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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 14  |  Issue : 3  |  Page : 217-225

Nontunneled hemodialysis catheter among acute renal failure patients: nurses’ knowledge and practices at El Fayoum Insurance Hospital


1 El Fayoum Insurance Hospital, El Fayoum, Egypt
2 Critical Care and Emergency Nursing, Faculty of Nursing Cairo University, Cairo, Egypt

Date of Submission15-Jan-2017
Date of Acceptance02-Feb-2017
Date of Web Publication1-Jun-2018

Correspondence Address:
Rasha M Saber Mohammed
El Fayoum Insurance Hospital, El Fayoum, 63511
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ENJ.ENJ_9_17

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  Abstract 


Background Hemodialysis requires access to blood vessels capable of providing rapid extracorporeal blood flow. A nontunneled catheter can be placed for initiation of acute hemodialysis. If dialysis for more than a week or so is likely, a cuffed, tunneled catheter can be used instead. Hemodialysis nursing is a specialized area of nursing practice focusing on the needs of patients with renal failure and their families across the lifespan.
Aim The aim of the present study was to assess nurses’ knowledge and practices related to management of nontunneled hemodialysis catheter among acute renal failure patients.
Design A descriptive exploratory research design was used in the present study.
Setting The present study was carried out at the hemodialysis unit of El Fayoum Insurance Hospital.
Sample A purposive sample of 50 male and female nurses working in the hemodialysis unit of El Fayoum Insurance Hospital was selected over a period of 6 months.
Tools of data collection Two tools were developed by the investigator to collect data: tool 1–nurses’ knowledge self-administered questionnaire consists of two parts − part one covers nurses’ personal background data, whereas part two covers knowledge assessment data; tool 2–nurses’ practice observational checklist. Structured interviews and direct observation were utilized for data collection.
Results The entire study sample had unsatisfactory level of knowledge, and all of them had unsatisfactory levels of practice regarding nontunneled hemodialysis catheter management. There was a significant, positive statistical correlations between age, years of experience, and total knowledge scores. In addition, there was a significant statistical correlation between age, years of experience, and total practice scores, and there was a significant statistical correlation between total knowledge and total practice scores.
Conclusion The results of the present study showed a real gap between nurses’ knowledge and practices as compared with evidence-based guidelines of the Centers of Disease Control and Prevention. Knowledge regarding nontunneled hemodialysis catheter management was unsatisfactory, and the level of nurses’ practice was unsatisfactory.
Recommendation The hospital should provide regular, continual training for nurses regarding use of nontunneled hemodialysis catheter, and ongoing clinical and educational competencies evaluation should be carried out.

Keywords: nontunneled hemodialysis catheter, nurses’ knowledge, nurses’ practice


How to cite this article:
Saber Mohammed RM, Mohammed WY, ElSalam Seloma YA. Nontunneled hemodialysis catheter among acute renal failure patients: nurses’ knowledge and practices at El Fayoum Insurance Hospital. Egypt Nurs J 2017;14:217-25

How to cite this URL:
Saber Mohammed RM, Mohammed WY, ElSalam Seloma YA. Nontunneled hemodialysis catheter among acute renal failure patients: nurses’ knowledge and practices at El Fayoum Insurance Hospital. Egypt Nurs J [serial online] 2017 [cited 2018 Aug 18];14:217-25. Available from: http://www.enj.eg.net/text.asp?2017/14/3/217/233669




  Introduction Top


Hemodialysis is the most commonly used method of dialysis. It is used for patients who are acutely ill and require short-term dialysis (days to weeks) and for patients with end-stage renal disease who require long-term or permanent therapy. Access to the patient’s vascular system must be established to allow blood to be removed, cleansed, and returned to the patient’s vascular system at rates between 200 and 800 ml/min. Several types of access are available. Immediate access to the patient’s circulation for acute hemodialysis is achieved by inserting a double-lumen or a multilumen catheter into the subclavian, internal jugular, or femoral vein. Although this method of vascular access involves some risks (e.g. hematoma, pneumothorax, infection, thrombosis of the subclavian vein, and inadequate flow), it can be used for several weeks. The catheters are removed when no longer needed, because the patient’s condition improves or another type of access has been established (Smelter et al., 2010).

