thus will cause environmental pollution, unpleasant smell, growth and

multiplication of vectors like insects, rodents and worms and may lead to the

transmission of diseases like typhoid, cholera, hepatitis and AIDS through injuries from

syringes and needles contaminated with human.[35]

A cross-sectional study was conducted in 2011, in government health

institutions at Gondar town to find out the incidence of HBV and HCV among 100

medical waste handlers and 100 non-clinical waste handlers using structured

questionnaires and their venous bloods were collected and the serums were tested for

hepatitis B surface antigen and anti-hepatitis C antibody using rapid Immuno-

chromatography assay. The study results revealed that, HBV was detected in 6 (6.0%)

and 1 (1.0%) and HCV in 1 (1.0%) and 0 (0.0%) of medical waste handlers and non-

clinical waste handlers, respectively. It was found that Prevalence of HBV and HCV

were significantly higher in medical waste in relation to non-clinical waste handlers. The

study recommended for the proper disposal of Bio medical Wastes.[36]

PART -C

Literature related to knowledge of health workers on biomedical waste management

Vijaykumar Mane et al. a cross sectional study was conducted for a duration of 5 months

from April 2016 to August 2016 among all the health care workers (both medical and

paramedical) of a tertiary care hospital in Koppal district of Karnataka state. The objective of this

study was to assess the knowledge, attitude and practices on biomedical waste and its

management among health care workers in the study setting. A cross sectional study was

conducted among 162 health care workers .Data was collected using a pretested and semi

structured questionnaire after taking an informed consent and analysed using WHO Epi info

software. Results was this study found out that the health care workers had satisfactory level of

knowledge, favorable attitude and better practices towards biomedical waste management.

However, their practices were not in proportion to the level of their knowledge and attitude.

They concluded that regular training, continuous monitoring and behaviour change

communication are recommended to improve their biomedical waste handling practices. [40]

Sourya Kanti Das et al. December 2014 to March 2015. , an observational, cross-sectional,

hospital-based study was conducted with a duration of 3 months from December 2014 to March

2015 to assess the knowledge and practice regarding hospital waste management among

healthcare providers of a tertiary care hospital. The study was conducted in the Departments of

General Medicine, Surgery, Gynecology and Obstetrics, and Radiotherapy among 198 different

hospital staff within 3 months with the help of a predesigned and pretested interview schedule to

elicit the knowledge of BMW management. An observatory checklist is used to find out
practices regarding BMW management prevailing in the above wards and staff of the hospital.

Results was the majority (60.6%) of the study population belonged to the age group of 21–30

years. About one-third of the total study population were junior doctors and nurses. 35.8%

worked for 1 year in the hospital, and 29.8% worked within 2–5 years. All the participants had

heard about BMW management, but only 1.5% had formal training. 6.6% knew about five-color

coding used for segregation of waste with red, black, yellow, blue bags and white puncture proof

container. 31.3% knew correct disposal of sharps. All the participants knew about the use of

personal protective measures while handling BMW and used in most of the time. 70.2% of

respondents knew the use of gloves and mask together. In 33.3% of observation, it was seen that

syringes were reused for the same patient. Four colored bins were used most of the time in the

above-studied wards. Their study was revealed certain paucity of knowledge among the

healthcare providers in the field of BMW management which adversely affected their practice.

They recommended that there should be regular comprehensive training programs regarding

BMW management for all level of workers and strict implementation of them.[38]

Mohammad Nasir Uddin et al. 2014, a descriptive type of cross sectional study design

was used to assess the level of knowledge regarding hospital waste management among senior

staff nurses working in Faridpur Medical College Hospital, Bangladesh. All respondents were

selected by random sampling. Results was in the answer of knowledge about general waste only

4% gave all correct answers. In the answer of knowledge about infectious waste 63.2% gave one
correct answer, of knowledge about pharmaceutical waste only 8% gave all correct answers, and

of knowledge about biomedical waste only 7.2% gave all correct answers. In the answer of

knowledge about color coded bins collecting waste 53.6% cannot give any correct answer and

only 46.4% gave all correct answers and of knowledge about the safe disposal of hospital waste

16% could not give any correct answer. However, against all questions were 5 options. They

concluded that Knowledge about hospital waste and its management is very poor among senior

staff nurses. As a recommendation to improve this situation continuous training should be made

compulsory for healthcare personnel specially staff nurses working in Bangladesh.[37]

Daljit Kapoor et al. 2014, was conducted a systematic review of relevant cross sectional

studies study on knowledge and awareness regarding BMW management among staffs and

students of dental teaching institutions in India. Objectives of the study was proper handling,

treatment and disposal of biomedical wastes are important elements in any health care setting.

Six studies were finally included in the review. Color coded of wastes was not done by 67% of

the subjects in one of the studies conducted in Haryana. Almost all the subjects agreed to the fact

that exposure to hazardous health care waste can result in disease or infection in another study.

According to another study reports, none of the respondents was able to list the legislative act

regarding BMW when asked. The results of the present review showed that knowledge and

awareness level of subjects was inadequate and there is considerable variation in practice and

management regarding BMW. There is a great need for continuing education and training

programmes to be conducted in dental teaching institutions in India. [39]

 Manish Patidar et al.2014, a pre experimental study was conducted to assessing the

knowledge of Nurses regarding Biomedical Waste Management, evaluate the effectiveness of

Structure Teaching Programme on Bio-Medical Waste Management and find out association

between pre test knowledge score and selected demographic variables. : A one group pre-test

post-test pre-experimental design and evaluative approach was adopted. The study was

conducted among 60 staff nurses conveniently selected from two hospitals of Vadodara. The

content validity of the tool and teaching plan was established. The reliability of tool was

established by testing the internal consistency by using Test -retest method. Result of study

indicate that p-value = 0.000 < 0.01 , the difference between the Pre-test and Post-test scores is

highly significant at 1% level of significance this shows that the Structured Teaching Programme

on Bio-Medical Waste Management is effective. This study concluded that structure teaching

program is effective tools to improve the knowledge of staff nurses regarding bio-medical

management.[19]

PART- D

Literature related to effectiveness of video assisted teaching program.

