الفهرس 
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Abstract
Nursing the neurological patients in coma can be a challenging experience. Unconscious patients have no control over themselves or their environment and thus are highly dependent on the nurse. The skills required to care for unconscious patients are not specific to critical care and theatres as unconscious patients are nursed in a variety of clinical settings. Nursing such patients can be a source of anxiety for nurses. However, with a good knowledge base to initiate the assessment, planning and implementation of quality care, nursing patients who are unconscious can prove highly rewarding, and the skills acquired can promote confidence in the care of all patients (Geragthy, 2011).
So that continuing professional development is essential to ensure that, nursing practice remains aligned with the health care needs of the Egyptian community.
Aim of the Study
This study aimed to evaluate the impact of a training program regarding caring for neurological patients in coma upon nurses’ performance
Through the following:
1. Assessing nurses’ performance “knowledge and practices” regarding caring for neurological patients in coma.
2. Planning, developing and implementing the training program regarding caring for neurological patients in coma upon nurses’ performance.
3. Evaluating the impact of the training program regarding caring for neurological patients in coma upon nurses’ performance.
Research Hypothesis:
The training program will have a positive effect regarding caring for neurological patients in coma upon nurses’ performance.
Subjects and Methods
Research design:
A quasi-experimental research design was used in the study.
Setting:
The study was conducted at the Intensive Neurological Care Units, Emergency Department and Geriatric ICU, in Ain Shams University Hospitals. The choice was based on surveying all emergency departments and ICUs at Ain Shams University Hospitals.
Subjects:
The subjects of the present study included all the available nurses as a convenience sample. Including 32 nurses after gaining their consent to participate in the study.
Study tools:
The researcher used the following tools for data collection:
1- Self-administered Questionnaire sheet. It is divided into two parts:
Part one: It is concerned with characteristics of the nurses under study such as; age, level of education, occupation ect.
Part two: It was designed to assess knowledge of nurses working with neurological coma patients (pre, post & 6 months after program implementation).
For scoring system, one point was given for the correct answer and zero point for the incorrect one.The total score for all questions was 78. The scoring levels were used as follows:
Unsatisfactory level <70%
Satisfactory level ≥70%
2- Nurses Performance Observational Checklist:
To assess the level of nurses’ practices during their work in ICU and emergency units (pre, post and 6 months after the program implementation.
Scoring system of observation checklist:
Each item of observation checklist separated assessed and scored as following:
One point was given for a done step, and zero point for a not done step.
The total score for all observation checklists was 214. The scoring levels were categorized as follows:
Incompetence level of nursing performance <80% for steps not done at all.
Competence level of nursing performance ≥ 80% for steps done correctly with or without priorities
3- Nurses Attitude Assessment sheet:
It was used to assess the nurses’ attitude towards neurological coma patient’s pre, post and 6 months later of the program implementation.
The total score ranges were as follows: (5 to 1): strongly agree (5), agree (4), uncertain (3), disagree (2), strongly disagree (1).
4- Nurses opinionnaire sheet (Appendix IV):
It was developed to test and know view of the nurses in the training program
Pilot study:
It was carried out on four I.C.U and emergency nurses. They were chosen from Ain Shams University Hospitals. This was done in order to test the applicability of the tools and to estimate the time required for filling in the questionnaire. Modifications on the tools were based on the results of the pilot study. Some statements were omitted, added or rephrased and then the final forms were developed. All subjects who shared in the pilot study were excluded from the main study sample.
The field work:
Data collection of this study was carried out in the period from beginning of September 2011 to the end of September 2012, during morning and afternoon shifts in the ICUs and emergency departments at Ain Shams University Hospitals, three days each week. The purpose of the study was explained for the nurse’s prior data collection. The researcher assured that the data collected and information will be treated confidentially.
The main results are displayed as follow:
The present study results revealed that the mean age among the studied group was 29.8±6.9 years, more than two thirds of them 68.75% had diploma in nursing, less than three quarters of them (71.88%) were staff nurses, more than two thirds of them (68.8%) had less than ten years of experience and more than three fifths of them (62.5%) attended training program related to critical care.
The results of the present study revealed statistically significant differences regarding total level of nurses’ knowledge pre/ post program implementation in relation to most of items (P=0.001); pre/ 6 months after the program implementation (P=0.027) and insignificant difference between post/after 6 months later of program implementation (P=0.076).
There was noticeable improvement in the nurses’ knowledge detected after the implementation of the training program which dropped slightly 6 months after program implementation.
There were statistically significant differences regarding total level of nurses’ practice pre/post training program in relation to most of items (P=0.001), and insignificant differences between pre/after 6 months and between post/ 6 months after program implementation (P=0.079 & 0.0148 respectively).
Regarding total level of nurses’ practice pre/post and after 6 months after program implementation. This study showed also noticeable improvement in the nurses’practice detected after the implementation of the training program compared to pre/ 6 months after program implementation.
There were statistically significant differences regarding neglected items of performance among all study phases pre/post, pre/after 6 months, post/6 months after program implementation in relation to most of variables and there were statistically insignificant differences regarding one item only “identify the patient using two identifiers” in all study phases.
There were three variables not applicable among all study phases, which include “put on goggles, gown and mask; put sterile gloves on dominant hand; and aspirate and examine the stomach contents, test the pH in Ryle feeding.
Regarding nurses attitude toward the neurological coma patients, this study showed statistically significant differences regarding half of variables at all program phases.
Most of the studied nurses expressed that the learning strategy was suitable, and theory of program was benefiting (90.62% & 87.5% respectively), the researcher was available most of the time and direct method of evaluation, was suitable (65.6% & 62.5% respectively), while more than three quarters of them agreed about the content of the program covered the topics and method of explanation was understandable (78.12%).
Statistically significant positive relations were detected between nurses’ characteristics and level of studied nurses’ performance (knowledge & practice) regarding pre/post program implementation.
This study revealed that there were statistically significant relations between age of studied nurses 18-<30 years and their level of knowledge and practice (P<0.05&<0.01) at all study phases except post/6 months after program implementation.
There were statistically significant relations between academic qualification of studied nurses ”diploma of nursing” and their level of knowledge and practice (P=<0.05, <0.01) except post/6 months after program implementation.
The study revealed statistically significant relations between years of experience of studied nurses less than 10 years and their level of knowledge and practice.
There were statistically significant relations between nurses who attended training courses related to critical care and their level of knowledge and practice regarding pre/post, post/ 6 months after program implementation.
There was a statistically significant correlation between total score of nurses’ knowledge and total practice (r = 0.765, P <0.001).