Nurses’ Knowledge and Practices about Administration of Medications via Nasogastric Tube among Critically Ill Patients

Administering medication via enteral tube is predominantly a nursing responsibility across countries. It is important to identify what nurses actually know and do when giving enteral medication for critically ill patients to ensure patient's safety and prevent complications. The aim of this study is to assess the nurses’ knowledge and practices about administration of medications via nasogastric tube (NGT) among critically ill patients at Cairo University Hospitals. Sample consists of sixty bedside male and female nurses who are working in the different Critical and Intensive Care Units. Descriptive/exploratory research design was utilized in the current study. This study was conducted at the different Critical and Intensive Care Units at El-Manial Specialty Hospitals affiliated to Cairo University. Three tools were utilized to collect data pertinent to the study; Nasogastric medication administration nurses' knowledge questionnaire schedule, Nurses' opinionaire sheet and Nasogastric medication administration observational checklist. The nurses were interviewed for answering the knowledge questionnaire schedule and opinionaire sheet then each nurse was observed during administration of medication via NGT for three different times using nurses' observational check list. The mean of the three observations was calculated. Findings of this study shows that the majority of the studied sample were females, married and having diploma qualification as well, more than two third of them their age ranged between 26 – 45 years. More than half of them had more than 10 years of experience. All of them were having an unsatisfactory level of knowledge and practices. Results of the present study indicated that there is a gap between nurses' knowledge and practices as compared to the standard guidelines about medication administration via nasogastric tube. The study recommended that enrichment of the Critical Care nurses at El-Manial Specialty Hospital knowledge and practices related to administration of medications via nasogastric tube according to the standard guidelines will be helpful to ensure patient safety and provide cost effective care. Also replication of this study on larger probability sample at the different geographical location at Egypt is highly recommended. Keywords: Nasogastric tube – administration of medication via nasogastric tube – critically ill patient – nurses' knowledge – nurses practices

Nurses’ Knowledge and Practices about Palliative Care among Cancer Patient in a University Hospital - Egypt

Background: Comprehensive cancer care requires the integration of palliative care practices and principles across the trajectory of the cancer experience and may be the sole focus of care for those patients with advanced incurable disease. As the incidence of cancer increases worldwide and the burden of cancer rises, especially in low and middle resource countries, the need for palliative care is greater than ever before and this care is most effectively provided by a multidisciplinary team. Because nurses have integral roles on that team by; identifying symptoms, providing care coordination, and assuring clear communication, so assessing nurses’ knowledge and performance of palliative care is important. Aim of the study: to assess the nurses’ knowledge and practices of palliative care among cancer patients. Sample: A sample of convenience including thirty male and female nurses who are working in the Intensive Care Unit. Research Design: A descriptive/exploratory research design was utilized in the current study. Setting: This study was conducted at the National Cancer Institute, Cairo University. Tools: Two tools were developed by the researcher and utilized to collect data pertinent to the study; A structured knowledge assessment questionnaire, and performance observational checklist. Included nurses were interviewed to fill out the knowledge assessment questionnaire then each nurse was observed in three different occasions using nurses' observational checklist. Results: About half of the studied sample were at the age group of 18-25, with a mean age of 26.53 + SD= 6.29, married, graduated from technical nursing institute. Around one third of the studied sample had years of experience ranged from 5 to <10 years. Concerning knowledge, and practice the current study revealed that the studied nurses had unsatisfactory knowledge as well as practice level, with mean scores of 57.7% of 26.53 + SD= 613.28, and 51.09 + SD =9.17 respectively. There is positive correlation between years of experience and age (r = 0.893,at p < 0.000); years of experience and total practices scores (0.437, at p< 0.016); general knowledge scores and physical symptoms (r= 0.389, at p0.033); physical symptoms and psychological symptoms and total knowledge scores(r = 0.683 at p< 0.000;r=0.949,at p<0.000); psychological symptoms and total knowledge scores(r=0.788,at p<0.000) respectively. Conclusion: There is need for continuing education for upgrading nurse’ knowledge about palliative care. Recommendations: enrichment of all nurses at any educational institute about knowledge and practices related to palliative care according to the standard guidelines will be helpful to achieve quality of life. Also replication of this study on larger probability sample at the different geographical location at Egypt is highly recommended. Keywords: Palliative care – Cancer patients – nurses' knowledge – nurses’ practice

