23
CHAPTER 4 Results
CHAPTER 4
Res
ults
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RESULTS
The software SPSS (Statistical Package for Social Sciences) version 15 for
windows was used to analyze the data. Demographic as well as group-wise data was
summarized with descriptive statistics.
Pre and post test scores were collected from both experimental and control
groups using structured knowledge questionnaire on respiratory unit medication,
practice checklist on oral drug administration, Nebulization, Metered Dose Inhaler,
and practice of Mini Peak Flow Meter.
The post-test score was analyzed performing analysis of covariance
(ANCOVA). Since differences in pretest score may contribute to the differences in
post test score, it is decided to use pretest score as a covariate for the comparison of
post-test scores by teaching method for the data collected from various questionnaire
and checklists. Findings are organized based on the objectives of the study.
Organization of the study findings
Section 1: Demographic characteristics of the nursing students
Section -2 Effectiveness of the teaching learning approaches
Comparison of post- test knowledge scores of nursing students on respiratory
drugs
Comparison of post- test practice scores on oral drug administration.
Comparison of post- test practice scores on Nebulization.
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Comparison of post- test practice scores on MDI check list
Comparison of post- test practice scores of Mini Peak flow meter.
Patients’ understanding to drug therapy as an impact of nursing students’
communication about the drugs that they receive - a post-test comparison.
Section 3: Opinnionnaire of the students’ on video form of learning.
Section 4: Correlation between students’ competence and their performance in
pharmacology in second year university examination.
Demographic characteristics of the nursing students
The present study begined with a sample size of 100 per group. Students who
did not attend either pre or post-test were excluded from analysis. The experimental
group had 87 students and 80 students in the control group for analysis.
The description of the data regarding the sample characteristics is given in table1.
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Table No. 1: Frequency and percentage distribution of demographic
characteristics of nursing student in the experimental and control group.
SL.
No Demographic characteristics
Experimental
n=87
Control
n=80
f % f %
1. Age in years
<20 years 44 50.6 71 88.75
>20 years 43 49.4 9 11.25
2. Sex
Male 1 1.1 5 6.2
Female 86 98.9 75 93.8
3. Mother’s educational status
Secondary and below 33 37.93 30 37.5
Above secondary 54 62.07 50 62.5
4. Father’s educational status
Secondary 32 36.78 28 35
Pre degree 55 63.22 52 65
5. Mother’s occupation
Clinical nurse / Nurse teacher 18 20.68 4 5
Home maker and others 69 79.32 76 95
6. Father’s occupation
Health professionals 0 0 0 0
Others 87 100 80 100
7. PUC education
Private college 51 58.6 53 66.2
Government college 36 41.4 27 33.8
8. Medium of instruction in PUC
English 65 74.7 59 73.8
Mother tongue 22 25.3 21 26.2
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SL.
No Demographic characteristics
Experimental
n=87
Control
n=80
f % f %
9. Percentage obtained in PUC
50-60 15 17.2 11 13.8
61-70 49 56.3 48 60
71-80 21 24.1 20 25
>80 2 2.3 1 1.2
10. Marks obtained in Anatomy and Physiology
Less than 70% 86 98.85 76 95
70% and above 1 1.15 4 5
11. Marks obtained in Biochemistry &
Nutrition
Less than 70% 83 95.40 77 96.25
70% and more 4 4.60 3 3.75
12. Marks obtained in Fundamentals of nursing (Theory)
Less than 70% 85 97.70 75 93.75
70% and more 2 2.30 5 6.25
13. Marks obtained in Fundamentals of nursing (Practical)
Less than 70% 45 51.73 43 53.75
70% and more 42 48.27 37 46.25
14. Marks obtained in Microbiology
Less than 70% 83 95.40 79 98.75
70% and more 4 2.86 1 1.25
15. Marks obtained in Pharmacology
Less than 70% 87 100 80 100
70% and more 0 0 0 0
Data on table 1 shows that experimental and control groups were almost
similar in all the demographic characteristics.
