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Abstract Noninvasive continuous positive airway pressure (NICPAP) has become a useful modality in management of respiratory problems, especially in preterm neonates. The acronym NICPAP reflects a positive pressure applied to the airway of spontaneously breathing neonate throughout the respiratory cycle. Care of neonates with respiratory problems involves all the observation and intervention related to respiratory therapy. So, clinical pathway could be very beneficial for the patient, physician, nurse, and all health professionals. A clinical pathway explicitly states of goals and key elements of care based on evidence based medicine (EBM) guideline by facilitating the communication, coordinating roles and sequencing the activities of the multidisciplinary care team, patients and family; by documenting, monitoring and evaluating variances and by providing the necessary resources and outcomes (Schmölzer et al., 2013 and Brichard, 2014). The present study was aimed to assess nurses’ knowledge regarding to clinical pathway, designing, implementing, and evaluating the effect of clinical pathway intervention on nurses toward care of neonates on noninvasive continuous positive airway pressure (NICPAP). Subject and method: Study design A Quasi -experimental design. Settings This study was carried out at the neonatal intensive care units (NICUs) of the following hospitals: 130 1- Children and Maternity & Gynecological Hospitals affiliated to Ain-Shams University. 2- El-Fayoum University Hospital. 3- El- Fayoum Teaching Hospital. 4- El-Fayoum Health Insurance Hospital. Research subjects All avilable nurses who cared for neonates on NICPAP, at NICUs in the previously mentioned settings regardless to their age, educational qualifications, years of experience, place of work and attendance of previous program related to clinical pathway comprised the subjects(N=69 nurse). All available neonates who were indicated for NICPAP regardless to their gestational age, birth weight, current weight, gender, diagnosis and length of hospital stay comprised the subjects(N=56 neonate). Neonates with congenital anomalies will be excluded from the study. Tools of data collection Tools of the study included: 1 -Pre-designed questionnaire sheet (pre/post test) (Appendix II) This tool was designed by the researcher in simple Arabic language, after reviewing the related literature and after reviewing from the researcher supervisors. It included the following parts: Part I: characteristics of nurses include age, educational qualifications, years of experience, place of work, attendance of previous program related to clinical pathway and care of neonates on NICPAP. 131 Part II: Knowledge of nurses regarding to clinical pathway such as definition, elements, steps, nursing role in clinical pathway, benefits of clinical pathway for nurses and for neonates, barriers, variance, causes of failure for implement the map of clinical pathway and nurses’ role in clinical pathway . Part III: Knowledge of nurses regarding to NICPAP such as components of device, indications, contraindications, complications and weaning process. Part IV: Knowledge of nurses regarding to care of neonates on NICPAP such as suctioning, oxygen administration, blood gases technique, feeding and nutrition, skin care and prevention of infection for neonates on NICPAP. PartV: Knowledge of nurses regarding to multidisciplinary team management such as role of Physician, imaging technician, lab technician, line of communication between technician for NICPAP device check-up and nurses, CSSD and role of infection control team in NICUs. Part IV: Knowledge of nurses regarding activities of clinical pathway such as assessment, diagnostic test, nutrition and elimination, activity/mobility, skin care, medication, consultation, nursing documentation, neonates follow up) were covering the phases of care for neonates on NICPA (preparatory phase, curative phase, recovery phase, and discharge phase). II- Assessment Sheet for Neonates (Appendix III): It included data regarding to the neonate’s diagnosis, gestational age, gender, weight on admission / grams, period of hospital stay, methods of NICPAP 132delivery as well the recurrence of respiratory problems during the hospitalization period and comprised (N=56 neonates). III- Structured observational checklist (AppendixVI) was developed by the researcher guided by Abd-Elmenem, (2008) and Abd-Allah, (2013) to assess nurses’ knowledge regarding to performance, it include assist in extubation, care of neonate after extubation, NICPAP application, connect neonates on NICPAP, care of neonates on NICPAP, administration of oxygen therapy by nasal cannula, oxygen hood and nasal mask, chest physiotherapy, suctioning, taking capillary blood gases and gavage feeding. 5. The Clinical Pathway Map: It is adopted from National Health Services (2009). The clinical pathway formats and contents were modified by the researcher and reviewed by the researcher supervisors to suit the nature of the study. The clinical pathway format and contents is care map, which describes the clinical work of each professional discipline. This model is mapped for care of neonates on NICPAP using the grant chart format of clinical pathway care map based on a time matrix, listing the activities of clinical pathway in one column and across aligning these data with columns pertaining of time (days of hospitalization) (appendix VI). Categorize of multidisciplinary staff actions is listed in the column on the pathway map with specific actions for each day of hospitalizations. Activities of clinical pathway in the map of care covering the phases of neonates on NICPAP from admission until discharge. The clinical pathway map using time by hours from 0-2 hr in admission phase, then curative phase from 1-7 days and recovery phase from 7-15 days until discharge from NICUs. 133 Pilot study A pilot study was conducted on 10% which constitute (7 nurses and 6 neonates) of the subjects who fulfilled the eligible criteria to evaluate the effectiveness of the applicability of the study tools and determine the time consumed & apply the tool. According to the results obtained from the pilot study, the necessary modifications were done by changing in questions style from list only to multiple choices, list and discuss to assess nurses’ knowledge, skills and attitude and added questions to assess nurses’ knowledge about role of multidisciplinary health team. The subjects of pilot study were excluded from the study subjects. Field work |