An evaluation of Glasgow coma scale knowledge among ICU nurses in a tertiary care hospital in Karachi, Pakistan: a quantitative descriptive cross-sectional study

Muhammad Gulzada, Ali Asghar Mirjat, Abida Razzaq, Saqib Mahmood, Nasir Mahmood, Ijaz Batool, Mairaj Hafeez Chang, Ali Akbar Mirjat, Rozina Shazad Ramji. An Evaluation of Glasgow Coma Scale Knowledge Among ICU Nurses in a Tertiary Care Hospital in Karachi, Pakistan: A Quantitative Descriptive Cross-Sectional Study. Cardiometry; Issue No. 28; August 2023; p. 43-47; DOI: 10.18137/cardiometry.2023.28.4347; Available from: evaluation-glasgow-coma-scale-knowledge-among

The Glasgow Coma Scale (GCS), developed by Graham Teasdale and Bryan Jennet at the University of Glasgow in 1974, is a standardized tool used to assess the extent of impaired consciousness in patients with acute medical and trauma conditions [1]. The GCS scoring system measures the complexity and extent of compromised awareness, making it a valuable tool for decision-making and triage in a wide range of clinical situations [2].

The GCS consists of three indicators: best eye response (E), best verbal response (V), and best motor response (M). Each indicator is graded on a scale, with higher scores representing a better conscious level. The sum of the three parameters ranges from 3 to 15. A lower score indicates a worse conscious level, with a score of 8 or below classifying the patient as comatose and a score of 3 indicating total unresponsiveness [3].

Assessing and documenting the level of consciousness is considered a fundamental aspect of care for patients with neurological or neurosurgical problems, chronic illnesses in elderly patients, and emergency conditions. It helps identify neurological issues, evaluate health interventions, and guide appropriate interventions or treatments. Failure to assess GCS after a head injury can lead to unnecessary mortality and morbidity due to delays in diagnosis and management [4].

Nurses play a vital role in the care of critically ill patients, and their knowledge of GCS is crucial for accurate assessment and effective communication with other healthcare professionals [5]. However, studies have shown that misinterpretation and misapplication of the GCS are common due to its ease of use [6]. Therefore, it is essential for nurses working in critical care to possess a strong understanding of the GCS and incorporate its assessment as a routine part of patient care.

This study aims to assess the knowledge of nurses regarding the Glasgow Coma Scale. By evaluating nurses’ understanding of GCS, we can identify areas where knowledge gaps exist and develop targeted educational interventions to improve their competence in utilizing the GCS scoring system. Enhancing nurses’ knowledge in this area will contribute to better patient outcomes and prevent harm resulting from inadequate assessment and management of patients’ conscious levels.

Methodology

This study is a quantitative, descriptive cross-sectional study among nurses. The cross-sectional study design has the advantage of enabling researchers to compare numerous factors, such as it allows to collect data from a large pool and compare differences between groups, it is cheap and less time consuming.

The target population was nurses of PNS SHIFA Hospital, who were working in ICU/CCU/HDU and having experience at least 01-year, tertiary care hospital in Karachi. The sample size was 60 nurses of PNS Shifa. The sample size was calculated through open EPI with 95% confidence interval, with population size 60 the obtained sample size is 54. Convenient sampling technique was used for sample collection from targeted population.

The study setting was in PNS Shifa hospital Karachi, which is located in DHA phase-II near Korangi road Karachi. Nurses of PNS shifa hospital who are

44 | Cardiometry | Issue 28. August 2023

working in ICU were included in the study. Nursing who was on leave, non-volunteer during data collection period, Lady health visitors, having experience less than 1 year, having qualifications less than GN and Para medical staffs were excluded from the study.

Study duration was from September to December, 2022. Data was collected from September to December 2022.

First of all, permission letter was given by Jesus and Marry institute of nursing Karachi faculty. After that the permission, to collect data from PNS SHIFA hospital administration, was acquired through the research committee of hospital. The written consent form, was given by the faculty, to take signatures from nurses before participation.

The data was collected by questionnaire form was distributed to nursing students which met the inclusion criteria. Each participant was given approximately 15 minutes to answer the questionnaire which was then returned. Tool designed with the help literature and having two components were 1stcomponent demographic data and 2nd component socio-graphic data. In demographic data component there are 04 questions related to demographic data addressing age and gender.

In sociographic data, 2nd component is consisting of 10 multiple choice questions related to knowledge assessment on GCS. The data was analyzed with the program “SPSS” for Windows version 26. Mean, mode, frequency and standard deviation was used for the quantitative variable.

Results

The analysis of the research data was conducted using the SPSS. The results of our research indicate that participants’ knowledge levels varied among the sample group. Out of the total participants, 1.67% had a low level of knowledge, 35% had a moderate level of knowledge, and the majority, 63.33%, exhibited a high level of knowledge Table 1.

Further the data collected from the participants’ responses to the 10 questions were entered into SPSS for the calculation of percentages and descriptive statistics.