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Comparison of Knowledge score
Table 2: Knowledge of students on respiratory medications and drug
administration (Max. Score 60)
Group N Mean Std. Deviation
Pre-test Control 80 29.13 5.03
Experimental 87 28.14 4.29
Post-test
(unadjusted)
Control 80 39.61 4.23
Experimental 87 42.30 3.30
Table 2 shows increase in Post-test score compared to pre-test score in both
experimental and control groups.
Table 3: Comparison of post-test knowledge score adjusted for pre-test score
Mean* (Std. Error)
Mean %
Mean
difference
Std.
Error
of
diff.
P-
value
95% CI for
difference
Lower
Bound
Upper
Bound
Experimental (A) Control (B)
3.15 0.48 <0.001 2.21 4.1 42.52(0.33)
70.87
39.37(0.35)
65.62
* Pretest score in the model was evaluated at the value: Pretest score = 28.61.
The covariate Pre-test score on knowledge of students on respiratory
medications and principles of medication administration was significantly related to
the student’s Post-test score, F(l, 164) = 84.07, P<0.001. There was also significant
effect of teaching method on post test score after controlling for the effect of pretest
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score, F(1, 164) = 43.26. P<0.001. Post-test knowledge score was higher for
experimental group (ALV) compared to control group (ALLD)
The difference in mean score was 3.15, SE = 0.48, P< 0.001 (Table 3).
Comparison of practice checklist score on oral medication
Table 4: Group Statistics for oral medication (Max. Score: 24 )
Group N Mean Std. Deviation
Pre-test Control 80 12.91 1.021
Experimental 87 12.39 0.94
Post-test
(unadjusted)
Control 80 17.24 1.34
Experimental 87 21.82 1.18
Table 4 shows increase in post-test score compared to pre-test score in both
experimental and control groups.
Table 5: Comparison of Post-test oral medication score adjusted for Pre-test
score
Mean* (Std. Error)
Mean %
Mean
difference
Std.
Error
of diff.
P-
value
95% CI for
difference
Lower
Bound
Upper
Bound
Experimental Control
4.92 0.174 <0.001 4.58 5.26 21.98 (0.118)
91.58
17.06 (0.124)
71.08
* Pre-test score in the model was evaluated at the value: Pre-test score = 12.64
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The covariate Pre-test score on oral medication was significantly related to the
student’s Post-test score, F(l, 164) = 57.47, P < 0.001. There was also significant
effect of teaching method on Post-test score after controlling for the effect of pretest
score, F(1, 164) = 797.21, P<0 .001. Post test score on oral medication checklist was
higher for experimental group. The difference in mean score was 4.92, SE = 0.174,
P < 0.001 (Table 5).
Comparison of Practice Checklist score on Nebulization
Table 6: Group Statistics for Nebulization score (Max. 29)
Group N Mean Std. Deviation
Pre-test Control 80 21.29 1.36
Experimental 87 21.46 1.17
Post-test
(unadjusted)
Control 80 25.63 1.22
Experimental 87 27.79 1.00
Table 6 shows increase in post-test score compared to Pre-test score in both
experimental and control groups.
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Table 7: Comparison of Post-test Nebulization score adjusted for Pre-test score
Mean* (Std. Error)
Mean %
Mean
difference
Std.
Error
of
diff.
P-
value
95% CI for
difference
Lower
Bound
Upper
Bound
Experimental Control
2.12 0.164 <0.001 1.80 2.44 27.77(0.113)
95.76
25.65(0.118)
88.45
* Pre-test score in the model was evaluated at the value: Pre-test score = 21.38
The covariate Pre-test score on nebulization was significantly related to the
student’s Post-test score, F(l, 164) = 18.61, P<0.001. There was also significant
effect of teaching method on post test score after controlling for the effect of Pre-test
score, F(1, 164) = 167.67, P <0 .001. Post-test score on nebulization for experimental
group was higher. The difference in mean score was 2.12, SE = 0.164, P < 0.001
(Table 7).