Cuffed and uncuffed catheters used for dialysis are central lines with an external exit site, and therefore by design are at greater risk of infection than a fistula or graft. The access for port catheters is under the skin. Cuffed catheters with a balloon-type barrier near the skin opening are associated with a slightly reduced risk of associated infection when compared with uncuffed catheters. All types of catheters require meticulous skin preparation and strict aseptic techniques (Association for Professionals in Infection Control and Epidemiology (APIC), 2010).

The Centers for Disease Control and Prevention (CDC) published guidelines for preventing catheter-related bloodstream infection, the benchmark for all central venous catheter (CVC) care recommendations. The guidelines recommend hand hygiene, maximal sterile personnel protection equipment, chlorhexidine for skin preparation, catheter site dressing regimens, and specific sites for catheter placement. Several studies have validated these factors in reducing catheter-related bloodstream infection (Jawad, 2015).

Central venous dialysis catheter infection can be classified as exit-site infection, tunneled infection, and catheter-related bacteremia. Nursing staff play an important role in preventing these infectious complications. Following the insertion of central venous dialysis catheter, it is the nurse who carries out connection/disconnection procedures and insertion-site dressing procedures (Bennett et al., 2005).

Hemodialysis nursing is a specialized area focusing on the needs of patients with renal failure across their lifespan and their families. This specialized care requires the nurse to provide competent, safe, ethical care and demonstrate current specialty knowledge and practice. Patient education is a fundamental and essential component of nursing practice that improves the health of individuals and provides necessary knowledge and skills for managing chronic illnesses such as kidney disease. The ultimate goal of patient education is to achieve long-lasting changes in behavior by providing knowledge, skills, and abilities that allow patients to make autonomous decisions and take ownership of their care to improve their own outcomes (Yaseen, 2013).


  Significance of the study Top


A study conducted by Afifi et al. (2004) at Elminia University Hospital, Egypt, on 600 patients revealed that patients who began hemodialysis with a catheter had more complications and higher mortality than those who began with an arteriovenous graft (12 months survival, respectively, 60 vs. 83%) (Afifi et al., 2004).

From clinical experience and observation in the hemodialysis units, it has been observed that a large number of acute renal failure patients on hemodialysis through central venous catheters developed problems and/or complications such as catheter infection, hematoma, pneumothorax, infection, thrombosis of the subclavian vein, and inadequate flow. Some of these problems/complications can be prevented through utilization of intensive and collaborative care to save their lives. Therefore, this study was carried out in an attempt to assess hemodialysis nurses’ knowledge and practices related to the management of nontunneled hemodialysis catheter among acute renal failure patients at El Fayoum Insurance Hospital.

Moreover, the findings of this study might be beneficial in many ways; the present study may serve as a foundation or a database for health professionals in this respect. It might aid in safeguarding such group of patients from catheter infection and other complications. It could also help in planning and implementing care for such patients. In addition, it is hoped to generate attention and motivation for further studies in this area.


  Aim of the study Top


The aim of this study was to assess nurses’ knowledge and practices related to the management of nontunneled hemodialysis catheter among acute renal failure patients at El Fayoum Insurance Hospital.


  Operational definition Top


  1. Nontunneled hemodialysis catheter: the central venous catheter is used for short periods (1–4 weeks) for hemodialysis in acute renal failure patients. It is inserted into the subclavian, internal jagular, or femoral vein.
  2. Nurses’ practice: includes assessment of nursing care during hemodialysis catheter connections, and disconnections, care of exit site and removal, discharge catheter care plan, and considering the application of aseptic measures as required.