Shiji Samuelet al. 2017 “Effectiveness of video assisted teaching programme on

knowledge regarding Primordial Prevention of Cardiac Diseases among High School

teachers in selected schools, Bangalore.” Pre-experimental one group pre-test post-test

design was adopted for this study. 40 high school teachers of Jyothi School, Bangalore

were selected for the study using non-probability convenient sampling technique. The

pre-test was administered using a structured questionnaire to assess the knowledge after

which the video was presented. Post-test was done after 14 days using the same
instrument. The data obtained were analyzed using descriptive and inferential statistics.

The findings of the study showed that the mean pre-test knowledge score 15.23+3.04 was

less than the post-test knowledge score 22.55+ 2.72. The ‘t’ test value computed between

the pre-test and post-test score was statistically significant at 0.05 level (t=28.820,

df=39). The findings also denoted a significant correlation between the post-test

knowledge and the demographic variables, age, monthly income, educational status and

teaching experience in years of high school teachers. The teaching has made a

commendable effect in improving the knowledge of high school teachers. A video

presentation on different aspects of the primordial preventive measures of cardiac

diseases is a useful strategy to improve their knowledge contributing to the prevention of

cardiac diseases at the earlier stage.[41]

Thiruvengadam Nanthini Karaline Karunagari. 2016, was conducted

“Effectiveness of video-assisted teaching program on safety measures followed by the

employees working in the silica-based industry in Puducherry, India” A total of 105

employees were selected from M/s ACE Glass Containers Ltd. at Puducherry, India using

the convenience sampling technique. Pretest was conducted using a self-administered

questionnaire. Subsequent video-assisted teaching was conducted by the investigator after

which posttest was conducted.Video-assisted teaching program was found to be effective

in improving the knowledge, attitude, and practice of the subjects. Periodical

reorientation on safety measures are needed for all the employees as it is essential for

promoting the well-being of employees working in any industry.[42]

 Anugrah Charan, Clinical Instructor KGMU Institute of Nursing, KGMU,

Lucknow,2016. “Study to effectiveness of Video Assisted Teaching on Knowledge and

Attitude of Adolescent Regarding Harmful Effects of Nicotine Addiction” This study

was under taken with objectives to develop a VAT for the adolescent regarding harmful

effects of nicotine addiction, to assess and evaluate the knowledge and attitude of

adolescence regarding harmful effects of nicotine addiction before and after the

administration of VAT and to find the relationship between post test knowledge and

attitude of adolescence regarding harmful effects of nicotine addiction before and after

the administration of VAT. The conceptual framework adopted for the study was based

on System Model (input process output) by open system model by Ludwig Von

Bertalanffys in the year (1980). The data was collected, analyzed and interpreted in terms

of the objectives. Descriptive and inferential statistics were utilized for the analysis of the

data. The mean knowledge scores was19.4 with a median of 19.5 and a standard

deviation of 3.32 against the maximum score of 32. The mean attitude score was 49.28

with a median of 50 and a standard deviation of 4.64 against the maximum score of 60.

The range obtained between 40-60 (96%) indicates a positive attitude among

students.[43]

Sheetal Udaykar, 2015,“ Effectiveness of Video Assisted Teaching Programme

on Prevention of Swine Flu among Students” Evaluative Research approach, Quasi

Experimental (one group pre-test and post-test) research design was adopted. The sample

consists of 40 students. Descriptive and inferential statistics like mean, median, standard

deviation, paired‘t’ test, correlation, coefficient and chi-sqsuare was used for data

analysis. Result was average knowledge (13-22) and their frequency was 31 where as 9
samples belong to good knowledge category (23-34) The post test mean score of level of

video assisted teaching program 26.13(SD±4.142) was higher than the pre test mean

score 13 (SD±3.258) the paired ‘t’ value 14.591, So the video assisted teaching was

highly effective in increasing knowledge of students regarding prevention of swine flu.

[44]

Arpita G.et al. 2015, was conducted “A study to evaluate the Effectiveness of Video

Assisted Teaching Programme on knowledge regarding screening of mental illness

among staff nurses working in selected hospitals of Vadodara.” The investigator used

true experimental research (pre-test post-test one group design). Simple randomized

sampling technique used to select the 30 staff nurses in selected hospitals of Vadodara.

Self structured questionnaire were used to assess the knowledge regarding screening of

mental illness . The conceptual framework for this study was based on modified Imogen

king’s Goal Attainment Theory. The data was analysed by using descriptive and

inferential statistics. Findings revels that in pre-test staff nurses having on average

19.75% knowledge regarding screening of mental illness 14.47±2.99 and in post-test,

average 55.32 % knowledge regarding screening of mental illness and mean score was

22.13±3.44.T calculated value is -8.483 which are more than the tabulated value of 2.75at

0.05 level of significance. So we accept H1 and conclude that there is significant

difference between pre-test and post- test knowledge score of staff nurses. It shows the

very highly significant and association between pre-test and post-test knowledge score

regarding knowledge on screening of mental illness. Hence research hypothesis H1is

accepted. They Concluded that the Video assisted teaching programme was very
effective tool to promote knowledge and practice regarding screening of mental

illness.[45]

Ariya .S. Kurup et al. 2015 was conducted a Study to Assess the Effectiveness of

Video Assisted Teaching Programme on Knowledge Regarding the Benefits of Outdoor

Play Among School Going Children in Selected School of Bhilai, Chhattisgarh. The

conceptual model for the study was developed by the investigator based on Bertalnaffy’s

general system–theory. The research design for this study is one group pretest-post test

design. The investigator has used a simple random sampling- lottery method. Sample size

60 School going children (10-11 years) who are studying in Khalsa public school Dung’s,

Chhattisgarh. Tools are divided in two sections SECTION-AI socio-demographic

variables, ii-demographic profile of study parameters ,SECTION-B- questionaries

regarding benefits of outdoor play. The pilot study was conducted in D.A.V Public

School, Hudco, Bhilai, Chhattisgarh, reliability of tool was found, r = 0.78. The major

findings that in pre test knowledge score revealed poor knowledge 41.67%, average

58.33%, mean is 11.23, SD 5.4, CV 48.09 while the post test knowledge score has been

increased to good 40% and 60% were excellent, mean 30.87, SD 1.56, CV 5.05.The t-

test revealed 26.50 was found highly effective i.e. video assisted teaching programme

was found highly effective in increasing the knowledge of the children regarding benefits

of outdoor play.[46]

Nagesh D. Gundap , V.R. Mohite et. al. 2012 “A Study to Assess Effectiveness of Video

Assisted Teaching on Needle Stick Injury Regarding Knowledge and Attitude among Staff
Nurses Working in Krishna Hospital, Karad” objectives of the study was to assess knowledge

and attitude among staff nurses regarding NSI ,to find out the effectiveness of VAT on

knowledge and attitude regarding NSI among staff nurses and to determine association between

socio demographic variables with knowledge and attitude among staff nurses regarding NSI.