Comparison of Practice Checklist score on MDI
Table 8: Group Statistics for MDI score (Max. Score: 14)
Group N Mean Std. Deviation
Pre-test Control 80 5.28 1.99
Experimental 87 5.14 1.70
Post-test
(unadjusted)
Control 80 9.78 0.95
Experimental 87 13.62 0.84
Table 8 shows increase in Post-test score compared to Pre-test score in both
experimental and control groups.
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Table 9: Comparison of Post-test MDI score adjusted for Pre-test score
Mean* (Std.Error)
Mean %
Mean
difference
Std.
Error
of diff.
P-
value
95% CI for
difference
Lower
Bound
Upper
Bound
Experimental Control
3.88 0.124 <0.001 3.63 4.12 13.64 (0.09)
97.43
9.76 (0.086)
69.71
* Pre-test score in the model was evaluated at the value: Pre-test score = 5.2.
The covariate Pre-test score on MDI, was significantly related to the student’s
Post-test score, F (l, 164) = 42.43, P<0.001. There was also significant effect of
teaching method on post test score after controlling for the effect of Pre-test score,
F(1, 164) = 974.58, P <0 .001. Post-test score on MDI was higher for experimental
group when compared to control group. The difference in mean score was 3.88,
SE = 0.124, P < 0.001 (Table 9).
Comparison of practice checklist on Mini Peak flow meter
Table 10: Group Statistics for Mini Peak Flow Meter score (Max.score:10)
group N Mean Std. Deviation
Pre-test Control 80 2.85 1.31
Experimental 87 2.99 1.02
Post-test
(unadjusted)
Control 80 7.25 1.00
Experimental 87 9.36 0.99
Table 10 shows increase in Post-test score compared to Pre-test score in both
experimental and control groups.
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Table 11: Comparison of Post-test Peak Flow score adjusted for Pre-test score
Mean* (Std.Error)
Mean %
Mean
difference
Std.
Error
of diff.
P-
value
95% CI for
difference
Lower
Bound
Upper
Bound
Experimental Control
2.06 0.14 <0.001 1.78 2.34 9.33 (0.098)
93.3
7.27(0.103)
72.7
* Pre-test score in the model was evaluated at the value: Pre-test score = 2.92
The covariate Pre-test score for Mini Peak Flow Meter practice was
significantly related to the student’s Post-test score, F(l,164) = 30.025, P<0.001.
There was also significant effect of teaching method on post-test score after
controlling for the effect of Pre-test score, F(1, 164) = 209.83, P <0 .001. Post-test
score on Mini Peak Flow Meter practice was higher for experimental group compared
to control group. The difference in mean score was 2.06, SE = 0.14, P < 0.001
(Table 11).
Patients’ understanding/communication of prescribed drugs
Table 12: Group Statistics for patient communication score (Max. Score:57)
group N Mean Std. Deviation
Pre-test Control 80 25.53 1.49
Experimental 87 25.57 1.47
Post-test
(unadjusted)
Control 80 39.85 1.71
Experimental 87 47.59 1.65
Table 12 shows increase in Post-test score compared to Pre-test score in both
experimental and control groups.
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Table 13: Comparison of Post-test patient communication score adjusted for
pre-test score
Mean* (Std. Error)
Mean %
Mean
difference
Std.
Error
of diff.
P-
value
95% CI for
difference
Lower
Bound
Upper
Bound
Experimental Control
7.70 0.21 <0.001 7.29 8.11 47.57(0.14)
83.46
39.87(0.15)
69.95
* Pre-test score in the model was evaluated at the value: Pre-test score = 25.55
The covariate Pre-test score on patients’ understanding of the drug prescribed
for them through communication made by the student nurse was significantly related
to the student’s Post-test score, F(l, 164) = 93.44, P<0.001. There was also
significant effect of teaching method on Post-test score after controlling for the effect
of Pre-test score, F(1, 164) = 1367.54, P<0.001. Post-test score on patients’
understanding of the drug prescribed for them through communication made by the
student nurse in the experimental group was higher. The difference in mean score
was 7.70, SE = 0.21, P<0.001 (Table 13).
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Students’ opinion on the teaching learning approach
Table 14: Students’ opinion on the Video form of learning (ALV)
Sl.