  Research questions Top


  1. What do hemodialysis nurses know about management of nontunneled hemodialysis catheters among acute renal failure patients at El Fayoum Insurance Hospital?
  2. What are nurses’ practices related to management of nontunneled hemodialysis catheters among acute renal failure patients at El Fayoum Insurance Hospital?



  Participants and methods Top


Research design

A descriptive exploratory research design was utilized in this study.

Setting

The present study was carried out at El Fayoum Insurance Hospital in the hemodialysis unit.

Sample

A purposive sample consisting of 50 nurses working at the hemodialysis unit of El Fayoum Insurance Hospital was included in this study.

Tools

Data were collected using the following tools:

Tool 1

Nurses’ knowledge self-administered questionnaire, developed by the investigator: it consists of two parts − part one is used to assess nurses’ personal background data such as age, sex, years of experience, number of training courses attended, etc., and part two is used to assess nurses’ knowledge related to nontunneled hemodialysis catheter management consisting of 40 questions covering six main areas as follows: (i) general knowledge about nontunneled hemodialysis catheters, (ii) nursing care of nontunneled hemodialysis catheter insertion, (iii) nursing care during catheter connection/disconnection, (iv) nursing care during catheter removal, exit-site care, and documentation, (v) nontunneled hemodialysis catheter infections and complications, and (vi) discharge care plan.

Tool 2

Nurses’ practice observational checklist: this tool was used to evaluate nurses’ performance regarding nontunneled hemodialysis catheter. It involves 64 items covering five main areas as follows: (i) nursing care during catheter connection, (ii) nursing care during catheter disconnection, (iii) catheter exit-site care, (iv) nursing care during catheter removal, and (v) discharge care plan.

Pilot study

A pilot study was carried out to determine the feasibility, relevance, applicability, and clarity of the study tools as well as to provide the investigator experience to deal with the included participants, the research methodology, the data collection instruments, and to estimate the needed time to fill out data collection sheets. To achieve this, the tools were tested on five nurses (10% of the total participants). No modifications were done after the pilot study.

Ethical consideration

  1. Final approval was obtained from the Faculty Ethical Committee, Faculty of Nursing, Cairo University, Cairo, Egypt.
  2. An official permission to conduct the present study was obtained from the vice dean for Higher Education and Research, Faculty of Nursing, Cairo University, and head nurses of the Hemodialysis Unit at El Fayoum Insurance Hospital.
  3. Nurses’ acceptance for participation: during the phase of data collection, the investigator obtained a written consent from each nurse who agreed to participate in this study after informing him/her about the aim of the study. Nurses were informed that they had the right withdraw at any time from the study.


Procedure

Designation phase

This phase included construction, testing, and piloting of the data collection tools. In addition, managerial arrangements were made to carry out the study. The designation phase was ended by carrying out the pilot study.

Implementation phase

Data collection was carried out from April 2014 to September 2014, once official permissions were obtained. The investigator visited the hemodialysis unit everyday during the morning and afternoon shifts. Each nurse was interviewed individually for 15 min where the nature, importance, and purpose of the study were explained and confidentiality was assured. During this time, the investigator obtained a written consent from nurses who agreed to participate in the present study. The investigator started the data collection process by collecting the nurses’ personal background data (tool 1, part 1), in addition to assessment of nurses’ knowledge using the nurses’ knowledge self-administered questionnaire (tool 1, part 2), which was distributed to each nurse at the beginning of the shift, and then collected at the end of the shift. Each nurse needed 30–45 min to fill out the knowledge questionnaire tool. This tool was distributed to the nurses during their working shifts to be completed in the presence of the researcher to clarify and answer any questions and were given the following instructions: do not write your name in the paper, read the questions carefully and then answer the questions attentively, do not answer in a hurry, answer all questions, select only one answer for the multiple-choice and yes or no questions, and answer the questions without assistance from anybody. Regarding nurses’ practice (tool 2), the nurses practices observational checklist was filled out by the investigator by direct observation for each nurse three times during nontunneled hemodialysis catheter connections and disconnections, exit-site care, removal, and discharge care (the interval between each observation was 1 week). The time needed to complete the checklist depended on the dialysis time, which ranged from 3 to 4 h. The investigator did not inform the nurses about the observation. The mean value of the three observations was calculated.