Research Design: Quasi- experimental- Pre and Post test Design. Sample Population wasStaff

nurses, Sampling Technique was Convenience sampling and Sample size was 60. Results was

The Pre-test mean knowledge and attitude score was 9.5 and 33.66 respectively which was

increased in Post-test to 15.16 and 34.64 respectively. where “t”- test value knowledge (t=2.235

<0.0001 )attitude (t= 0.3866 at p>0.001) which is considered to be extremely significant of

knowledge and there was no significant in attitude change So improvement in knowledge

regarding NSI after administering VAT.[47]

Pushpamala Ramaiah. et al. a study was conducted to assess the level of pre-test and

post-test knowledge among nursing students of third year BSc (N), regarding obstetrical

emergencies and to find out the association between the levels of knowledge of was

nursing students with their selected demographic variables. The research approach

adopted for this study is evaluative research approach. The research design adopted for

this study is pre-experimental design with one group pre-test and post-test design. Simple

random sampling was used to select the sample of sixty for this study, where structured

knowledge questionnaire was used to collect data. Questionnaire is prepared on basic

concepts about obstetric emergencies, hemorrhage and shock, cord prolapse and uterine

rupture. The overall pre-test knowledge score regarding management of selected

obstetrical emergencies among III year BSc nursing students was 36.38 with a SD of
5.52. The overall post test score regarding management of selected obstetrical

emergencies among III year BSc nursing students was 87.16 with a SD of 3.81 which

depict the effectiveness of video teaching. There is a significant association between

pretest knowledge score on management of selected obstetrical emergencies among III

year BSc nursing students with selected demographic variable such as gender, place of

residence, birth order & source of information. It also exist non-significant association

between pre-test knowledge score on management of selected obstetrical emergencies

among III year BSc nursing students with selected demographic variable such as age in

years, religion & general education.[49]

Mrs. Shalini Jose. 2016. A pre experimental study was conducted to determines the

effectiveness of video assisted teaching programme on knowledge among B,Sc Nursing

students regarding breast self examination” The study aimed to assess the knowledge

on breast self examination among students before and after video assisted teaching

programme; evaluate the effectiveness of video assisted teaching programme on breast

selfexamination among students; and find out the association of knowledge regarding

breast self examination among B.Sc Nursing students and selected demographic

variables. A pre experimental study was carried out with 40 students from Bombay

Hospital Collegeof Nursing Indore. Self administered tool i.e. multiple-choicestatements

were used to evaluate the knowledge level on breast selfexamination before & after video

assisted teaching programme. Datawas analyzed by chi-square and t test. The result showed that

therewas a significant difference between pre-test and post-test knowledgescores as

assessed by the paired t-test value at 10.58 (HS), t(39) =2.04 , p≤0.05). There was
significant association between knowledge and the selected demographic variables (age,

educational status, education of mother, family history of cancer, previous knowledge

about BSE andits sources) at 0.05 level of significance. Thus by this study one can

conclude that video assisted teaching programme helps to improve the knowledge of

students on breast self examination.[50]

CHAPTER III
 Chapter III
Research Methodology

Methodology refers to general pattern for organizing the procedure of the study.

Methodology of research organizes all the components of the study in a way that is most

likely to lead to valid answers to the sub problems that have been proposed.

This chapter includes research approach, research design, variables under study, settings,

population, sample and sampling technique, development of tool, description of tools,

establishing content of validity of tools, pretesting of tools, reliability of tool, pilot study

data collection procedure and plan of data analysis.

Research Approach

According to Burns and Nancy, research approach indicates the procedure for

conducting the study in order to accomplish the objectives of the study.the research

approach directed the researcher as to where the data was to be collected, when the data

was to be collected and how to analyze them. It also suggested the possible conclusion

and helped the researcher in answering specific research questions in the most accurate

and efficient ways possible.

A Pre-experimental research approach was adopted for this study, where the

knowledge of health workers on biomedical waste management was measured by a set of

structured knowledge questionnaire.

Research Design

The selection of research design is an important and essential step in research as it is

concerned with the overall framework of conducting the study by giving a plan, structure
and strategy of investigation. Research design is an investigator’s overall plan for
obtaining answer to the research questions.

In the present study one group pre-test post-test design was selected. This design is
appropriate in this study as it assess the knowledge among health worker on biomedical
waste management.

Symbolic representation of the research design for this study is;

P1 X P2

P1- Pre-test knowledge of the health workers before the Video assisted teaching program.

X- Video assisted teaching program on Biomedical waste management.

P2- Post-test knowledge of the health workers after the Video assisted teaching program.
Setting

The study was conducted at R.G. Kar. Medical College and Hospital, Kolkata 700004.

The rationale for selecting the setting was;

 It was convenient to the investigator.

 Co-operation of the health workers.

 Easy access and familiarity with the setting.

 Availability of adequate sample.

 Administrative approval.

Population

Population for the present study comprised of all the health workers working at the R.G.

Kar. Medical College and Hospital, Kolkata 700004.

Sample and sampling technique

Sample

In this present study, sample was 60 health workers who worked at the R.G. Kar.

Medical College and Hospital, Kolkata 700004.

Inclusion criteria

 Those who were willing to participate in the study.

 Those who could read and write in Bengali.

  Those who were present in the morning duty (2 pm-3pm) during the data

collection period.

Sampling technique

In this study, Non- probability, purposive technique was adopted.

Data Collection Tool and Technique

The most important and crucial aspect of the study is the collection of appropriate and

relevant information which help to provide the answer of the research problem. Data

collection is a very important , as well as, crucial aspect of the investigation. Tools

are developed based on the objectives of the study, to collect relevant necessary

information in order to attain the answer of the research question.

