الفهرس 
Nursing care process standards for patients in ICUOnly 14 pages are availabe for public view
 |  | from | 354 |  |  |
| | | from | 354 | | |
Abstract
Nursing care standard is a hall mark of professional nursing practice and high quality nursing care. It outlining what the profession expects of its members, promoting guides and directs professional nursing practice, important for self- assessment and evaluation of practice by employers, clients and other stakeholders, providing nurses with a framework for developing competencies,aids in developing a better understanding and respect for the various and complimentary roles that nurses have and aids in improving staff nurses’ performance (American Nurses Association, 2021).Formulation of nursing care standards (NCSs) is the first step toward evaluating nursing care delivery. Moreover, developing standards for patients in surgical care units will enable the nurses to identify deficiencies in the provision of care and to compare their performance with the required
performance established in the standards, furthermore, if the standards of nursing intervention are set clearly, they demonstrate what nurses need to do to provide acceptable level of care (De Groot et al., 2019).The present study was conducted to design and validate standards for nursing care in surgical care units (critical and intermediate). This was achieved through assessing the structure standards and process standards (actual staff nursing performance) in surgical care units, designing standards of nursing care rendered in surgical care units, testing the validity of a designed nursing care standards, implementing the designed standards and evaluating the effect of this
standards on nursing performance post implementing nursing care standards.Research design:The study adopted analytical, quasi-experimental research design.Study setting:The study was conducted at National Liver Institute which affiliated toMenoufia University Hospitals in Shebin El-Kom which is the capital of El-Menoufia Governorate. This Institute was built since 2004. It consists of eight
floors. It is specialized in caring hepatic patients; it provides free and economic services. It provides its services to the community through its different departments and units, which include surgical department, surgical care units (intermediate care unit and critical care unit), medical department, medical care units (intermediate care unit and critical care unit), pediatric department, pediatric care units (intermediate care unit and critical care unit), in addition to the
operating theatres, endoscopy department, radiology department, outpatient clinics and also provide laboratory services. The total number of nurses is 956 nurses including those in leaves. The bed capacity of this Institute is 410 beds.The study setting was divided into two categories which included the following: Critical care unit contains (13 beds). Intermediate care unit contains (8 beds).Subjects of the study:The subjects included in the study composed of two groups:group 1: Staff nurses All staff nurses working in surgical care units (critical and intermediate)during the time of data collection and accept to participate in the study were involved in the study. The total number of staff nurses was 65 (40 staff nurses in critical care unit and 25 staff nurses in intermediate care unit).group 2: Panel of Experts in nursing care standards The snowball sampling technique was employed to select the Panel subjects for Delphi Technique. Fifteen panel subjects were found good when keeping in mind that they are experts in nursing care standards. This technique resulted in nine of them are professors in nursing administration, four are professors in medical surgical, one is professor in pediatric and finally, one is professor in medicine. Regarding to their affiliation, eleven of the were affiliated to work in Menoufia University, three works in Cairo University and one works in Ain Shams University. Their years of experience range between 20-30 years. The Panel of Experts in nursing care standards for this Delphi Technique were subjects who reported involvement in teaching nursing care standards and/or nursing research theory content and had developed and disseminated findings on teaching nursing care standards through either presentations, poster board presentations,papers, peer reviewed publication or consultation.Instruments of data collection:To achieve the aim of this study, three main tools were used for collectingdata in this study. They were:1- Personal characteristic instrument This instrument entailed personal data about staff nurses as work unit, age,gender, nursing qualifications, marital status and years of experience (Appendix
II).2- Observational checklistAimed at assessing the structure standards that present and the processstandards that actually carried out by the nurses in the surgical care units (critical
and intermediate) (Appendix III).3- Delphi panel’s consensus opinionaire sheet:Aimed at assess the experts’ opinions about validity of the designed nursing care standards in surgical care units (critical and intermediate) (AppendixV).Pilot study:After reviewing of the observational checklist by the experts, the researcher conducted a pilot study of the developed checklist before administrating the final checklist. During the period from the beginning of January 2020 till the end of January 2020, the researcher conducted the pilot study on 10% of the total sample (n=7) to ascertain clarity and applicability of the study instruments and to determine obstacles that may be encountered during data collection. It also helped to estimate the time needed to fill the form that
approximately ranged from 30-45 minutes. Based on the result of the pilot, no modifications were done to the instruments. The piloted subjects were included in the final sample.Field work:
A- Preparatory phase: The researcher started to develop observational checklist to assess the actual nursing care standard (structure and process standards) in surgical care units but outcome standard not assessed because the nursing care standards (NCSs) are really not present and this will be difficult to assess the outcome but the researcher will develop it in the designed standards.
