الفهرس 
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Abstract
Summary
Aim of the study:
The current study aims to evaluate the effect of educational program on the performance of nurses caring for patients with spinal cord injury. This aim was achieved through the following:
• Assessment of nurses’ level of knowledge regarding care for patients with spinal cord injury.
• Assessment of nurses’ level of practice regarding care for patients with spinal cord injury.
• Assessment of nurses’ level of attitude regarding care for patients with spinal cord injury.
• Development and implementation of educational programs for nurses based on their needs.
• Evaluation of the effect of the developed educational program on nurses’ performance for patients with spinal cord injury.
Research hypothesis; the current study hypothesized that educational program will improve nurses’ performance regarding care of patients with spinal cord injury.
Operational definitions:
Performance: It means knowledge, practice and attitudes of nurses regarding care of patient with spinal cord injury.
Spinal cord injury: Traumatic event result in dysfunction or injury of the spinal cord of a person.
Educational program: It refers to the systemically planned formulated teaching program designed to provide knowledge related to certain piece of issues.
The study was portrayed under the four main designs as follows:
I. Technical design.
II. Operational design.
III. Administrative design.
IV. Statistical design.
I. Technical design:
The technical design includes research design, setting, subjects and tools for data collection.
Research design:
A quasi-experimental design was utilized to achieve the aim of the current study. A quasi-experimental design is a one-group (pretest-posttest).
A quasi-experimental design is used frequently because is practical, less costly, and feasible with potentially generalizable findings. This design is more adaptable to the real-world practice setting than the controlled experimental design. This design may be the only way to evaluate the effect of the independent variable for some research hypotheses (LoBiondo-Wood & Haber, 2021).
Research setting:
This study was conducted at the General Intensive Care Unit (ICU) at El-Dermdash Ain Shams University Hospitals, ICU located at the 1st floor in hospital. It was distributed into three wings, first unit contains 12 beds, second unit contains 12 beds, and the third unit contains 8 beds and there is an isolation room contains 8 beds with total number of 40 beds, receiving different types of patients including (intracerebral hemorrhage, poly-trauma, spinal cord injury, traumatic brain injury, respiratory failure) that’s why we select this setting to conduct the current study.
Research subjects
Convenient sample of all available nurses (No=35), who working in previous mentioned setting and accepted to participate in the study from both gender with different qualifications, age, training courses and years of experiences were recruited to this study.
Tools of data collection:
Three tools were used for data collection.
I. Self-administered Questionnaire: (Appendix I).
The researcher developed it in the Arabic language to assess nurses’ level of knowledge regarding the care of patient with spinal cord injury after reviewing recent related literature. It included two parts: First part: it was concerned with the characteristics of nurses under study such as age, gender, education level, years of experience and attending previous training courses regarding spinal cord injury care.
Second part: It was developed by researcher guided by Paul et al., (2016); Urden et al., (2017); Burns and Delgado, (2019); Chulay et al., (2019); It was concerned with the assessment of nurses’ level of knowledge regarding to care of patient with spinal cord injury. It included 56 questions in the form of multiple-choice and true/false questions. It was categorized into three sections as follows; Section (1): it is concerned with the assessment of nurses’ knowledge regarding the structure and function of spinal cord. Section (II): It is concerned with the assessment of nurses’ knowledge regarding spinal cord injury including its definition, types, risk factors, causes, signs and symptoms, complications, diagnosis and management. Section (III): It is concerned with the assessment of nurse’s knowledge regarding nursing care of patient with spinal cord injury.
II. Nurses’ observational Checklist (Appendix II):
It was concerned with the assessment of the nurses’ practice regarding the care of patient with spinal cord injury. It was adapted and modified by the researcher from Perry et al., (2019); Stein and Hollen, (2020); Lister et al., (2021); Perry et al., (2021). It consists of nursing assessment, nursing interventions and nursing measures to avoid complications for patient with spinal cord injury. It include checklist namely; primary and secondary survey (39 steps), vital signs monitoring (5 steps), neurological assessment (orientation, GSC, sensory, motor assessment and deep tendon reflexes) (24 steps), cardiac monitoring (9 steps), oxygen therapy (14 steps), endotracheal suction and care (29 steps), nasogastric feeding and care (29 steps), mobilization and skin care (5 steps) and nursing measures to avoid complications (15 steps).
III. Nurses’ attitudes Likert scale toward caring for patient with spinal cord injury (Appendix III): It concerned with assessment of the nurses’ attitudes toward caring of patient with spinal cord injury. It was developed in the Arabic language to assess nurses’ attitudes toward caring of patient with spinal cord injury after reviewing recent related literature (Abdoh et al., 2017; Al-Othman et al., 2018). It consists of 16 statements that is reflect nurses feeling and reactions toward caring of patient with spinal cord injury and nurses’ responses is grading according to Likert scale (agree, neutral and disagree). Scoring system for Nurses’ attitudes Likert scale toward caring for patient with spinal cord injury consisted of 16 statements including 14 statements reflect positive attitude and two statements reflect negative attitude, the 3-point Likert scale responses was ranged 2 (agree), 1 (neutral), 0 (disagree).
Results:
Findings of the current study can be summarized as the following: 51.4% of the studied nurses were between the age group 20 to less than 30 years old with mean age 29.2 ±7.2 years old, and 54.3% of them were females. Meanwhile, 60% of the studied nurses were technical institute nurses, 42.9% of them had previous experience less than 5 years with mean years of experience 8.5±3.8. Moreover, 20% of the studied nurses attended previous training courses regarding spinal cord injury care, and reported that no availability of manual /booklet regarding care of patient with spinal cord injury.
Moreover, 28.6% the studied nurses had total satisfactory knowledge level regarding spinal cord injury care pre-program compared to 85.7% post-program, and 86.6% at the follow up phases with high statistically significant difference between pre/post, and pre/follow-up with (x2=23.333, P<0.001) & (x2=11.209, P<0.001 respectively).
Meanwhile, 5.7% of the studied nurses had positive attitude toward care of patient with spinal cord injury preprogram, while 80% and 74.3% had positive attitude post program and at the follow up phase respectively, with statistically significant difference between pre/post with (x2=39.433, P<0.001) and pre/follow-up (x2=34.285, P<0.001).
The total satisfactory level of practice of the studied nurses regarding care of patient with spinal cord injury was 17.10% at the pre-program assessment compared to 74.30% at the post-program assessment, and 60% at the follow up phase with high statistically significant difference between pre/post with (x2=23.026, P<0.001), and pre/follow with (x2=13.566, P<0.001).
Conclusion:
On the light of the current study results, it could be concluded that educational program had positive effect on the studied nurses caring of patient with spinal cord injury with statistical significance improvement in the total satisfactory level of knowledge, attitude and practice throughout program phases which support study hypothesis that educational program will improve nurses’ performance regarding care of patient with spinal cord injury.
Recommendations:
Based on the result of the current study the following recommendations could be suggested:
• Workshops, seminars and conferences aiming to update nurses’ knowledge, skills and attitude regarding care of patient with spinal cord injury should be arranged periodically at the critical care units.
• Nursing protocol related to care of patient with spinal cord injury should be available at the critical care units.
• Manual book including nursing guidelines related to care of patient with spinal cord injury should be available in health care setting caring for such group of patients.
Research:
• Development of a system to evaluate nurses performance periodically to determine strategies for upgrading and enhancing their performance continuously with strict follow up plan during patient care.
Finally, the present study concluded that the application of educational program had a positive effect on studied nurses’ performance as well as support the research hypothesis.