Table 1 : Data collection Tools & Techniques

Tool
No. Data collection tool Variables to be Data collection
Measured Technique

1 Structured Knowledge Questionnaire.

Demographic
Part A-Demographic Data Characteristics Paper and Pen
of the sample.
Part B-Structured
Knowledge Knowledge on
Questionnaire biomedical Paper and Pen
waste
management
Development and Description of Tool

The investigator prepared a structured knowledge questionnaire to assess

the knowledge of the health worker regarding biomedical waste management. The

selection of content for the structured knowledge questionnaire was based on

extensive review of literature and discussion with the experts. The major steps

taken for development of structured knowledge questionnaire were:

Step-1: Planning for tool

Step-2: Developed a blue print based on domain and 1st draft for structured

questionnaire for assessment of knowledge.

Step-3: video and questionnaire validity was established by expert’s

opinion and modification made as per suggestion.

Step-4: 2nd draft was developed.

Step-5: Try out of tool

Step-6: Establishment of reliability

Step-7: Final tool of structured questionnaire.

According to the objectives & conceptual framework of the study, following tools were
developed to gather data. The tools were classified into Tool-1 (Part-A, Part-B)

Tool – 1: Structured questionnaire of demographic profile

Part A: Structured questionnaire of demographic profile of health workers.

Part B: Structured Knowledge questionnaire.

Planning for tool

In planning the structured knowledge questionnaire, the objectives and specific

content areas were outlined. Expert’s opinion were taken and consultation with the

Guide and Co-Guide were done. Development of demographic profile, Structured

knowledge questionnaire was prepared for the health workers on biomedical waste

management and video teaching program prepared for teaching to the health workers

about biomedical waste management.

Developed a blue print based on domain and 1st draft for structured questionnaire

for assessment of knowledge.

A blue print which specific the content areas, domain of the objectives, the total no of

items and maximum possible score for each category of response was prepared. Based on

the blueprint , a structured knowledge questionnaire on knowledge was developed to

measure the health workers knowledge on biomedical waste management. The structured

knowledge questionnaire on knowledge had two parts, part A consisting of all correct

answer type questions and part B consisting of multiple choice questions.

Establishment of content validity

The prepared structured knowledge questionnaire along with the video teaching program

as per objectives and criteria checklist were given to 7 experts from the field of obstetrics

& Gynecology, Medical &Surgical, Community, Biomedical waste department experts

and Nursing experts for establishing the content validity of the tool. The experts were

asked to consider regarding addition, omission, suggestions to improve clarity of items.

Item wise validation was done. 28 questions had 100% agreement, 2 questions had

85.71% agreement. Necessary modifications were made as per expert’s suggestions.

Development of second draft

The second draft of structured knowledge questionnaire schedule on knowledge was

prepared after necessary corrections, deletions, additions and changes in question,

wording and sequences to eliminate the imperfections discovered. The Bengali version of

the tool was prepared with the help of a language expert. Language validity was

established by retranslating it into English with the help of another language expert.

Try out of the tool

Try out of the tool was done to check the clarity of the items, feasibility and any
ambiguity of language. The structured knowledge questionnaire was tested on 10 health
workers. It was found out that the structured knowledge questionnaire took a average of
20 min to respond and it was easily understood by them.

Reliability of the tool

Reliability computed using split half technique for establishing the internal consistency of
the questionnaire. The reliability of the tool is .89% which indicate reliability of the tool.

Development of final draft of structured knowledge questionnaire schedule on

knowledge.

Part –A

It comprises of information regarding subject’s demographic data which included

designation, age, general qualification, professional qualification, working area, working
experiences and any special training. On Biomedical waste management.
Part –B

This part included the structured knowledge questionnaire. It comprised of 30 multiple

choice questions.

The items were on concept of Biomedical waste management, sources,

classification, segregation, collection, benefits, harmful effect, transportation, treatments,

special points about biomedical waste management.

Each item had only one correct response and each correct response scored one. The

maximum score was 30.

Details of the development of treatment

Development and description of the Video-based teaching program

The major steps taken for development of structured knowledge questionnaire were:

Step I Preparation of content

Step II Preparation of lesson plan and script of Video- assisted teaching program.

Step III Development of criteria checklist

Step IV First shooting of video .

Step V First editing of the video

Step VI Content validity of video- assisted teaching program.

Step VII Final editing of the video.

Step VIII Try –out of the video.

Preparation of content

Based on the blue print of the tool the outline of the content was prepared in such a way

that it a could complete the video in 20-25 minutes. The content was then checked by the

guide and co-guide and necessary modifications, additions and deletions were made

accordingly. The content covered was,

--Concept of Biomedical waste

-- Sources, categories, segregation ,collection, classification, benefits, harmful effects of

biomedical waste management.

--Transportation, treatment

--Special points about biomedical waste management.

Preparation of lesson plan and script of video-assisted teaching program

The lesson plan was prepared based on the prepared content in six areas. The general and

specific objectives were outlined. The lesson plan was planned to complete within 20-25

minutes. The script were prepared for the role play which was to be included in the video.

Development of criteria checklist

The criteria for validation of the video assisted teaching program were prepared in the

areas of information in the content, organization of video clips, language used in video,
feasibility, and overall organization . the opinion of five experts was sought for the

validation of the criteria checklist. The criteria checklist is presented in Appendix D3.

First shooting of video

First shooting of video was done at the investigator’s house and Sree Balaram Seva

Mandir SG Hospital, North 24 Parganas. After obtaining formal permission from the

concerned authority. The device used for shooting was a compact digital camera . a

digital voice recording device was used for dubbling.

First editing of video

The final editing of the video was done in collaboration with the opinion of seven

experts. After content validation, the investigator proceed with the final editing of the

video. Necessary modification were incorporated as suggested by the validators. Final

editing was also done by using the professional video editing software namely Royal

Studio.

Description of the video assisted teaching program on biomedical waste

management.

The video-assisted teaching program on biomedical waste management was prepared

with utmost care, maintaining the continuity of the lesson for easy, scientific and

meaningful grasping of the topic by the health workers. Most of the areas were projected

with the help of video clips, role play, background narration and slide show in the areas

of the Concept of Biomedical waste, Sources, categories, segregation ,collection,

classification, benefits, harmful effects of biomedical waste management.,

Transportation, treatment, Special points about biomedical waste management.

Pilot study
After obtaining the necessary permission from the concerned authority, the pilot study

was conducted from 11/9/2017-19/09/2017 at NRS Medical College And Hospital,

Kolkata 700014.