Statistical design

Statistical package for social science, version 20 (IBM, Chicago, USA) was used for statistical analysis of the collected data. Data are summarized and tabulated using descriptive and inferential statistics (mean, SD, t-test and Pearson’s correlation). Significance level was set at less than 0.05.

Limitations of the study

  1. The findings of the present study are less amenable to generalization because the sample was selected from one geographical area in Egypt (i.e. El Fayoum Insurance Hospital).
  2. The scope of the study is also limited. It was restricted to nurses who agreed to participate in the study and those who were on duty.
  3. Catheter insertion was performed in the ICU at night only by the physician, and therefore observation of nurses during insertion could not be carried out.



  Results Top


The main findings of the present study are presented in three main sections as follows:

Nurses’ personal background data

As shown in [Table 1], 84% of the sample were females, 94% of them were married, and 84% of them had a diploma in nursing. Overall, 98% of them did not receive any training regarding hemodialysis catheter care. Regarding age, 32% of the studied sample were aged between 26 and 30 years with a mean age of 28.6±4.92 years. Finally, in relation to years of experience, 32% of the studied sample had 1–5 years of experience with a mean of 8.1±4.68 years.
Table 1 Personal background data of the studied sample (N=50)

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Answering the two research questions

As shown in [Table 2], the total mean knowledge scores of the studied sample was 0.46±0.47 out of 40. In relation to subitems of the questionnaire, patients’ health education represented the highest mean (0.64±0.48) out of 7, and catheter insertion showed the lowest mean (0.18±0.38) out of 8. [Table 3] shows that 100% of the studied sample had unsatisfactory knowledge about nursing management of nontunneled hemodialysis catheter. [Table 4] shows that the total mean practice score of the studied sample was 0.37±0.358 out of 64. In relation to subitems of the questionnaire, patients’ health education represented the lowest mean scores (0±0) out of 7 and catheter removal showed the highest mean scores (0.49±0.42) out of 13. [Table 5] shows that hundred percent of the studied sample had unsatisfactory practice level in relation to nursing management of nontunneled hemodialysis catheter.
Table 2 Total and subtotal means of knowledge scores of the studied sample (n=50)

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Table 3 Percentage distribution of the studied sample according to knowledge score levels (n=50)

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Table 4 Total and subtotal mean practice scores of the studied sample(n=50)

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Table 5 Percentage distribution of the studied sample according to practice levels (n=50)

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Additional findings

[Table 6] illustrates that there was a significant statistical difference between knowledge scores, marital status, and courses (F=8.2, P≤0.001 and t=2.5, P≤0.016, respectively). In addition, there was no statistical difference between knowledge scores, in relation to sex and educational level. [Table 7] shows that there was a significant statistical difference between practice scores, sex, and educational level (t=2.96, P≤0.005 and t=2.6, P≤0.012, respectively), and there was no statistical difference in practice scores, in relation to marital status and courses. [Table 8] shows that there was a significant positive statistical correlation between age, years of experience, and knowledge scores (r=0.75, P≤0.0001 and r=0.74, P≤0.0001, respectively). In addition, there was a significant statistical correlation between age, years of experience, and practice scores (r=0.81, P≤0.0001 and r=0.83, P≤0.0001, respectively). There was also a significant statistical correlation between total knowledge scores and total practice scores (r=0.61, P≤0.0001).
Table 6 Difference in knowledge scores of the studied sample in relation to sex, marital status, education, and training courses (n=50)

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Table 7 Difference in total practice scores of the studied sample in relation to sex, marital status, education, and courses training (n=50)

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Table 8 Correlation between nurses’ knowledge, practices, age, and years of experience in hemodialysis units (n=50)

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  Discussion Top


Nurses’ personal background data

The present study revealed that the majority of nurses were females and married. More than three-quarters of them had a nursing diploma. The majority of them did not attend training courses. They had a mean age of 28.7±4.54 years, mean years of work experience of 9.7±5 years, and mean years of experience in a hemodialysis unit of 6.6±5.3 years.

