| Abstract: |
SUMMARYComa is not considered as a dangerous cause of death, but the danger may be raised from its complications. The effects are systemic and functional due to impaired protective reflexes.Any unconscious patient is totally dependent on the nurse for support and maintenance of all basic functions, as well as, prevention of complications, whatever the cause of unconsciousness, he/she requires special nursing care. The key role of nursing in The aim of the present study was two folds: A) to improve knowledge and performance level of nurses about care of unconscious patients, B) to study its effect on patient’s outcome. The study was conducted at the Neurological ICU and Emergency Medical UnitTo fulfill the aim of the present study, the following research hypotheses were formulated:H1: The mean knowledge socres of nursing working with comatose patients post-program will be higher than that of their pre-program scores. H2: The mean perforamcne socres of nursing working with comatose patients post-program will be higher than that of tTo fulfill the goal of the study, the researcher dealt with a sample of 36 nurses working in these units during morning shifts; 18 nurses were diploma, 8 nurses were Hakima, and 10 nurses were graduated from the High Institute of Nursing, having at least Implementing this study required three tools:1) Pre- / post-test questionnaire sheet was utilized for testing theoretical information related to all aspects of care of the unconscious patients It included; assessment of level of consciousness, definition of coma, causes, complications and management2) Observational checklist was utilized to assess nurses performance level. It included; maintenance of adequate ventilation, nutrition, patients hygiene, elimination, applying ROM, moving, and positioning and using safety measures (Appendix II).3) Patient’s outcome sheet was utilized to assess the impact of unconsciousness over all body systems for the subjects under study, including; assessment of the patient past history, clinical examination, investigation and assessment of physical, respiratEducational program: According to literature review and objectives of the study, impact of a training program provided for nurses working in critical care units, for nurses knowledge and performance level, as well as, patient’s outcome. Based on the data,The main findings of this study were:* Nurses knowledge and performance were unsatisfactory before the program implementation.* After the program implementation, there was a significant improvement in the knowledge and performance for the nurses working with the comatose patient.* Comatose patients cared by nurses under study developed complication(s). As a matter of fact, the majority of the sample (97%) suffered from respiratory complications, and stasis of secretions, cardiovascular complications, gastrointestinal, and/or urin* Concerning the association between total complications and factors influencing, it was found that:* There is no significant difference between patient sex and the prevalence of complication(s) (P>0.05).* There is no significant difference between patient age and prevalence of complication(s) (P>0.05).* There is a highly significant relationship between hospital stay and the prevalence of complications (P<0.01).* There is no significant correlation between types of illness and prevalence of complications (P>0.05).* There is no significant correlation between total score of nurses knowledge / performance, and prevalence of complication (P>0.05).* There is a highly significant relationship between nurses knowledge and nurses age levels of education / years of experience.* There is a highly significant relationship between nurses performance and nurses age / level of education, while no significant relation between nurses performance and years of experience.* There was a direct relationship between nurse’s knowledge and their performance scores.* There was no significant relationship between nurses knowledge / nurses performance and development of complications for comatosed patients.These results ensured that the educational program had a greatly positive impact on the knowledge and performance related to all of its items (for the comatose patients).Recommendations:* Pre-service training program should be conducted for all new nurses, who start working in the ICU and Emergency Medical Units.* Continuous in-service training programs for the purpose of refreshing and updating the knowledge and performance for nurses working with critical ill patients, which should be followed by continuous evaluation.* Procedure manual should be available in each ward in order to provide the nurses with knowledge and guidance for what to know and how to do.* During academic studies, the students should have course outline about critical care nursing involving availability of laboratory equipments, updating knowledge and performance, new technology, audiovisual material and special budget.* Administratively, the ratio of qualified registered nurses for comatose patients in ICU and Emergency Medical Units should be sufficient enough to provide optimal care.* Nurses working in the Critical Care Units for 3 years must be rotated into another units, with increased incentives and rewards and nurses should participate in decision making processes that influence their work.* New technology advices are needed to reduce complications among the patients.REFERENCESAbd El-Moniem, H.A. (2001): Impact of training program on the performance of nurses working in intensive care units in Zagazing University Hospitals. Doctorate Thesis, Faculty of Nursing, Zagazin University., pp42-69.Abd-El-Sattar, M.I. (1994): Impact of head injury care self learning package on performance of nurses working at Neuro-Surgical Department, Ain Shams University Hospital, Doctorate Thesis, High Institute of Nursing, Ain Shams University, Egypt, pp12, 14, Adam, S.K.; and Osborne, S. (1997): Critical Care Nursing Science and Practice. Oxford Medical Publication, pp1-79, & 255-267.Akel, D.T. (1997): The Impact of an Educational Program on Head Nurses’ Performance: As Related to the Planning Function. Doctorate Thesis, HIN, Ain Shams University.Alferaness, K. (1995): Optimyzing performance through process improvement. J. Nurs. Care Qual., 60(1): pp1-9.Allen, D. (1986): Nursing the unconscious patient: The professional Nurse, 2(1), pp15-17.Allen, R.J.; and Myers, P. (1994): Medicine: the National Medical Series of Independent Study, 2nd Ed., Philadelphia, Tokyo, pp529-539.Alxender, M.F.; Fawcett, J.N.; and Runciman, P.J. (1994): Nursing Practice Hospital and Home: The Adult. Churchill Livingstone, New York, pp334-355.Aly, H.S.; El-Senousy, T.; AbuNegm, L.M.; and Tag El-Din, M.A. (2003): Factors affecting management of patients on mechanical ventilation: The 7th International Nursing Congress Toward Mental Health and Quality of Life. Ain Shams University, Cairo, Egypt,
|
|
|