For Question No. 1, which inquired about the function of GCS (Glasgow Coma Scale), 31 participants (51.7%) provided the correct answer, while 29 participants (48.3%) gave an incorrect response. Question No. 2, regarding the number of indicators in

Table 1

Shows the distribution of Participants’ Knowledge Levels

Sr. No	GRADING	TOTAL PARTICIPEANTS =60	PERCENTAGE
01	LOW LEVEL OF KNOWLEDGE	UP TO 50%= 01	1.67%
02	MODERATE LEVEL OF KNOWLEDGE	60 TO 80%= 21	35%
03	HIGH LEVEL OF KNOWLEDGE	80 TO 100%= 38	63.33%
	TOTAL PARTICIPANTS	60	100%

GCS, yielded a positive outcome, with 60 participants (100%) answering correctly. Similarly, Question No. 3, concerning the best score in GCS, was correctly answered by all 60 (100%) participants.

In terms of Question No. 4, which focused on the worst score in GCS, all 60 (100%) participants provided the correct response. For Question No. 5, related to the motor response in the number 4 GCS scale, 13 participants (21.7%) answered correctly, while 47 participants (78.3%) gave an incorrect answer.

Regarding Question No. 6, which asked about the GCS scale indicating a coma, the majority of participants, 58 (96%), provided the correct answer, while 2 participants (3.3%) gave an incorrect response. Similarly, for Question No. 7, which inquired about the meaning of a GCS score of 3, 56 participants (93.3%) answered correctly, while 4 participants (6.7%) gave an incorrect response.

In regards to Question No. 8, which explored how to check a patient’s GCS eye-opening, 54 participants (90%) provided the correct answer, while 6 participants (10%) gave an incorrect response. Question No. 9, concerning the number of coma types, saw

22 participants (36.7%) answering correctly, while 38 participants (63.3%) gave an incorrect answer. Finally, Question No. 10, which asked for the meaning of GCS, was correctly answered by 55 participants (91.7%), with 5 participants (8.3%) providing an incorrect response Table 2.

Overall, the research results highlight that while the majority of participants demonstrated a high level of knowledge in the area of GCS, there were variations in their responses to specific questions. This indicates the need for further education and understanding in certain aspects of GCS evaluation and interpretation.

Discussion

The findings of our research, which explored participants’ knowledge levels regarding the Glasgow Coma Scale (GCS), provide valuable insights into the understanding of this assessment tool. The results revealed that a significant proportion of participants exhibited a high level of knowledge (63.33%), while a smaller percentage had a moderate level (35%) and a very small percentage had a low level (1.67%). These results align with previous studies that have report-

Table 2

Participants’ Responses to GCS Knowledge Questions

Sr. No	Statement	Correct answers	Wrong answers
1	What is the function of GCS?	31 participants (51.7%)	29 participants (48.3%)
2	How many indicators of GCS?	60 participants (100%)	0 participant
3	What is the best score of GCS?	60 participants (100%)	0 participant
4	What is the worst score of GCS?	60 participants (100%)	0 participant
5	What is the motor response in the number 4 GCS scale?	13 participants (21.7%)	47 participants (78.3%)
6	Which GCS scale score indicates that the client is in a coma?	58 participants (96.7%)	2 participants (3.3%)
7	What does a GCS of 3 mean?	56 participants (93.3%)	4 participants (6.7%)
8	How can I check the patient’s GCS eye-opening?	54 participants (90%)	6 participants (10%)
9	How many types of comas?	22 participants (36.7%)	38 participants (63.3%)
10	GCS stand for?	55 participants (91.7%)	5 participants (8.3%)

ed a similar distribution of knowledge levels among healthcare professionals and trainees when assessing GCS [7, 8].

Upon analyzing participants’ responses to specific questions, we observed variations in their understanding of different aspects of GCS. For example, Question No. 5, which focused on the motor response in the number 4 GCS scale, revealed that only 21.7% of participants answered correctly. This finding is consistent with a study [9], which reported similar difficulties in correctly identifying the motor response in GCS.

In contrast, other questions, such as Question No. 2 regarding the number of indicators in GCS, showed a high level of accuracy with 100% of participants answering correctly. This result aligns with the findings of [10], who reported similar levels of knowledge regarding the indicators of GCS in their study of healthcare professionals.

While our research indicates a generally high level of knowledge among participants, the variations observed in specific questions highlight the need for targeted education and training in certain aspects of GCS evaluation and interpretation. Healthcare institutions should consider implementing regular educational programs and providing resources to enhance the understanding and application of GCS, particularly focusing on areas where participants demonstrated lower levels of proficiency.

It is worth noting that our study had some limitations, including the relatively small sample size and potential sampling bias. Future research with a larger and more diverse sample would provide a more comprehensive understanding of knowledge levels and could further explore factors influencing GCS comprehension among different healthcare professionals and trainees.

Conclusion

Our research examined participants’ knowledge levels regarding the Glasgow Coma Scale (GCS) and identified variations in their understanding. The findings indicate that a majority of participants exhibited a high level of knowledge, with 63.33% demonstrating proficiency in GCS. However, there were variations in their responses to specific questions, indicating areas that require further education and understanding. Notably, questions related to motor response and the number of coma types received lower correct response rates.

These results emphasize the importance of continuous education and training to ensure accurate and consistent assessment using the GCS. By addressing the identified gaps in knowledge, healthcare professionals can improve their proficiency in evaluating and interpreting GCS scores. This, in turn, can enhance the quality of care provided to patients.

Acknowledgements

The authors would like to thank the PNS Shifa Hospital for facilitating the study.

Conflict of interest

All authors declare no conflict of interest.

Funding