The purpose and usefulness of the study was explained to the sample and informed

consent prior to the study was taken from them.

The pilot study was designed to find out the feasibility of conducting the study and to

decide on the plan of statistical analysis.

Data was collected from 10 subjects through non probability purposive sampling from

NRS Medical College And Hospital, Kolkata 700014.

Day-1

Pre test was conducted by the administration of structured knowledge questionnaire to

assess the knowledge of the health workers on biomedical waste management and to

collect their background data . After this, the video assisted teaching program on

biomedical waste management was administered on the same day.

Day-8
Post test was conducted with the help of the same questionnaire.

Result of the pilot study

 The study was found to be feasible.

 Time taken per participants was 20-25 minutes.

 The investigator administered the tool and treatment effectively.

 No problem was faced by the investigator during data collection period.

Data collection procedure for final study

The investigator conducted the final study from 16/10/2017-11/11/2017.

 Prior to study, formal peremission was sought for and obtained from Principal,

College of Nursing, R.G.Kar Medical College and Hospital, Principal, R.G.Kar

Medical College and Hospital, MSVP of R.G.Kar Medical College and Hospital,

Kolkata 700004.

 Self-introduction and establishment of rapport with the participants was done and

purposes of the study were explained to each participant separately to gain free

and frank responses.

 The participants were adssured about the confidentiality of their responses.

 Consent was taken from the participant for willingness to take part in the study.

During data collection period, following steps were done by the investigator.
Day-1

Pre test was conducted by the administration of structured knowledge questionnaire

to assess the knowledge of the health workers on biomedical waste management and to

collect their background data. After this, the video assisted teaching program on

biomedical waste management was administered on the same day.

Description of the administration of video assisted teaching program on biomedical

waste management.

Arrangement for administration of the video assisted teaching program on biomedical

waste management was made in classroom of School of Nursing, R.G.Kar Medical

College and Hospital, Kolkata 700004. The sitting facilities for the participants were

arranged in two separate classroom s for convenience. Two LCD Projectors were hired

from the School of Nursing, R.G.Kar Medical College and Hospital, Kolkata for

presentation of the video assisted teaching program on biomedical waste management.

Two sound systems were installed to facilitate audibility. The course of the video assisted

teaching program lasted for 25 minutes. An interactive doubt clearing session was carried

out after that for 5 minutes.

Day -8

Post test was conducted with the help of the same structured knowledge questionnaire.

Plan for data analysis

The data analysis was planned with the help of descriptive and inferential
statistics based on the objectives and hypothesis of the study.
 Frequency and percentage distribution to describe the demographic
variables of the participants.
 Mean, Median and Standard deviation of pretest and post test knowledge
score.
 Ogive to compare the pre test and post test knowledge score.
 ‘t’ value to determine the significance difference between the pre test and
post test knowledge score.
 Chi-squire value to determine the association of pre test as well as post
test knowledge score and selected variables such as designation, age,
general qualification, professional qualification, working area, working
experiences and any special training on Biomedical waste management.
CHAPTER IV
 Chapter IV

Data Analysis and Interpretation

This chapter deals with analysis and interpretation of data obtained to determine the

effectiveness of a Video- assisted teaching program on biomedical waste management

among the health workers working in a selected hospital of Kolkata.

The data was obtained through structured knowledge questionnaire on biomedical

waste management from 60 health workers working in R. G. Kar Medical College and

Hospital, Kolkata from 16th October 2017 to 23rd October 2017.

The purpose of the analysis was to make the collected data interpretable in form so

that the objectives were justified. Statistical procedure enabled the researcher to reduce,

summarize, organize, evaluate, interpret and communicate numerical information.

Data collected through tool from the participants before and after intervention was

analysed and interpreted with the help of both descriptive and inferential statistics.

Data was analysed in the perspective of achieving objectives, testing hypotheses and

facilitating interpretations of the answer in relation to the research problem.

Objectives of the study:

1. To develop and validate the video assisted teaching program on knowledge of

biomedical waste management among health workers of selected hospital in
Kolkata.

2. To assess the knowledge of the health workers regarding biomedical waste

management before and after the video assisted teaching program.

3. To evaluate the effect of video assisted teaching among health workers on

knowledge of biomedical waste management of selected hospital in Kolkata.

4. To find out the association between pre-test knowledge score on biomedical waste
management and selected demographic variables among health workers.
 Table 2: Organization and presentation of data

Objectives Section Description Statistical analysis

To develop and I Findings related to Percentage of
validate video the percentage of agreement among
assisted teaching on agreement among experts on validation
knowledge of health experts on of criteria checklist of
biomedical waste validation of criteria the video assisted
teaching program and
management for checklist of video lesson plan on
health workers. assisted teaching biomedical waste
program on management.
biomedical waste
management
Findings related to Frequency and
To identify demographic percentage
demographic variables II characteristics of the distribution. Pie
of the health workers. health workers. diagram.

To assess the III Findings related to Mean percentage.

knowledge of the pretest and posttest
health workers knowledge score of
regarding biomedical the health worker on
waste management biomedical waste
before and after the management.
video-assisted
teaching program.

To determine the IV Comparison of pretest Mean, Median and

effectiveness of video and post test Standard deviation,
teaching program in knowledge score paired‘t’ test,
terms of gain in before and after frequency polygon
knowledge score application of video- and Ogive.
among health workers. assisted teaching
program.
To find out V Findings related to Chi-square test.
association between association between
the pretest knowledge pretest knowledge
score on biomedical score and selected
waste management demographic
and selected variables.
demographic variables
among health workers.
 SECTION I

Findings related to the percentage of agreement among experts on validation of

criteria checklist of video assisted teaching program on biomedical waste

management.

Table 3-Percentage of agreement among experts on content validation of criteria

checklist of video teaching program regarding knowledge on biomedical waste

management among health workers.

Sl.No Criteria Percentage Remarks Action Taken

1 Objectives 100% Nil No Change

2 Content 100% Nil No Change

Need
3 Organization 88.89% modification Modified

Need
4 Language 88.89% Modification Modified

5 Audio Visual Aids 100% Nil No Change

This data in agreement in content area is presented in the table3 details of agreement as

per criteria checklist as given in appendix as presented in appropriate percentage of

agreement on content area. There was 100% agreement in objectives and AV aids,

content and organization. Agreement in language was modified as per suggestion by

guide, co guide, and experts.