No Items
Experimental group (n=87)
Control group (n=80)
Strongly agree
or agree
Strongly agree
or agree
The teaching learning methods used in the
session
f % f %
1. The present teaching enabled me to
understand pharmacology rather than simply
memorize the subject materials
87 100 80 100
2. The audio visual materials used in the teaching
learning made an impact in my learning.
87 100 80 100
3. Drug administration is a challenging task in
nursing practice as errors can cause loss of
lives or unwanted complications.
87 100 80 100
4. Helped me to calculate and analyze the doses
accurately in clinical practice.
87 100 78 97.5
5. I feel a sense of confidence in administering
drug from now onwards.
85 97.7 79 98.7
6. It allowed my creative thinking in patient
teaching regarding their drugs
87 100 87 100
7. Enabled me to relate the knowledge gained to
my professional practice in the clinical areas
87 100 87 100
8. Encouraged me to become more independent
in my learning in relation to drug administration
87 100 87 100
9. Aroused my interest to learn 87 100 87 100
10. The subject materials were presented clearly 87 100 87 100
11. Helped me to understand the fact that learning
takes place in more organized form
87 100 87 100
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Sl.
No Items
Experimental group (n=87)
Control group (n=80)
Strongly agree
or agree
Strongly agree
or agree
The teaching learning methods used in the
session
f % f %
12. Gave me freedom to clarify my doubts during
the teaching learning sessions.
87 100 97 98.7
13. Helped me to analyze the fact that
pharmacology is an important subject that is
applied to my daily patient care.
87 100 87 100
14. Geared me to be more active in learning the
subject as the sessions were lively.
87 100 87 100
15. Enabled me to relate the knowledge gained to
my professional practice
87 100 87 100
16. Made me realize the importance of educating
patients regarding their drugs towards their
compliance to the regimen prescribed for them.
87 100 87 100
17. Motivated me to learn and take active part in
my patient medication administration.
87 100 87 100
18. Induced me to improve my IPR with my
patients and clarify their doubts on their
treatment regimen
87 100 87 100
19. Made me realize my responsibility and
accountability towards my patient as a nurse
87 100 79 98.7
20. The session helped me to internalize that
variety of teaching learning activities helped me
to understand the subject better.
87 100 75 93.75
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Data presented in table 14 is the opinion collected from both the groups. The
opinion from the control group is taken after exposing the students to both the
teaching learning methods. The study utilized rating scale scoring 3, 2, 1 and 0 for
strongly agree, agree, disagree and strongly disagree respectively. Strongly agree
and agree are clubbed for the purpose of analysis. It is observed that students in
both the groups felt that the teaching methods were useful for learning respiratory
drugs as well as drug administration and its principles required to safeguard the
patients and also communicate the purpose of the medications that they receive to
enhance drug compliance. Hundred percent students felt that varied A/V aids are
useful in understanding respiratory drugs and also drug administration. Students felt
that more organized form of learning with multiple teaching strategies with active
participation makes them feel more confident in learning drug administration.
Reinforcement in the areas such as drug calculation, accountability, and active group
participation can foster safe practice with complete understanding of the drugs that
they administer to their patients.
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Table 15: Subjective feedback about video CD from experimental group (n=87)
Sl. No Opinion f %
1. I have become aware of the importance and risk of administering
medication to my client
45 51.72
2. Lively class 31 35.63
3. Videos made me remember the procedural steps of drug
administration easily.
25 28.74
4. Continuous instruction during the drug administration made me
memorize the steps perfectly
27 31.03
5. Made me clear that pharmacology is not too tough to break the
head during examination hereafter.
13 14.94
6. Nurses’ responsibilities are clearly mentioned during this theory
classes and video demonstration
67 77.01
7. This class is different from regular because it involves theory as
well as demonstration and also a quiz which was motivating.
54 62.07
8. The videos were very good in making us learn step by step. 34 39.08
9. Teaching method was good 25 28.74
10. If entire pharmacology is taught like the present teaching it will be
very helpful.