Factors Predisposing to Organ (s) Dysfunction among Critically Ill Adult Patients at a Selected University Hospital in Egypt

Multiple organs dysfunction is one of the most challenging clinical problems in the intensive care units. It is one of the leading causes of morbidity and the main cause of mortality in critically ill patients. Therefore, requires efforts of of the health care team especially critical care nurses who are the healthcare providers and most closely involved in the daily care of critically ill patients. They have the opportunity to early detect and identify patients at risk for the development organs dysfunction. Aim of the study: to identify factors predisposing to organ(s) dysfunction among critically ill adult patients at a selected university hospital. Research questions: Q1-What is the frequency of organ dysfunction among critically ill adult patients at a selected university hospital, in Egypt? Q2-What are diffrent predisposing factors to organ dysfunction among critically ill adult patients at a selected university hospital, in Egypt?. Research design: A descriptive/exploratory research design was utilized. Sample: A sample of convince consisting of 110 adult male and female critically ill patients admitted to to different intensive care units over a period of six months was included. Tools of data collection: Four tools were utilized for data collection: Sociodemographic and Medical data Sheet; Predisposing Factors to Organ (s) Dysfunction Assessment Sheet; Physical Assessment Sheet; and The Sequential Organ Failure Assessment score (SOFA). Results: The current study revealed that: more than half (55.5%) of the studied sample had two organs dysfunction, of these (n=33/54.1%) were in age group from 58 - < 68, with no significant statistical relationship between the age and frequency of organs dysfunction (?2/P = 20.24/0.20). Infection, heart failure, hypertension, and diabetes were the common predisposing factors to organ(s) dysfunction in percentages of 63.6%, 30.2%, & 22% respectively. Mild degree of organs dysfunction were most frequently noticed on admission, after 24 and 96 hours of admission to the ICU with mean SOFA scores of 5.08 ± 1.601, 4.87± 1.86, & 5.00 ± 1.87 respectively. The mean total and subtotal SOFA scores didn’t differ significantly in different assessment times (F / P= 1.29/0.35, 3.63/0.10, 2.69/0.72). The fate of the studied sample differed significantly in relation to the total mean SOFA scores (?2= 54.96, p= 0.000). Conclusion: multi-organ(s) dysfunction was evident among critically ill patients. The most common predisposing factors were comorbidity diseases, infection on admission, after 48 and 96 hours of admission, having different types of shock, and trauma. So, identification and management of these predisposing factors may decrease the complication and improve patients' outcomes. Recommendations: Based on findings of the present study the following are recommended: strict application of universal precautions / infection control measures; prevention, and early detection of shock, sepsis, and so organ dysfunction; designing continuous practical educational programs about the application of the strict aseptic technique, the universal precautions and infection control for critical care nurses; Designing booklets and posters about early manifestation, predisposing factors, and importance of prevention of sepsis and organ dysfunction for critical care nurses; and utilization of SOFA scores in the management of patient with sepsis and organ dysfunction. Key words: Predisposing factors, Organ(s) Dysfunction, Critically Ill Patients, Sepsis, SOFA scores

Cerebrovascular Stroke Recurrence among Critically Ill Patients at a Selected University Hospital in Egypt

