الفهرس 
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Abstract
In a climate of rapid changes in the structure of health services and the development of new categories of nursing personnel, it is imperative to define and apply nursing care standards for the hematemsis patients. Such standards demonstrate to the public that nurses are concerned with the quality of nursing care and with self-regulation to assure a desirable level of care. Quality of care is a multidimensional, yet elusive concept that reflects a judgment about level of care rendered to patients. One way to quantify a particular level of care and, thus provide a mechanism for measuring its attainment is to establish standards. Standards are defined as the desired or achievable level of performance related criterion, against which actual performance is measured or compared. In addition, standards of care are defined as authoritative statements that describe common or an acceptable level of client performance. Upper gastrointestinal bleeding (UGIB) patients need special nursing care, and to assure quality of this care it is important to establish standards of nursing care. The focus of the standards and the framework within which the multiple activities of nursing care performed needs to be determined. Nurses represent the largest percent of workers in hospitals and any disturbance in nursing performance will have an affect on care that is provided to UGIB patients, thus this study will attempt to determine the impact of application of the pre-established nursing care standards for patients with upper gastrointestinal bleeding at the Hematemsis Unit in Mansoura Main University Hospital. Material and methods: Setting: The study was conducted at the Hematemsis Unit in Mansoura Main University Hospital. Subjects: Subjects of the study consisted of two groups: Group I (GI) a convenient sample composed of 50 adult patients aged from 20 to 59 years for both sexes who were admitted to the previously mentioned above setting and divided into two equal groups, group A (control group) and group B (study group) regardless the cause of upper gastrointestinal bleeding (UGIB). Group II (GII) consisted of all nurses staff present at the above mentioned setting, their number was 17-nurse work three shifts in the day, morning, afternoon and night shift. Tools: the tools of the study were arranged into three main sections: Section 1: This section consisted of four tools which were used in the study as follows: Tool I Tool I: ’’ patient’s health relevant information sheet’’ This tool was developed by the researcher and consisted of two parts, part 1, ’’patient’s socio demographic data ’’, this part concerned with bio-sociodemographic data. It included structured questions related to patient’s name, age, sex, education level, marital status, occupation, and date of admission. Part II ’’patient’s medical data ’’, this part consisted of statements regarding patient’s health history about, present diagnosis, recent time of bleeding, previous time of bleeding episodes, previous hospitalization, past medical history, laboratory studies, level of consciousness, mobility status and current intake of medications. In addition, this part included current events that may lead to bleeding such as recent ingestion of drugs known to irritate gastric mucosa, alcoholism, smoking, dietary habits (salt and fat diet, spicy food), frequent stress and anxiety, seasonal occurrence and associated diseases such as (chronic liver disease, cancer, and coagulapathies) Tool II Tool II: ’’structured interview patient satisfaction schedule’’ This tool was used to assess patient’s satisfaction and aimed to measure patient satisfaction on his admission and after application of proposed standards. Tool III: ’’patient’s knowledge questionnaire’’ This tool was developed by the researcher after reviewing the related literature. It aimed to assess patient knowledge on his admission and after application of proposed standards. Tool IV: ’’ The upper gastrointestinal bleeding (UGIB) nursing standards observational checklist’’ This tool was developed by the researcher after reviewing the related literature. It aimed to measure the application of the pre established nursing care standards competencies. Section 2: This section concerned with the proposed standards which was applied by the nurses for patients with upper gastrointestinal bleeding. Section 3: This section concerned with patients’ booklet in which drawing and simple instructions were clarified in order to facilitate instructions; information and care needed for hematemsis patients in Hematemsis Unit and for adapting his life after discharge. Results of the study revealed that: a) A significant difference between the mean score achieved by the study and control group regarding satisfaction and knowledge level. b) The results obtained show that, the application of nursing care standards for hematemsis patients had a positive effect on the clinical performance of the study group. c) The application of planned established standards can be expected to contribute to safer and more knowledgeable nursing practice, to more effective utilization of health care personnel , to the development of more creative and relevant ways of delivering health services and to increase community and interdisciplinary participation in meeting health goals. Recommendations: a) Generalized application of the nursing care standards for patients with UGIB at all Hematemsis Unit of Mansoura University Hospitals b) Newly appointed nurses to the Hematemsis Unit are required to successfully complete a test of basic knowledge and skills related to hematemsis patient care before assuming independent responsibility for patient care. c) Continuing performance appraisal of staff nurses by nursing service administrators, using the proposed standards. d) Continuing development of patients’ knowledge about disease and treatment course through guidance booklet contain relevant information with simple figures.