الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 161 |  |  |
| | | from | 161 | | |
Abstract
Intra-aortic balloon pump) IABP) is a commonly used circulatory-assistive device for patients experiencing unstable angina, left ventricular failure, mitral regurgitation, or cardiogenic shock. Nurses are responsible for many aspects of patients connected with IABP. Therefore, caring for those patients’ require knowledge about IABP therapy to allow nurses to better anticipate the needs of the surgical team and help to improve patient outcomes. In this regards, all nurses should have at least a basic understanding of the uses and mechanism of IABP therapy (Unverzagt, 2015).
Aim of the Study
This study aims to assess performance of nurses caring for patients undergoing Intra-Aortic Balloon Pump through the following:
1. Assessing nurses’ level of knowledge about caring for patients undergoing Intra-Aortic Balloon Pump: pre, during, and post.
2. Assessing nurses’ level of practice about caring for patients undergoing Intra-Aortic Balloon Pump: pre, during, and post.
3. Develop guidelines for nurses caring for patients undergoing Intra-Aortic Balloon Pump.
Research questions:
To fulfill the aim of the current study the following research questions are formulated:
1. What is the level of nurses’ knowledge about caring for patients undergoing Intra-Aortic Balloon Pump: pre, during, and post?
2. What is the level of nurses’ practice about caring for patients undergoing Intra-Aortic Balloon Pump: pre, during, and post?
Subjects and methods:
Research design:
A descriptive, exploratory design was used to achieve the aim of this study.
Setting:
The current study was carried out at the adult intensive care units for cardiac surgery at the Cardio Thoracic Academy (CTA) at Ain Shams University Hospitals.
Subjects:
A Convenient subject of (40) bedside male and female nurses, working in intensive care units for cardiac surgery at the Cardio Thoracic Academy (CTA) at Ain Shams University Hospitals. They had different nursing educational background; bachelor, secondary school diploma and technical nursing institute diploma.
Tools for data collection:
Two tools were constructed by the researcher to collect data pertinent to this study, these tools are:
1- Self–administered nurses’ knowledge assessment questionnaire (Appendix I & II):
This tool was adapted by the researcher in an Arabic and English languages to assess nurses’ knowledge about caring for patients undergoing IABP based on review of relevant and recent literatures guided by (Rushdy, et al., 2015 and Shiraishi, et al., 2020). It consisted of two parts:
The first part: It was concerned with demographic characteristics of nurses under study including; gender, age, marital status, Educational level, Position, years of experiences in the field of nursing, and years of experience in the intensive care unit (ICU).
The second part: This part was concerned with assessment of nurses’ knowledge regarding care of patients undergoing IABP, it consisted of (40) questions; (32) of them were multiple choice questions and (8) of them were true and false questions. The items of knowledge include the following topics; description and physiological effects of IABP (12 questions), Indications, contraindications, and complications of IABP (6 questions), nursing care for patients connected with IABP (9 questions), weaning and removal of IABP (13 questions).
2- Observational checklist for nursing care of patients connected with IABP (Appendix III):
It was concerned with assessment of nurses’ practice regarding care of patients connected with IABP. It was adapted from (Neelavathi, 2018). It consists of (72 steps) classified under three domains: preparation and initiation of IABP therapy (23 steps), nursing practice during IABP therapy (25 steps), and nursing practice during weaning and removal of IABP (21 steps).
Results:
Statistical findings of the current study revealed the following:
Concerning personal background characteristics of the studied subject;
• More than half (53%) of the studied subject was female, had bachelor nursing and in the age group of 16-26.
• More than two thirds of the studied subject had a total of one year to five years of experience in their work place as nurses and in the ICU.
As regards to knowledge assessment, the current study revealed that;
• As regards the great majority (88%) of the studied subject had unsatisfactory knowledge level regarding care of patient connected with IABP with a mean score 9.45± 2.94.
