الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 229 |  |  |
| | | from | 229 | | |
Abstract
Summary
Open heart surgeries are one of the most common
surgical procedures performed worldwide. The operation
improves survival as well as the quality of life of patients
with coronary heart disease. Amount of risk can vary
according to age, general health, smoking history, specific
medical conditions and heart function. Open heart surgeries
are recommended to attention to change life style such as
(weight loss, smoking cessation, maintain simple exercise)
is need after surgery (American Heart Association, 2013).
Patient admitted to intensive care unit immediately
postoperative and the ICU nurse should receive a report
about the patient’s preoperative history, surgical procedure,
and intraoperative details includes volume of blood given
& blood loss, urine output and intraoperative medications.
Immediately the nurse performed closely assessment,
monitor’s cardiac rate & rhythm, auscultate lungs sounds,
assess patient pain, measures intake & output , assess level
of consciousness , care of ventilator tubes, measure central
venous pressure and observe wound site. (Stannard,
Krenzischek, 2018).
Summary
123
Aim of the study:
The aim of this study was to assess nurses’
performance caring for patient with open heart surgery
during the first 24 hours through the following:
Assessing nurses’ level of knowledge in caring of
patient with open heart surgery during the first 24
hours.
Assessing nurses’ practice and attitude in caring of
patient with open heart surgery during the first 24
hours.
Study design:
Exploratory descriptive design was utilized in this
study.
Setting:
The study was conducted in the cardiac surgery
intensive care unit and open heart surgery intensive care
unit at the cardiac academy and specialized hospital, at Ain
Shams University Hospitals.
Subjects:
A purposive study subject of the forty five (45) nurses
caring for patients with open heart surgery in the previously
Summary
124
mentioned units and agreed to participate in the study were
recruited in this study.
Tools of data collection:
I. Self-Administered Questionnaire Tool it used to
assess nurses’ knowledge in caring of patient with open
heart surgery during the first 24 hours, developed by the
investigator and based on reviewing of the recent literature
(Mohamed, 2007; Buist, 2010; Elsayed, 2012; David,
2013 & George, 2013) and it consists of three parts:
1. 1stpart concerned with demographic characteristics
of the nurses’ under the study included (age,
gender, educational level, marital status…)
2. 2ndpart concerned with nurses’ opinion about
factors affecting nurses’ performance that included
work system factors, environmental factors and
infection control precautions.
3. 3rdpart concerned with nurse’s knowledge
regarding caring of patient with open heart surgery
during the first 24 hours that included: preparation
intensive care unit & patient assessment and
nursing interventions & expected complications
occurred during the first 24 hours.
Summary
125
II. Nurses’ Performance Observational checklist it
used to assess nurses’ practice in caring of patients with
open heart surgery during the first 24 hours; this part
quoted from (Black, 2005; Brown, 2007; Carpenito,
2010; Osborn, 2010 &Elkin, 2012) modified by the
investigator and includes the following:
Nursing assessment of the patient on admission
intensive care unit.
Nursing practice regarding hemodynamic stability
stage.
Nursing care during the first 24 hours included:
• Hand washing & applying a cardiac monitor
• Suctioning technique & care of patient on
ventilator
• Measuring central venous pressure
• Management underwater-seal & care of arterial
pressure line.
III. Likert scale quoted from (Mcnabb, 2013) it used to
assess nurse’s attitude in caring of patient with open heart
surgery during the first 24 hours.
Pilot study:
A pilot study was conducted on 10% of the study
subjects in order to test applicability of the study tools, the
Summary
126
clarity of the included questions as well as estimated the
average time needed to complete all questions. Result
obtained were studied and analyzed. Accordingly,
modifications were made for the final development of the
study tools. Then five nurses selected for the pilot study
were excluded from the study sample and replaced by
another 5 nurses.
Fieldwork:
Field work included two phases as follow:
Preparatory phases: it included reviewing of the
current and more recent national and international literature
concerning of the patient with open heart surgery from the
various aspects of the study issues in order to develop the
data collection tools.
Implementation phase: including 2 phases: first:
interviewing with (45) nurse to explain the aim of the
study, the effect of the study on their performance as well
as quality of patients care and take their approval to
participate in the study prior to any data collection, second:
assessing nurses’ knowledge & practice and attitude
regarding caring of patient with open heart surgery during
the first 24 hours by using self-administered questionnaire
tool, an observational checklist and likert scale.
Summary
127
Result of this study showed that:
1. Regarding nurse’s opinion about factors affecting
their performance the results of the study revealed
that, more than half of the nurse disagree about work
system & infection control precautions (57.8% &
51.1% respectively) and about two third of them
(60%) have unsuitable work environment.
2. Regarding level of knowledge the study revealed
that, about half (53.3%) of nurses had insufficient
knowledge regarding preparation intensive care unit
& patient assessment and nursing interventions &
expected complications occurred during the first 24
hours.
3. Regarding attitude the study revealed that, more than
half of nurses (57.8%) had negative attitude regarding
caring for patient with open heart surgery during the
first 24 hours.
4. Regarding level of practice the study revealed that,
about half of nurses (51.1%) had unsatisfactory level
of nursing practice regarding caring for patient with
open heart surgery during the first 24 hours.
5. There was statistically significant difference between
total level of nurses knowledge & practice (X2=27.253
at P<0.001*)
Summary
128
6. There was no statistically significant difference
between total level of nurses’ knowledge & attitude
(X2=3.593 at P>0.05).
7. There was no statistically significant difference
between total level of nurses’ practice & attitude
(X2=1.067 at P>0.05)
8. There was a statistically significant relation between
level of nurses’ knowledge and demographic
characteristics about age, marital status, and years of
experience (r=0.003 at P=<0.05 & r=0.004
respectively) at P=0.05
The study concluded that:
1. More than half of nurses disagree about work system
& infection control precautions and two third of them
have unsuitable work environment.
2. More than half of nurses had insufficient knowledge
regarding preparation intensive care unit & patient
assessment and nursing interventions and expected
complications occurred during the first 24 hours.
3. More than half of nurses had negative attitude
regarding caring for patient with open heart surgery
during the first 24 hours.
Summary
129
4. More than half of nurses had unsatisfactory level of
nursing practice regarding caring for patient with
open heart surgery during the first 24 hours.
The study recommendation that:
1. Conducting periodic in-service training advanced
care program for nurses caring for patients under the
study for improving their performance and patient
quality of care is essential.
2. Developing a procedure book for open heart surgery
patient care during the first 24 hours including initial
operational history taking, assessment of
hemodynamic stability procedure & policy
instructions is important and will have a positive
effect on quality of nursing care.
3. Open heart surgery intensive care unit should be
supplied by standardize checklist, drug books and
advanced equipment.
4. For the administrative point of view, sufficient
number of qualified nurses should be provided
throughout the three shifts for improving efficient
quality of care needed for patient with open heart
surgery during the first 24 hours.
Summary
130
5. Further researches are recommended periodically to
be caring out the new approaches in the area of
management of patients with open heart surgery and
evaluate its reflection on patient’s outcomes