These results are in agreement with Raafat (2013), who reported in a published study entitled ‘Assessment of nurses’ knowledge and practice provided to the patient undergoing hemodialysis’ that the majority of nurses’ age ranged between 20 and 50 years, about three-quarters of them were females, more than three-quarters of them had experience of more than 5 years, and three-quarters of them had never been introduced to any kind of learning or training courses related to hemodialysis, except the experience they gained through their work with colleagues under the supervision of head nurses.

These results are similar to results of a study carried out by El-Dakhakhny (2007) entitled ‘Identification of universal infection control precautions followed by nurses at pediatric hemodialysis unit’, which found that the majority of nurses in different hemodialysis units were female, most of them had a diploma and experiences of 6–9 years. In addition, Mahabeer (2009) in a study entitled ‘A descriptive study of the cultural competence of hemodialysis nurses.’ in Canada revealed that the majority of nurses in different hemodialysis units were females, most of them were diploma holders, and had experiences of 6–9 years.

These results are in agreement with a study conducted by Ahmed (2005) entitled ‘Assessment of quality of care provided for hemodialysis patients by technical nurses in different selected military hospitals’, where most of the participants were female, all of them had a nursing school diploma, and none reported attending a unit-based or hospital-based staff development program. Moreover, Abdel-Lateef (2009) reported in a published thesis entitled ‘Assessment of nurses’ performance related to nosocomial infection prevention in kidney dialysis units in Damietta city’ that most of the study participants were female, all of them had a nursing school diploma, and none reported attending a unit-based or hospital-based staff development program.

In agreement with this is a study conducted by Hussein (2011) entitled ‘Implementing a developed Nursing Care Standards for hemodialysis patients in Zagazig University Hospital’, which showed that most of the study participants were female, all of them had a nursing school diploma, and none of them reported attending a unit-based or hospital-based staff development program. In addition, they (Ahmed, 2005; Abdel-Lateef, 2009; Hussein, 2011) stated that most of their participants’ ages ranged from 18 to 38 years, and nearly half of them had more than 10 years of experience.

However, findings of this study are contradicted by the study by Yaseen (2013) entitled ‘Awareness of nurses concerning the procedure of hemodialysis and related complications’, who found that more than half of the nurses were males. Regarding the number of years of employment, findings of this study revealed that one-third of the nurses had worked for less than 1 year. Despite this, more than two-thirds of the nurses were college graduates.

Nursing knowledge regarding nontunneled hemodialysis catheter

The present study revealed that the majority of the study sample had an unsatisfactory level of knowledge regarding nursing management of the nontunneled hemodialysis catheter. This result might be due to lack of continuous training, evaluation, lack of incentives, and time to improve their knowledge, especially among those who are working in the hemodialysis unit for long hours and overloaded by increased number of patients and being overwhelmed by a lot of duties.

In agreement with this result was a cross-sectional study including 87 full-time students and 57 part-time students by Mlinar and Malnarsic (2012) entitled ‘knowledge of nursing students about central venous catheter’, which found that the majority of students have insufficient knowledge about the procedures, including insertion of catheter, signs that indicate correct functioning of the CVC, frequency of flushing a catheter when it is not in use, and the reason for introducing an implanted CVC.

In concordance with these results, a study by Densie and Ferreia (2007) entitled ‘vascular access thrombosis in new hemodialysis patients’ indicated a lack of nurses’ knowledge regarding care of venous accesses’ and by Yaseen (2013) indicated that nurses showed inadequate awareness about catheter insertion accurately and the majority of them did not document every nursing procedure.