Findings related to development and validation of criteria checklist of video assisted

teaching program and lesson plan on biomedical waste management.

Table 4: Percentage and agreement among experts on validation of criteria checklist of

video assisted teaching program and lesson plan on biomedical waste management.

Criteria No of agreement No of Expert CVI

Objectives 9 9 1

Content 9 9 1

Organization 8 9 0.88

Language 8 9 0.88

Audio visual aids 9 9 1

Table 4 shows percentage and agreement among experts on validation of criteria

checklist of video assisted teaching program and lesson plan on biomedical waste

management, Content validity index was calculated and the value of it was 0.97. So it

was found valid.

 SECTION II

Findings related to demographic variables of health workers. This section describes

the sample characteristics of 60 health workers.

Table 5: Frequency percentage distribution of health workers according to their samples

characteristics. n=60

Sample characteristics Frequency Percentage

1. Age (yrs)
18-33 14 23.33

>33 46 76.67

2. Designation

Staff nurse 32 53.33

Sister in charge 28 46.67

Table 5 shows among health workers only 14 (23.33%) were within 18-33 years of age

and 46 (76.66%) were within >33 years of age and 32 (53.33%) were staff nurse and

28(46.67% ) were Sister in charge.

Findings related to demographic variables of health worker. This section describes

the sample characteristics of 60 health workers.

Table 6: Frequency percentage distribution of health personnel according to their samples

characteristics. n=60

Sl. No Sample characteristics Frequency Percentage

3. General Qualification

Higher Secondary 30 50

> Higher Secondary 30 50

4.Professional Qualification

GNM 34 56.67

B.SC.Nursing 26 43.33

5. Any Special training

Yes 14 23.33

No 46 76.67%

Table 6 shows that 30 (50%) were having Higher Secondary education and

also above Higher Secondary education, 34(56.67%)were having GNM and

majority of them 46 (76.66%) having no special training on biomedical waste

management.
 n= 60

29 31
0-10
>10

Working experience in yrs

Figure 1: Pie diagram showing percentage of working experience among health

workers.

Figure 1 shows that most of health workers about 29(47.67%) having >10 years
working experience and 31 (51.67%)having 0-10 years working experience.
 n= 60

28 General Ward
32 Special Ward

Working Area
Figure:2 Pie diagram showing percentage of working area among health workers.

The data presented data represented that 32(53.33%) working in special ward and

28(46.67%) working in general ward .

 SECTION III

Findings related to assessment of pre test and post test knowledge score of the health

workers on biomedical waste management.

Table 6: Mean percentage of pre test and post test knowledge score and gain scores of

health workers in different areas of biomedical waste management.

n=60

Area of knowledge Maximum Mean Mean% Gain%

Pre Post Pre Post
Possible test test test test Actual Possible Modified
Score Gain Gain Gain
1.Concepts of BMW. 6 2.86 5.18 46.66 86.33 39.67 53.34 0.74

2.Classification,categ- 11 5.86 9.56 53.27 86.9 33.63 46.73 0.71

ories, Segregation,
collection, benefits
of BMWM.

3.Transportation and 4 2.01 3.71 50.25 92.75 42.5 49.75 0.85

treatment of BMW.

4.Special points about 9 5.45 7.85 60.55 87.22 26.67 39.45 0.67
BMWM

Table 6 shows that maximum knowledge gain happened in the area of transportation

and treatment of BMW, and minimum knowledge gain happened in the area of special

points about BMWM

 n=60

96.66
100
90 76.66
80
70
Percentage

60
50 Pretest
40
30 Posttest
20
1.66 3.33
10
0
Good Very good
Knowledge score

Figure 3: Comparison between the pre test knowledge score% and post test

knowledge score% of health workers on biomedical waste management.

Figure 3 shows that the post test knowledge score of health workers of effective of

video assisted teaching programme on knowledge of bio medical waste management

were more than pre test knowledge score.

 SECTION IV

Findings related to effectiveness of video assisted teaching program on

biomedical waste management in terms of difference in knowledge score

among health workers.

In order to find out the significant difference between two correlated means of

pre test knowledge score,‘t’ values were computed and the following hypothesis

were stated.

H1- After exposure of the video-assisted teaching program on

biomedical waste management the mean post test knowledge score

of the health workers is significantly different than the mean pre

test knowledge score at 0.05 level of significance.

H01- After exposure of the video-assisted teaching program on

biomedical waste management there is no significant difference

between the mean post test knowledge score of the health workers

and mean pre test knowledge score at 0.05 level of significance.

 n=60

30

25
─ Mean
Pecentage

20 ─ Median

15

10 Pre test
Post test
5

Knowledge score

Figure 6 : Frequency polygon shows comparison between the pre-test knowledge score
and post-test knowledge score.

The frequency polygon in figure 6 shows that the distribution of pre-test knowledge
score and post-test knowledge score with the depiction of mean and median. The pre-test
knowledge score ranged from 16-17 with mean of 16.35 and median of 17. Maximum
frequency lay in the class interval of 16-18. The post-test knowledge score ranged from
26-27 with mean of 26.21 and median of 27. Maximum frequency lay in the class
interval of 26-28. The figure 6 depicts that the pre-test distribution was more skewed
(Skewness =0.68) than the post-test distribution (skewness=0.88). it seems that the post
test is more normal than the pre test. It is evident from the graph that the post test
knowledge scores of the most health workers fall beyond the pre test knowledge scores,
which indicate that there is considerable gain in knowledge suggesting the effectiveness
of the video based teaching program.For further elucidation pre test and post test were
plotted in ogive
 n=60

120

100

percentage
80

60

40 Pretest
20 Post test

Knowledge score

Figure7: Cumulative frequency percentage curve (Ogive) of pre test and post test

Knowledge scores of health workers.

Cumulative frequency percentage curve of pre test and post test knowledge scores

plotted in figure 7 in same co-ordinate axis. They shows that the post test ogive laid on

the right side of the pre test ogive over the entire range. It indicates that the post test

scores were consistently higher than the pre test scores. The distance separating the two

curves at various levels showing the gain in knowledge after exposure of the video

assisted teaching program.