The researcher reviewed the current available literature (e.g., articles, textbook,journals, etc.,) to modify the study instruments of data collection (AppendixIII) then approved by the study supervisors. The preparation, construction and approval of the data collection instruments from supervisors consumed around three months. It started in September, 2019 and lasted at November, 2019. The researcher took all staff nurses working in the surgical care units (criticaland intermediate) who are responsible for providing direct nursing care for patient.B- Implementation phase: Data on assessment of structure’s items were collected by the researcher through observing the structure standards that actually present in care units.Also, data were collected for assessment of actual staff nurses’ performance(Appendix III). Each one of the nurse was observed by the researcher three times on different shifts. This was done six days per week. Each nurse has been under observation until the entire observation checklist was fulfilled. Collection of data was done in different times of work during the three shifts.The morning shift started from 9,00 A.m. to 2,00 P.m. The afternoon shift started from 2,00 P.m. to 7,00 P.m. The night shift started from 7,00 P.m. to 9,00 A.m. The researcher has informed the nurses that they will be observed but not informed them about the hours of observation or the content of the tool. The duration of the collection of data was lasted five months from February 2020 to June 2020. Three months were in the critical care units and the other two were in intermediate care units. After the assessment of structure and process nursing care standards, the researcher began to design nursing care standards (NCSs) based on reviewing literature of nursing care standards and reviewing the previous standards(national and international) (Appendix IV ). This stage took three months started from July 2020 to September 2020. After designing the nursing care standards (NCSs), the researcher started to test validity of the standards by developing Delphi Panel consensus opinionaire sheet which consisted of three rounds. This tool was designed to test the face and content validity of the designed nursing care standards (NCSs) by eliciting the opinions of the jury members on the proposed standards. The jury members were 15 Experts. This tool consisted of three parts: Part 1 consisted of jury characteristics(personal characteristics) such as specialty, job place and years of experience.
Part 2 was designed to test the agreement of the jury group on the general format of the designed nursing care standards (face validity) and it consisted o9 items. Part 3 was designed to test the agreement of the jury with respect to the items in the NCSs (content validity). This part consisted eleven main descriptions of structure standards and six main descriptions of process standards (Appendix V). The researcher started Delphi process (Delphi rounds):The Delphi process can be continuously iterated until consensus was determined to have been achieved. The literature reflects that an adequate number of rounds must be employed in a Delphi Technique in order to find the balance between producing meaningful results without causing sample fatigue.Recommendations for Delphi Technique suggested that two or three rounds are preferred to achieve this balance (Melnyk et al., 2017).Frist round:The first round consisted of open questions. The questionnaire distributed aimed to elicit the experts’ opinions about items to be included in the nursing care standards. The literature was viewed by an Expert panel and has provided the base knowledge for items to be included in the guiding standards. Each of the items that researcher intended to include in the guiding standards had its own explanatory note and a blank area for experts to write examples for items and a place for certain notes. This round took one month at October, 2020.Second Round:
After the first round, the researcher designed guiding standards by extensive reviewing of the literature and integration of Experts’ opinions. The guiding designed standards explain for staff nurses how they can utilize and realize the nursing care standards at their work. These guiding standards consisted of two sections. The first section discussed structure standards that should be
present in surgical care units and the second section mentioned process standards that the staff nurse should done. The Delphi panel’s consensus opinionaire sheet was given to each Expert and aimed to elicit the experts’ opinions and consensus about agreement or disagreement about the details of these sections included in the guiding designed standards. The Panel of Experts in nursing care standards were asked to investigate each item and component of the guiding designed standards and
provide feedback, additions, any comment based on their analysis and experience in the field of nursing care standards. The second round took two months. It was started at November 2020 and lasted at December 2020.The second round comments of the Panel of Experts include: Make the guiding standards in points to look like a standard from the structural perspective. Avoid duplication (Many items are duplicated in different way). The structure standards need more clarification and to beunder standable and need to be written comprehensively. The process standards need to be comprehensive and to beunderstandable, Third round:After analysis the second round’s responses, the sections which the panel of experts in nursing care standards identified was not clearly and
comprehensively written were reworded after extensive reviewing on literature concerning nursing care standards. All comments and disagreements by the panel of experts were taken into consideration by the researcher. The designed standards were resent to the panel of Experts to see that their feedback had been integrated and they were asked to review the guiding standards and give any comment. The third round aimed to: gain consensus and weigh the panelists’ agreement about the
designed standards of nursing care utilization for staff nurses. The third round took two months. It was started at January lasted February, 2021.The third round comments of the Panel of Experts include: Good writing of the nursing care standards, very clear, direct to the point. The researcher put huge efforts in developing the standards whic resulted in excellent work.