The current study revealed that the great majority (90%, 85% &82.5%) of them had unsatisfactory knowledge about helium use as the drive gas, assessment of the effectiveness of the balloon inflation and deflation timing and physiological effects of IABP, respectively.
The current study revealed that (85% & 82) of them had unsatisfactory knowledge level about when to stop IABP catheter insertion and complication suspected if a sudden DROP occurs in urine output respectively.
The current study revealed that (85%, 82%, 62.5%, 60%, &55%) of the studied nurses had unsatisfactory knowledge related to nursing actions in case of temporary stoppage of the balloon cycle and the width of the balloon pressure waveform: maintenance of positioning for patients connected with IABP, nurses’ assessment of tissue perfusion among patients connected with IABP and nursing interventions for IABP catheter insertion site, respectively.
The current study revealed that (70% & 60%) of them had unsatisfactory knowledge about discontinuing heparin infusion before removal of IABP and criteria for weaning from IABP therapy respectively.
• As regards to nurses’ level of practice, the current study revealed that (95%) of the studied subject had unsatisfactory practice level regarding care of patient connected with IABP with a mean score 30.05±7.43.
The current study revealed that the majority (87.5%, 75%, 75 & 72.5%) of the studied participants not done the following steps: adjusting augmentation alarm setting, obtaining consent, assessing circulation to extremities and capillary refill and recording assisted & unassisted pressures respectively.
The current study revealed that the majority (97.5%, 92.5%, 92.5 & 90%) of the studied nurses not done the following steps: checking if inflation occur at the dicrotic notch, observing helium tank, changing the helium tank or switch to a new pump, assessing and demonstrating intervention for errors in timing respectively.
The current study revealed that the majority (87.5%, 85% & 85) of the studied nurses not done the following assessment: readiness to wean, capillary refill, absence of angina and absence of lethal or unstable dysrhythmias respectively.
The current study revealed that there is significant statistical relationship between studied nurses’ knowledge and their gender (t=2.46 at P= 0.018) with tendency of female nurses to have higher mean scores than males (10.47±3.12) as compared to (8.31±2.31).
The current study revealed that there is insignificant statistical relationship in the mean knowledge scores in relation to years of experience, ICU experience and qualifications (f=.148, p= .863), (f=.059, p= .943), and (f=.710, p= .498) respectively.
The current study revealed that there is insignificant statistical relationship between mean practice scores, nurses’ gender, and age category (t= 0.086, at P= 0.932, and t= 0.1.37at P= 0.176) respectively.
The current study revealed that there is insignificant statistical relationship in the mean practice scores in years of experience, ICU experience and Educational level (F= 0.488, at P= 0.618, F= 1.133 at P= 0.333, and F= 0.758 at P= 0.476) respectively.
The current study revealed that there is no statistical significant correlation between age, total knowledge mean score and total mean practice score.
Conclusion
Based on findings of this study, it was concluded that:
- The majority of nurses under study had unsatisfactory knowledge level regarding caring of patients connected with IABP.
- Most of nurses under study had unsatisfactory practice level regarding caring of patients connected with IABP.
Recommendations
Based on findings of the present study, the followings are recommended:
1. Updating for nurses’ knowledge and practice of ICU nurses through carrying out continuing educational programs about IABP.
2. Strict observation of nurses’ practice when caring of patients connected with IABP and guidance for correction of poor practices.
3. Providing nurses with periodic training sessions to improve their practices regarding assessment and management of patients connected with IABP.
4. Availability of written guidelines, posters and algorithms about nursing management of patients connected with IABP.
Recommendations for further researches:
1. Replication of the study on a larger subject from different geographical locations in Egypt.
2. Future studies are recommended to:
• Compare nurses’ practice for care of patients connected with IABP in different work settings among nurses with different educational background.
• Implementation of suggested guidelines for nurses caring patients undergoing IABP.
• Study the impact of a designed nursing intervention protocol on the outcome of patients connected with IABP.
• Study complications associated with IABP.
• Explore factors that hinder nurses’ practice of care for patients connected with IABP.