 Table 7: Mean, Median, Mean Difference, Standard Deviation and ‘t’ value

of Pre test and Post test knowledge score of health workers regarding

biomedical waste management.

n=60

Sl.No. Knowledge Score Mean Median Mean Difference SD t' value

1 Pre –test 16.35 17 9.86* 2.83 22.68*

2 Post-test 26.21 27 2.68

t (59)=2 * p<0.05

Table 7, indicates that the mean post test knowledge score of 60 health workers

(26.21) was significantly higher than the mean pre test knowledge score (16.35)

after exposure of the video assisted teaching program on biomedical waste

management with a mean difference of 9.86 as evident from the structured

knowledge questionnaire. The obtained difference between post test and pre test

knowledge score of health workers was found to be statistically significant as

evident from ‘t’ value of 22.68 for df 59 at 0.05 level of significance. Therefore,

the obtained mean difference between pre test and post test knowledge score was

a true difference, not by chance. Hence the research hypothesis was accepted and

null hypothesis was rejected.

 SECTION V

Findings related to association between pre-test knowledge score and selected

demographic variables.

In order to find out the association between pre-test knowledge score and selected

demographic variables, the following hypothesis were formulated.

H2- There is significant association between pre-test knowledge scores on

biomedical waste management with selected variables (designation, age, general

education, professional education, working area, working experience and any

special training) among health workers at 0.05 level of significance.

H02- There is no significant association between pre-test knowledge scores on

biomedical waste management with selected variables (designation, age, general

education, professional education, working area, working experience and any

special training) among health workers at 0.05 level of significance.

Table 8: Chi square values computed between pre-test knowledge score and selected

variables

Chi
Variables Pre test knowledge square df Inference
<Median >Median Value

Age in years
18-33 7 7 0.18 1 Not Significant
>33 26 20

Designation
Staff Nurse 16 17 0.96 1 Not Significant
Sister in charge 12 15

General Qualification
HS 14 16 0.66 1 Not Significant
>HS 15 15

Professional Qualification
GNM 17 17 0.34 1 Not Significant
B.SC Nursing 11 15

ᵡ2 1df=3.84, p<0.05

Table 8 shows that there was no significant association between pre-test

knowledge score on biomedical waste management and selected variables such as age,

designation, general education, professional education.

Table 9: Chi square values computed between pre-test knowledge score and selected

variables

Chi
Variables Pre test knowledge square df Inference
<Median >Median Value

Not
Working Experience (in years ) 0.64 1 Significant
0-10 18 13
>10 11 18

Not
Working Area 0.58 1 Significant
General Ward 14 14
Special Ward 13 19

Not
Any Special Training 2.4 1 Significant
Yes 4 10
No 24 22
ᵡ2 1df=3.84, p<0.05

Table 9 shows that there was no significant association between pre-test

knowledge score on biomedical waste management and selected variables such as

working experience, working area, and any special training.

Summary

This chapter deals with the analysis and interpretation of data collected from 60 health

workers regarding bio-medical waste management. Descriptive and inferential statistics

were used to analysis. Frequency and percentage analysis were used for analysis the

sample characteristics, mean, mean percentages were used to describe the gain in

knowledge score.The effectiveness of video teaching programme on Biomedical waste

management was established by pair ‘t’ test. Chi- squire test was used to analyze the

association between pre test knowledge score and selected variables at 0.05 level of

significance. The findings showed that there was no significant association between pre

test knowledge score on Biomedical waste management

and selected variables such as age, designation, general education, professional

education, working experience, working area, and any special training.

CHAPTER V
 CHAPTER V

Discussion
This chapter deals with the major findings of the study, discussion with other related
studies, conclusions and implication of the study in the field of nursing education,
administration, nursing practice and nursing research. The limitation of the study has
been stated and the recommendation for the future research in different aspects has also
been presented.

Major findings of the study

Major findings of the study are summarized as below:

Description of demographic variables

 About 46 (76.66%) were within >33 years of age of health workers belongs to the
age above 33years.
 About 32 (53.33%) of health workers were staff nurse.
 30 (50%) were having Higher Secondary education and also above Higher
Secondary education.
 Majority of them 46 (76.66%) having no special training on biomedical waste
management.
 Majority of the health workers 34 (56.67%) had GNM as their professional
qualification
 Majority of the health workers 31 (51.67%) having 0-10 years working
experience.
 About 32(53.33%) of health workers were working in special ward
Findings related to effectiveness of video-assisted teaching program

 The maximum knowledge gain as per modified gain score was in the area of
transportation and treatment of BMWM.
 And minimum knowledge gain as per modified gain score was in the area of
special points about of BMWM.
 Mean pre-test and post-test knowledge score were 16.35 and 26.21 respectively
with a mean difference of 9.86.
 Standard Deviation of Mean pre-test and post-test knowledge score were 2.83 and
2.68 respectively.
 The mean difference 9.86 was a true difference because it was found to be
statistically significant as evident from ‘t’ value 22.68 at 0.05 level of significance
and suggested the effectiveness of the video assisted teaching program on
biomedical waste management to increase the knowledge among health workers.

Findings related to association between pre-test knowledge scores on biomedical

waste management with selected variables (designation, age, general education,
professional education, working area, working experience and any special training)

The association between pre-test knowledge score on biomedical waste management

and selected variables i.e. age, designation, general qualification, professional
qualification, working area, working experience and any special training were calculated
by Chi-square. There was no significant association between pre-test knowledge score
on biomedical waste management and selected variables such as designation, age,
general qualification, professional qualification, working area, working experience and
any special training on biomedical waste management.

Discussion in relation to other studies

In this section findings of the study have been discussed with the reference to the
result obtained by the investigator. The present study is based on Ludwig Von Bertanffly
General System Theory (1968). Pre –experimental research approach was considered for
study. Investigator has selected 60 samples by non-probability purposive sampling for
study. Study result shows that mean post test knowledge score (26.21) is significantly
higher than mean pre test knowledge score (16.35) and video assisted teaching program is
effective from ‘t’ value (22.68) which is significant at 0.05 level of significance.

A study to assess the effectiveness of a video assisted teaching program on

knowledge regarding non pharmacological pain relieving intervention for children among
staff nurse in a selected hospital. In the pre-test more than half (53.3%) of the staff
nurses had average knowledge, 40% of them had poor knowledge and 6.7% had good
knowledge regarding non- pharmacological pain relieving interventions before the video
assisted teaching program, but in the post test there was significant improvement in the
knowledge scores, 80% of nurses had good knowledge.[47]

The study is similar in respect of sample and research design.