Cerebrovascular stroke (CVS) is a fatal disease. Literature review cited that, CVS recurrence is more devastating than the first attack. The risk of recurrent CVS is up to 15 times greater than the risk of CVS and is attributed to insufficient control of risk factors and non compliance with medical advice. So that, identification of risk factors of recurrence is an important role of the critical care nurses, plays an essential role in the prevention of further stroke. Aim: to study the risk factors, frequency and severity of recurrent cerebrovascular stroke among adult critically ill patients admitted to intensive care units. Research questions: Q1- What are the risk factors of recurrent cerebrovascular stroke among critically ill patients at a selected university hospital? Q2- What are the intervals of recurrence from the first attack of cerebrovascular stroke? Q3- What is the frequency of recurrent cerebrovascular stroke attacks among critically ill patients?  Q4-What is the severity rate of recurrent cerebrovascular stroke among critically ill patients?. A descriptive exploratory research design was utilized in the current study. The study was conducted at different CVS intensive care units at a selected University Hospital. A sample of convenience including all adult patients admitted to the ICU with recurrent CVS over a period of six months (80 patients) was included. Three tools were used for data collection: socio-demographic and medical data sheet, CVS risks factors assessment sheet, and the National Institutes of Health Stroke Scale (NIHSS). Results: The majority of the studied group admitted with the first recurrence of CVS, had different chronic illnesses such as hypertension (100%) & diabetes mellitus (95%). The duration of CVS recurrence ranged from two - < five years among 30% of the studied group. 36.25% of the studied group admitted with severe degree of CVS with a mean severity score of (X = 19.17 + SD = 1.255). Conclusions: uncontrollable risk factors (old age, male gender, marriage); life style risk factors (smoking, obesity, low income); chronic medical diseases (old CVS, hypertension, diabetes mellitus, ischemic heart disease,  myocardial infarction, heart failure,… etc ); noncompliance with prescribed drugs of chronic illnesses, abnormal laboratory investigations (high cholesterol, triglyceride, low density lipoprotein) represented the common risk factors and contributed to recurrent cerebrovascular stroke with different severity. Key words: Cerebrovascular stroke, recurrence, critically ill patients, risk factors, severity

Effect of Earplugs and Eye Mask on Sleep Quality Among Patients with Acute Coronary Syndrome at Assiut University Hospital

Background: Sleep disturbance can cause multiple negative cardiovascular effects among patients with Acute Coronary Syndrome (ACS). Aim: this study carried out to investigate effect of earplugs and eye mask on sleep quality among patients with ACS. Design: a quasi-experimental design. Setting: Coronary Care Unit at Assiut University Hospital. Subjects: Convenience sampling of 60 male and female adult patients were assigned randomly to two equal groups (30 each). Tools: Four tools were utilized to collect data of study, which were: Tool I Acute Coronary Syndrome patient assessment sheet Tool II: Factors affecting sleep quality among patients with ACS during night Tool III: 0–10 Numeric Pain Rating Scale Tool IV: ST Mary’s Hospital Sleep Questionnaire (SMHSQ). Methods: Researcher assessed factors affecting sleep quality during night as base line data and on daily basis for 3 consecutive days. Then, earplugs and eye mask were placed for study group between 7:10 PM. On morning, sleep quality was assessed for study and control groups by using (SMHSQ) between 7:8 AM. Results: Finding of this study supported stated research hypotheses with statistical significant difference between study and control groups regarding total mean of sleep quality score during 1st and 2nd nights of intervention (P=0.000**, P= 0.014*) respectively as well as some of environmental factors affecting sleep quality with P. value < 0.05. Conclusion Earplugs, eye mask significantly improve sleep quality of patients with ACS. Therefore, offering earplugs and eye mask as a part of routine nursing practice for all ACS patients is highly recommended.                                                                                        Key words: earplugs and eye mask, sleep quality, acute coronary syndrome patient

Impact of Early Ambulation on Patients' Outcome Post Transfemoral Coronary Procedures, at Assiut University Hospital