The nursing care standards are very comprehensive and relevant to its purpose. It was concise which make it easier for the reader and those who will utilize it. After gaining consensus from the Delphi panel that the designed standards for nursing care was valid, the researcher scheduled the teaching sessions for both theory and practice (Appendix VI). The researcher divided the nurses into
small groups, each group contains 5 nurses. Teaching has been implemented for nurses in terms of sessions and teaching on the spot during their official working hours, there were a total of 11 sessions. Number of nurses in each session 5 nurses, the duration of each session was 45minutes to one hour, including 10 minutes for discussion and feedback. Each session usually started by a summary of what has been taught during the previous sessions and the objectives of the new topics. Feedback and reinforcement of the developed nursing care standards was performed according to nurses needs to ensure their understanding. Each nurse obtained a copy of the developed nursing care
standards booklet that included all the training contents (Appendix VII). Additionally, the researcher also put posters on walls to also make staff nurses more knowledgeable about nursing care standards (Appendix VIII). This took four months. It started at the beginning of March 2021 and lasted at the end of June 2021.C- Evaluation phase: Finally, the researcher evaluated the effect of post implementing a designed nursing care standards on staff nursing performance in surgical care units(critical and intermediate) by using the previous observational checklist to evaluate their performance. This was taking three months from July 2021 to September 2021.Statistical methodology:
The data collected was tabulated and analyzed by Statistical Package for Social Sciences (SPSS) program version 22.Results:The main findings of the present study revealed the following: Regarding to personal characteristics of staff nurses, it was noticed that more than half staff nurses (61.1%) working in critical care unit, while (35.5%) working in intermediate care unit. The largest proportion of staff nurses(73.8%) were in the age group 20-<30 years. As regards gender, more than half of staff nurses (63.1%) were female. As for nursing qualification, more than
half of staff nurses (55.4%) had nursing diploma. Regarding marital status,about half (52.3%) of the staff nurses were married. Concerning years of experience, more than half of staff nurses (52.3%) had experience 1-< 5 years. Regarding to personal characteristics of jury group, it was noticed that more than fifty (60.0%) of experts were professor in Nursing Administration. As regards the Job place, about three quarter (73.3%) of jury members worked in Menoufia University. There was no statistically significant differences in both structure and process standards pre implementing a designed nursing care standards in critical and intermediate care unit. The designed nursing care standards were considered valid by the Delphi Panel by (86.7%) for structure standard and (93.3%) for process standard. The researcher evaluated nurses’ performance post implementing a designed
nursing care standards (NCSs) in surgical care units (critical and intermediate)and found:-There was statistically significant difference in the total mean process scores in critical care unit as P (<0.05%).- All items of nursing process standards pre implementing nursing care standards
were improved after implementing a designed nursing care standards in critical care unit (mean: 39.18±10.35- 52.63±17.96) respectively.- There was statistically highly significant difference in the total mean process scores in intermediate care unit as (P < 0.001%).- All items of nursing process standards pre implementing nursing care standards were improved after implementing a designed nursing care standards in intermediate care unit (mean: 40.00±7.75 - 53.48±5.27) respectively.