Mimi Lalmuanpuii et al.2013, conducted a study to assess the effectiveness of video

assisted teaching program on biomedical waste management among staff nurses. One
group pre test post test design and evaluative approach were selected for this study
among 60 staff nurses working in Krishna Hospital and Medical Research Centre, Karad.
Pre test was conducted before administration of video assisted teaching program and post
test was conducted after 7 days. It was observed that after administering the video
assisted teaching program the mean of total knowledge score was increased to 26.033
from 17.383 that of pre test knowledge mean score. The paired ‘t’ value is 12.947 giving
‘p’ value <0.0001 which is considered to be extremely significant, indicates significant
improvement in knowledge of staff nurses regarding BMW management.[12]

This study is similar in respect of sample group, sample size and research design.

Manish Patidar et al.2014, a pre experimental study was conducted to assessing the
knowledge of Nurses regarding Biomedical Waste Management, evaluate the
effectiveness of Structure Teaching Programme on Bio-Medical Waste Management and
find out association between pre test knowledge score and selected demographic
variables. A one group pre-test post-test pre-experimental design and evaluative
approach was adopted. The study was conducted among 60 staff nurses conveniently
selected from two hospitals of Vadodara. The content validity of the tool and teaching
plan was established. The reliability of tool was established by testing the internal
consistency by using Test -retest method. Result of study indicate that p-value = 0.000 <
0.01 , the difference between the Pre-test and Post-test scores is highly significant at 1%
level of significance this shows that the Structured Teaching Programme on Bio-Medical
Waste Management is effective. This study concluded that structure teaching program is
effective tools to improve the knowledge of staff nurses regarding bio-medical
management. [19]

This study is similar in respect of sample group, sample size and research design
and approach.

Mrs. Shalini Jose. 2016. A pre experimental study was conducted to determines the
effectiveness of video assisted teaching programme on knowledge among B,Sc Nursing
students regarding breast self examination” The study aimed to assess the knowledge
on breast self examination among students before and after video assisted teaching
programme; evaluate the effectiveness of video assisted teaching programme on breast
selfexamination among students; and find out the association of knowledge regarding
breast self examination among B.Sc Nursing students and selected demographic
variables. A pre experimental study was carried out with 40 students from Bombay
Hospital College of Nursing Indore. Self administered tool i.e. multiple-choice statements
were used to evaluate the knowledge level on breast selfexamination before & after video
assisted teaching programme. Data was analyzed by chi-square and ‘ t’ test. The result showed that
there was a significant difference between pre-test and post-test knowledge scores as
assessed by the paired t-test value at 10.58 (HS), t(39) =2.04 , p≤0.05). There was
significant association between knowledge and the selected demographic variables (age,
educational status, education of mother, family history of cancer, previous knowledge
about BSE and its sources) at 0.05 level of significance. Thus by this study one can
conclude that video assisted teaching programme helps to improve the knowledge of
students on breast self examination.[50]
This study is similar in respect of research design and approach.
Conclusion

On the basis of the findings of the present study the following conclusion
can be drawn.

The findings showed the majority of the participants were staff nurse and majority of
them belong to the age group above 33 years. Maximum participants had higher
secondary as their general qualification and majority of them GNM.

Majority of the health workers had more than 10 years of working experience. And
maximum of health workers had no special training on biomedical waste management.
Among the 60 participants only 1.66% were found to have very good knowledge on
biomedical waste management before the administration of video assisted teaching
program, but knowledge has increased ( 96.66%) after exposure of the video assisted
teaching program, Chi square value reveals that there is no association between pre test
knowledge score on biomedical waste management with selected variables(age,
designation, general education, professional education, working area, working experience
and any special training ) at 0.05 level of significance.
The video assisted teaching program can be developed by other health workers. It is
effective to enhance knowledge of the health workers regarding biomedical waste
management..

Implication

The findings of the study have implications in nursing education, nursing practice,

nursing administration and nursing research.

Nursing education

Education is the key component in improving the knowledge of an individual. The

findings of the video assisted teaching program is effective in increasing the knowledge
 in this study. So a Nurse educator should be trained to produce and use this method of
instruction for teaching rather than using the traditional teaching method with chart,
posters, which is unable to create sensory stimulations among participants as does the
video assisted teaching program.

Nursing practice

Continuing education is essential to improve the health worker’s knowledge to

maintain safe biomedical waste management as well as to prevent different biohazards. A
video assisted teaching module can serve as a guideline for the biomedical waste
management. A nurse researcher can use the video assisted teaching module for health
workers in a different set up and a different hospital to evaluate the effectiveness of the
video. It can be used over a long period to see the effectiveness.

Nursing administration

The present study is done on biomedical waste management to encourage safe

biomedical waste management and to prevent biohazards. The findings of the study will
help nurse administrator to initiate policy making, at the hospital setting, to organizing
rigorous in-service training program on biomedical waste management. The nurse
administrator is in a position to see that the hospital policy is being followed or not and to
organize periodic audit of competency assessment among health personnel.

Nursing research

Research has a significant and vital role in nursing. Nursing recognizes the professional
responsibility of broadening the body of knowledge of nursing; by publishing the
research study, is one such way. So the findings of researchers can be published, so that
the other members of the nursing community can utilize such findings.

Limitation

The findings cannot be generalized because of the following reasons;

 Purposive sampling used in the study.

 Small sample size.
 Only Govt. setup was taken for the study.
 Time constraints.
 No attempt is made to do the follow up to measure the retention of knowledge of the
health workers.

Recommendation
 Keeping in view of the finding of the presented study, the following recommendations
are made.
 Since the study has been carried out on a small purposive sample, the result can be used
as a guide for further studies.
 A similar study can be done on other health workers like doctor, class IV staff, laboratory
worker and waste handler.
 A similar study can be replicated by using a large sample.
 A comparative study can be done to assess the knowledge of health workers working in
Govt. hospitals and private hospital.
 A follow up study can be done to assess the effectiveness of a video assisted teaching
program in terms of knowledge score.

Summary

This chapter has dealt with the summary of the study, conclusion, discussion, implication,
limitation and recommendations for the further study.
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