These results were also supported by the results of a study by Jawad (2015) titled ‘Improving nurses’ knowledge to reduce related bloodstream infection in hemodialysis’, which found that 46% of the participants rated their knowledge as being inadequate and 54% rated their knowledge as moderate.

In accordance with this result, a study by Higgins and David (2008) titled ‘nurses’ knowledge and practice of vascular access infection control in hemodialysis patients in the republic of Ireland’ found lack of knowledge and adherence to CDC (2002) and NKF-KDOQI (2000) guidelines among nurses. Less than half of the respondents were aware of the types of CVCs that cannot be cleaned with cleaning agents. In terms of soaking CVC tubes, 93% of those using 10% povidone–iodine were soaking them for less than the NKF-KDOQI (2000) recommended time of 3–5 min. Of those using chlorhexidine, all respondents were soaking CVCs as opposed to wiping and allowing them to dry, as recommended by the manufacturer’s instructions. Recommended use of chlorhexidine is neither given in NKF-KDOQI (2000) nor in CDC (2002) guidelines. For those using gauze for CVC dressings, 51% changed them after every dialysis session as recommended by NKF-KDOQI (2000). Among those using semipermeable membranes for CVC dressings, 50% changed them after every dialysis session as opposed to the once-a-week recommendation by the CDC (2002).

Nursing practices regarding nontunneled hemodialysis catheter

The results of the present study revealed that the majority of participants had unsatisfactory practice levels regarding nontunneled hemodialysis catheter management. From the investigator’s point of view, these results could be due to lack of proper training, lack of awareness of job description, poor monitoring and supervision, absence of an instructional poster and booklets, and inadequate equipment. Other possible reasons might be due to carelessness of nurses.

In concordance with these results, Barsuk and Jeffrey (2010) in a study titled ‘Long-Term Retention of Central Venous Catheter Insertion Skills After Simulation-Based Mastery Learning’ found that pretest checklist scores were poor. The mean internal jugular (IJ) score was 49.1% (SD=24.3), whereas the mean subclavian (SC) score was 44.1% (SD=26.9). Only 12.2% of residents met or exceeded the minimum passing score for IJ and 8.2% for SC. After the test, all residents met or exceeded (mastered) the minimum passing score for IJ and SC.

This result was also reported in a study by Raafat (2013), who found that all nurses had unsatisfactory practice levels about care of patients during a hemodialysis session, ‘observe the venous access for any complications’.

The findings of the present study are also in agreement with the findings of the study by Abouel-Enein et al. (2011) entitled ‘Standard precautions: a KAP study among nurses in the dialysis unit in a University Hospital in Alexandria’, which emphasized that, during the study period, none of the nurses washed their hands before and after different activities that required hand washing. In contrast, all of them wore nonsterile gloves before or after the different activities that required use of gloves. Regarding the participants’ performance in preparing the patient in the predialysis phase, all of them showed unsatisfactory performance.

In agreement with these results, a prospective study carried out by Caylan et al. (2010) entitled ‘Incidence and risk factors for bloodstream infections stemming from temporary hemodialysis catheters’ found that temporary hemodialysis catheters are associated with a high rate of infectious complications. Compliance with infection control precautions causes a significant decrease in the rate of catheter-related bloodstream infections. In view of the high frequency of infectious complications of temporary hemodialysis catheters, the most effective method of prevention seems to be the promotion of infection control precautions that should be emphasized by educating and training the healthcare providers.

In disagreement with this study, a study by Abdelsatir (2013) entitled ‘Evaluation of Nurses Awareness and Practice of Hemodialysis Access Care in Khartoum State, Sudan’ indicated that structured training on hemodialysis (HD) machines and HD access care was received by 56 and 54% of respondents, respectively. All participants stated that proper HD access care helps prevent infection, but only 54% stated that it helps in preserving access function. Most nurses (98%) stated that hand hygiene in HD centers was necessary to prevent infection, but only 70% adhered to hand hygiene practices before access manipulation. Most nurses (98%) evaluated HD access function before connection, but only 52% evaluated it for signs of infection. Nurses with a bachelor’s degree tended to be more adherent to hand hygiene (72.5 vs. 42.9%, P=0.1) and use of gloves (100 vs. 85.7%, P=0.1) compared with nurses with a diploma degree, but the difference was not statistically significant.