Cardiac catheterization remains the most definitive procedure for diagnosis and evaluation of coronary artery disease. Aim: this study was carried out to investigate the impact of early ambulation post transfemoral coronary procedures on back pain, urinary discomfort and vascular complications. Design: a quasi-experimental design. Setting: in catheterization and coronary care units. Subjects: A convenience sample of all adult educable and mentally competent male and female patients aged from (18-60 years old) who are scheduled for non-emergency percutaneous coronary intervention (PCI) and coronary angiography (CA) through femoral artery during a period from july 2010 to june2011 were eligible for inclusion in the sample. Tools: Four tools were utilized to collect data pertinent to the study, tool assessment of patients after femoral sheath removal and angioplasty data tool II: assessment of back pain tool III: urinary discomfort assessment tool. tool IV: vascular complications measurement after femoral cardiac catheterization Methods: patients in the study group were ambulate after four hours bed rest post transfemoral PCI and 2 hours after CA, whereas patients in the control group were ambulate after 12–24 hours post transfemoral PCI and 6-8 hours after CA(usual care). Results: Finding of the present study revealed that a significant statistical difference was existed between both studied groups in relation to back pain and urinary discomfort for PCI and CA. As regards to vascular complication, no significant statistical differences were put into evidence between both studied groups. Conclusion: early ambulation is safe and feasible for patients undergoing PCI and CA. Key words: early ambulation, femoral coronary procedures, back pain, urinary discomfort, nurse's role, and vascular complications

Intensive Care Nurses’ Knowledge & Practices regarding Infection Control Standard Precautions at a Selected Egyptian Cancer Hospital

Critical care nurses are the health care professionals who have the obligation to protect critically ill patients against infection especially those who are immune compromised, in order to enhance their recovery, prevent deterioration in their health, and achieve high quality nursing care. Therefore critical care nurses should have sound knowledge and strict adherence to infection control standard precautions. Aim of the study: to assess nurses' knowledge and evaluate their practice regarding infection control standard precautions. Research design: A descriptive research design was utilized in this study. Sample: A sample of convenience including 77 ICU nurses was recruited in the current study.  Setting: The study was carried out at the Intensive Care of a selected Cancer Hospital in Egypt. Tools of data collection: Two tools were developed, tested for clarity and feasibility, and then used to collect data pertinent to the current: a- Structured Interview Questionnaire to assess nurses' knowledge regarding infection control standard precautions. b-Nurses’ Performance Observational Checklist to evaluate nurses' practice / utilization of infection control standard precautions. Results: the current study revealed that, approximately two thirds (63.6%) of the studied sample had unsatisfactory knowledge level (<75%) with a mean total knowledge score of 102.5 + 13.7. However, more than half (57.1%) of the studied sample had satisfactory performance level (>75%) with a mean total performance scores of 77.3+4.4. Negative significant correlations were found between: mean knowledge scores, and age; mean knowledge scores and years of experience (r = -.323 & r = -.325 at P < 0.004 respectively); between mean practice scores and age; and mean practice scores and years of experience (r = -.235 & r =-.291 at P < 0.39, 0.010 respectively). However, positive correlations were found between mean knowledge scores and mean practice scores; age and years of experience (r = 0.318 & 0.794 at P < 0.005 & 0.000 respectively). Conclusion: Based on findings of the current study, it can be concluded that inspite of having satisfactory performance level regarding infection control standard precautions, critical care nurses had unsatisfactory knowledge level. Recommendation: updating knowledge and performance of ICU nurses through continuing in-service educational programs; emphasizing the importance of following the latest evidence-based practices of infection control in continuing education / training programs; strict observation of nurses’ performance/ utilization of infection control standard precautions and correction of poor practices by the infection control team are required; and providing training programs for  newly joined ICU nurses about infection control standard precautions and at regular intervals. Key Words: Infection control (IC), Standard precautions (SP), Intensive care unit (ICU), Knowledge, Practice

Knowledge and Attitude of Pregnant Women towards Antenatal Exercise in Erbil City