48 55.17
11. This pharmacology class was very memorable and student
friendly teaching method
41 47.13
12. My fear about pharmacology subject has vanished. 15 17.24
13. This method will enhance every student’s learning level 42 48.28
14. We were given lots of time for group discussion and interaction 46 52.87
15. It made my learning clear in terms of understanding 39 44.83
16. I got clear picture of each and every procedure from the video 53 60.92
17. Entire basic nursing procedures to be available in video form 25 28.74
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Data presented in table 15 indicates that students could procedures time and
again with clarity. They also felt that if daily pharmacology classes use multiple
teaching learning strategies with active group participation, they could fair well and
fear of the subject could be eliminated.
Table: 16 Subjective feedback about video demonstration from control group
(n=80)
Sl.
No
Opinion f %
1 The video form of learning is better than demonstration as it can be
repeatedly viewed
56 70
2 CD was convenient as we could view time and again in our free time 71 88.75
3 In demonstration only students who stand in front can view directly
but all cannot view properly
34 42.50
4 In demonstration the teacher demonstrates only once and it is
difficult to remember all the steps although she discusses even at the
end of the demonstration.
40 50
5 Video gives facilities to stop and re-watch but in demonstration
interruption during demonstration was not appreciated by the
teacher.
25 31.25
6 It is nice to learn in the absence of teacher 31 38.75
7 The video clips made us remember better and less laborious than
standing and viewing live demonstration in a laboratory.
46 57.50
8 The video procedures were very systematic to learn 15 18.75
9 Video demonstration made us independent learners and the entire
sessions made learning complete.
20 25
10 Quiz was effective in learning the specific instructions as well as
calculations of various drugs. Having the quiz content in the CD
really helped to practice drug calculations time and again.
42 52.50
11 Teachers capabilities are different in live demonstration 15 18.75
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Data presented in table 16 show that students prefer independent form of
learning with active group participation and interaction. Although demonstration is
one of the most effective forms of learning nursing procedures yet, video proved to
be convenient as it could be viewed time and again and helps them remember steps
of procedure whereas demonstration is not too often repeated by the teacher.
Moreover the number of students viewing single live demonstration is limited to 10
and even then students find it hard to view directly. It is also observed that students
prefer a teacher teaching the subject to supervise their practice in the clinicals
postings. Students of both experimental and control group expressed that quiz is one
of the form of learning strategies which made them learn large amount of drugs, their
mechanism of action, indications, contraindication, side effects, drug interaction and
specific nursing roles in a short span of time. Quiz motivated the students to take
active part in the small group discussion.
Data presented in table 16 indicates that students could rightly sense the
impact of variety of teaching learning activities, when put together makes them
confident, accountable, reason with clarity, critically analyze and also take a right
decision to educate their patients to help them comply to their therapeutic regimen.
Hundred percent of the students agreed that variety of teaching learning makes them
learn in an organized form in order to integrate theory into practice. They also opined
that team of doctors and nurses teaching pharmacology and drug administration
together was interesting and motivating.
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Initially the students in their second year feel that Pharmacology is a threat
and they naturally lose their interest and pay less attention and depend on other
combined subjects to clear the exams. But the present research was able to induce
interest in the subject by stimulating multiple foci of their learning through varied
teaching learning methods. Today, the young nursing students are also well
equipped with the knowledge of computer and hence, learning through video form of
procedures related to drug administration made them feel more confident as they
could view them time and again the procedural steps with ease and perfection. The
findings also indicates that minority of the students are yet to achieve their correct
drug calculations and gain confidence in drug administration. As the students get
more exposure in the clinical areas and with supportive supervision they will be able
to gain 100% skills in their drug administration which is the prime responsibility of the
nurse.
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Correlation
Table 17: A correlation between marks obtained in pharmacology and students’
performance in post-test of both the groups
Areas of assessment
Marks obtained in pharmacology
(University exam) n=167
Nebulization
Post-test
29 items
r .100
Sig. (2-tailed) .197
Knowledge
Post-test
60 items
r .054
Sig. (2-tailed) .491
MDI
Post-test
14 items
r .138
Sig. (2-tailed) .076
Oral medication
Post-test
24 items
r 0.172*
Sig. (2-tailed) 0.026
Communication
Post-test
57 items
r .193*
Sig. (2-tailed) .012
Peak flow meter practice
Post-test
10 items
r .189*
Sig. (2-tailed) .014
* Correlation is significant at the 0.05 level (2-tailed).