Devoted to additional data of the study sample

The results of the present study revealed that there was a significant statistical difference in nurses’ total knowledge scores in relation to nurses’ marital status and training courses. Moreover, there was no significant statistical difference in nurses’ total knowledge scores in relation to nurses’ sex and educational level.

The results of the present study are in agreement with Jawad (2015), who revealed that there was no statistical correlation between level of education and total knowledge scores.

This result contradicts with Raafat (2013), who revealed that that there was no statistically significant relationship between the nurses’ total score of knowledge and their age, sex, duration of work with hemodialysis patients, attending related courses, and the number of courses in this area.

The present study revealed that there was a significant statistical difference in nurses’ total practice scores in relation to nurses’ sex and educational level. In addition, there was no significant statistical difference in nurses’ total practice scores in relation to nurses’ marital status and training courses.

In agreement with this result, the study by Al-Hakkak (2004) entitled ‘Effectiveness of nursing educational program on nurse’s knowledge and practice in hemodialysis units’ showed that there was a significant relationship between nurses’ practices and their age, level of education, and years of experience in hemodialysis units at Baghdad teaching hospitals.

This result contradicts the results of the study by Jafar (2013) entitled ‘Evaluation of nurses’ practices throughout hemodialysis treatment for patients in hemodialysis unit at Baghdad teaching hospitals’, which showed no significant relationship between nurses’ practice and their sex, level of education, and years of experience in hemodialysis units.

The present study revealed that there was a significant positive statistical correlation between ages, years of experience, and total knowledge scores. In addition, there was a significant statistical correlation between age, years of experience, and total practice scores, and there was a significant statistical correlation between total knowledge scores and total practice scores.

The findings of the present study agree with the study by Fahmy et al. (2009) entitled ‘Assessment of nurse’s knowledge provided to hemodialysis patients’ and the study by Wilkinson et al. (2011) entitled ‘Error detection and recovery in dialysis nursing’, which concluded that there is a statistically significant positive correlation between years of experiences and knowledge in nurses’ working in different hemodialysis units.

The findings of the present study are also in agreement with the study by Draper et al. (2008) entitled ‘The role of nurses in hospital quality improvement’, which revealed that there was a strong positive correlation between nurses’ knowledge and their practice in hemodialysis units (r=0.741, P=0.000<0.01).

The result of the present study disagree with Jawad (2015), which revealed that there was no significant statistical correlation between age, years of experience, and total knowledge scores.


  Conclusion Top


On the basis of the results of the present study, it can be concluded that all the nurses working in the hemodialysis unit of El Fayoum Insurance Hospital had unsatisfactory levels of knowledge regarding nontunneled hemodialysis catheter management, and all of them had an unsatisfactory level of practice regarding the use of nontunneled hemodialysis catheter. This indicated a real gap between nurses’ knowledge and practices as compared with evidence-based guidelines of the CDC. This can be explained, as they had no training courses about the management of nontunneled hemodialysis catheter.

Recommendations

On the basis of the findings of this study, the following recommendations were made:
  1. Establishment of teaching classes in hemodialysis units to enrich the theoretical information about care while using hemodialysis catheters.
  2. Nursing staff should be trained, retrained, and involved in continued postgraduate education to learn the proper use of new medical devices and procedures.
  3. Ongoing clinical and educational competency evaluation should be carried out for nurses in all clinical settings.


Recommendations for future studies

  1. Replication of the present study on a larger sample and on different geographical settings to allow generalization of findings.
  2. Study the impact of a training program on hemodialysis nurses’ knowledge and practices regarding nontunneled hemodialysis catheter.
  3. Explore factors that hinder nurses’ practice regarding nontunneled hemodialysis catheter.
[24]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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