Background and objective: Antenatal exercises provide many health benefits not only to pregnant mothers but also to the fetuses. In the absence of medical or obstetrical complications, pregnant women are encouraged to continue and maintain active lifestyles during their pregnancies. The objective of this study is to assess knowledge and attitude of pregnant women towards antenatal exercises. Methods: A descriptive cross-sectional study was conducted to assess mother's knowledge and attitudes regarding exercise during pregnancy. The convenience sample of the study included 100 pregnant women. The study was conducted in Najdi Heydari Health Care Center in Erbil City / Kurdistan region / Iraq from December 2016 to Feb, 2017. Data were collected by interview with the pregnant women. A questionnaire was constructed to collect the data by researchers. A statistical package for social science (SPSS, version20) was used for data analysis the data. All statistical procedures were tested on a probability of P-value was ≤ 0.05 significant. Results: The majority of the study sample had poor overall knowledge regarding antenatal exercises (93%), Interest in attending antenatal exercise classes 80%, the barrier to attend antenatal exercise 79% during pregnancy. There was very highly significant relationship between the pregnant women’s educational level and overall knowledge regarding exercise during pregnancy. Conclusion: The knowledge of women about exercise during pregnancy was less than average and women do not believe in the positive effect of exercises during pregnancy. The main reason for poor knowledge was inadequate antenatal exercise education. It is recommended that the apply antenatal exercise education teaching program is important to in-crease pregnant women’s knowledge regarding to exercise during pregnancy and change their believe regarding antenatal exercises

Impact of Designed Nursing Intervention Protocol for Hemodialysis Patients on Patient's Outcomes

Background: End Stage Renal Disease (ESRD) is a total or nearly total permanent kidney failure. It is the progressive and irreversible renal destruction, which is ultimately fatal without the intervention of chronic intermittent dialysis and/or kidney transplantation. This study aimed to examine the impact of a designed nursing intervention protocol for hemodialysis patients on patients’ outcomes. Design: A quasi-experimental research design was utilized. A convenience sample of 60 patients undergoing hemodialysis therapy at Shebin Elkkom Teaching and University Hospitals were selected. They are divided into two equal groups matched for age, sex, educational status and co-morbidity. Tools for data collection were through a structured interview questionnaire and nutritional status assessment. The designed protocol was applied to improve the patients` level of nutritional status, and decrease the rate of complications. The tools were used for pretest before conduction of the designed protocol, immediate posttest, and follow-up at 4 and 8 months. The results of the present study revealed that:- the mean knowledge scores and mean practice scores among the study group increased immediately after the program, and continued to be high at the first and second follow-up phases. No such improvements could be noticed among the control group throughout the study phases. Statistical significant improvements in study group, fewer complications, and some improvement in their nutritional status. Conclusion, nursing care and education of hemodialysis patients are necessary to achieve fewer complications, and to improve their nutritional status. Recommendation: Application of the designed intervention is recommended in similar settings. Keywords: Hemodialysis, Nursing interventio

Factors affecting the Value Added Tax Evasion in Palestine

The study aims to identify the phenomenon of tax evasion in Palestine in terms of methods and reasons for evasion. It also aims at identifying and evaluating the mechanisms followed by the VAT Department in the Gaza Strip to combat VAT evasion. The study examines the ability of the legislations and laws to reduce tax invasion and the impact of the current socioeconomic situation on tax evasion. To accomplish the aim of the study, 58 questionnaires were distributed to employees at the VAT Department. Of the questionnaire 50 were valid to analyze. In addition, several heads of divisions were interviewed for the same aim. The most important results of the study are: 83% of the respondents state that training of staff leads to minimizing tax evasion. Also, 76% of the respondents mention that imposing many taxes and double taxation encourage the taxpayer to evade taxes. Further, the economic depression contributes to tax evasion according to 86% of the respondents. The most important recommendations are: the necessity of increasing tax exemption, avoiding double taxation, reviewing tax legislations, improving value added tax laws, enhancing the tax awareness and raising the level of voluntary commitment of the taxpayer