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Second year Pharmacology score was found correlated significantly (positive)
with the oral medication, Mini Peak Flow Meter practice and communication pattern
in the post-test (table17). Even though significant, the correlation observed was very
low. In this study the investigators have taken classes only on one unit of the subject
pharmacology where as the university exam covers the entire syllabus and hence
high correlation is not expected. Reinforcement in teaching learning pharmacology
using variety of method is essential to motivate students to learn this difficult but
important subject. When interactive teaching method with variety of visual aides are
used, the teacher can capture the attention of the students otherwise students get
easily bored.
A cross-sectional study conducted in three polyclinics in Singapore by Tan
et.al assessed the inhalation technique practiced by the patients in six steps. The
study observed that only 7.1% of patients could perform all six steps correctly.
Percentage of patients performing each of the following steps correctly was:
preparation (89.1%), exhalation (53.8%), lip closure (69.2%), inhalation (57.7%),
breath-holding (32.1%) and puff interval (35.4%). The study showed high incidence
of incorrect usage of metered dose inhaler amongst polyclinic patients. Only a small
minority (7.1%) of patients could perform all six steps correctly ie. obtained the
maximum 6 points. Of the six steps, breath holding and puff interval were the
weakest steps with only 32.1% and 35.4% of patients respectively performing it
correctly. The best step was preparation with 89.1% of patients performing it correctly
and negative correlation was noted using Spearman’s rank sum test between age
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and total score that is older patients tended to have a lower score as compared to
younger patients (p<0.001).
In the present study, in the Pre-test, 150 of 167(89.8%) students did not
explain the purpose of the medication the fact that bronchodilators relaxes bronchial
smooth muscle and increases diameter of nasal passages making breathing easy
and respiratory functions improves. Majority 145(86.8%) forgot to explain the
procedure to the client and 159(95.2%) of the students did not shake the inhaler
before use. None of the students knew that patient has to breathe out for 1-2
seconds away from the inhaler prior to inhalation of the medication. Majority,
107(64.1%) of the students did not explained to the patient to bring the inhaler to
his/her mouth between teeth and to close the mouth around it and start to breathe in
slowly, like sipping hot soup. Most, 163(97.6%) students did not explain to the client
that she has to hold the breath for 4-6 seconds and then to breath out. Maximum,
161(96.4%) of the students did not instruct their patient to rinse the mouth after the
medication is being taken. Few of these steps which are essential for a client to
understand his treatment has been neglected by the students and hence patient may
not comply to the therapy for his health problems.
Summary
Experimental and control groups were almost similar in all the demographic
characteristics. The post-test score adjusted for the covariate was significantly higher
for experimental group in all the areas compared to control group (p<.001). There
was a difference of 5-10 percentage points on knowledge score and score on
nebulization procedure. A difference of 10-20 percentage points was observed on,
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MDI practice score and patients understanding of the drugs prescribed for them.
About 20 percentage point difference is observed on oral medication checklist and
peak flow meter practice checklist.
Once the post-test was over for the experimental group, the video form of
learning was crossed over for the control group. A total of 56 (70%) students
expressed that video form of demonstration is better as it could be viewed many
times and another 46(57.50%) students felt that video demonstrations were
interesting to watch and helped in remembering the procedural steps. Twenty-five
(31.25%) of them experienced the possibilities of stopping in between the video
demonstration and re-watching. Thirty one (38.75%) of the students conveyed the
freedom to learn in the absence of teacher and also 18.75% of the students felt that
in the live demonstration, the teachers’ capabilities are different. For the rising
number of students and the number of procedures to be demonstrated and re-
demonstrated, video form of learning could save time, learn more independently as
well as same expert teacher demonstrating the procedures with ease and perfection
can enhance students’ clinical competency especially in drug administration.
