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   Table of Contents - Current issue
Coverpage
September-December 2017
Volume 14 | Issue 3
Page Nos. 211-268

Online since Friday, June 1, 2018

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ORIGINAL ARTICLES  

Assessment of pain during turning procedures in patients on mechanical ventilation p. 211
Hend M Allam
DOI:10.4103/ENJ.ENJ_7_17  
Background Pain is a significant problem for critically ill patients throughout their stay in the ICU, especially those who are mechanically ventilated. A turning procedure is one of the most common procedure that may cause pain for critically ill patients. Aim The aim of this study was to assess pain during turning procedures in patients on mechanical ventilation. Research question What are the characteristics of pain caused by turning procedures in patients on mechanical ventilation? Patients and methods A descriptive research design was used in the present study. A convenient sample of adult men and women on mechanical ventilation and unconscious patients in ICUs at Benha University Hospital were included in the study. Those above 65 years of age, receiving neuromuscular blocking agents, and with peripheral neuropathy were excluded. The following tools were used for data collection: (a) data collection sheet (developed by the researcher) included (i) sociodemographic data, (ii) medical-related data, and (iii) physiological parameters); (b) Critical Care Pain Observation Tool; and (c) facial pain scale. The duration of the study was 6 months, from May 2015 to October 2015. Results In our study sample (92 men and women patients), 87% had severe pain during turning procedures, which decreased to 4.3% 10 min after the procedure. There was no statistically significant difference between the level of pain for both men and women, as well comorbid diseases. There was a highly statistically significant difference between behavior indicators and physiological parameters before, during, and 10 min after the turning procedure. Recommendations Pain assessment should be a part of the overall management for mechanically ventilated patients and must be routinely documented in the patient’s record and nursing notes and regularly updated. In addition, the results of our study highlight the need to administer additional analgesia before turning procedures, particularly in mechanically ventilated patients unable to self-report or those with cognitive impairment.
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Nontunneled hemodialysis catheter among acute renal failure patients: nurses’ knowledge and practices at El Fayoum Insurance Hospital p. 217
Rasha M Saber Mohammed, Warda Y Mohammed, Yousria A ElSalam Seloma
DOI:10.4103/ENJ.ENJ_9_17  
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.
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Nursing management protocol for mothers of children having ventricular peritoneal shunt p. 226
Mohbouba S Abd Elaziz, Ebtisam M Abd Elaal, Basma R Abd El-Sadik, Khadiga M Said
DOI:10.4103/ENJ.ENJ_21_17  
Introduction Ventricular peritoneal shunts are considered to be permanent catheters with long-term complications. Management of ventricular peritoneal shunts presents major challenges later in children and their parents’ life, requiring multidisciplinary care from nurses. Aim This study was undertaken to evaluate the effects of nursing management protocols on mothers with children having ventricular peritoneal shunts. Research design A quasi-experimental design was used for the present study. Setting The present study was conducted at the Neurology Outpatient Clinic at Benha University Hospital followed by home visits. Sample A purposive sample of children visiting the Neurology Outpatient Clinic with ventricular peritoneal shunts during a period of 6 months was included. The study included 39 children. Two tools were used for data collection. A structured interview questionnaire was designed and consisted of four parts: part one included sociodemographic characteristics of the mother and child; part two included past and present medical history of the child; part three included mothers’ knowledge regarding ventricular peritoneal shunts, including its meaning, signs of infection, complications, prevention, and treatment; part four included others practices of mothers regarding ventricular peritoneal shunt care such as preventing of infection in the shunt area, preventing other infections, nutrition, treatment, and regular follow-up.
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Challenges and work crisis facing critical care nurses p. 235
Ghada S.K Mahran, Asmaa A.M Taher, Nadia M.A Saleh
DOI:10.4103/ENJ.ENJ_27_17  
Background Nursing turnover and shortage are acknowledged as worldwide issues. Therefore, understanding the challenges that faces the nurses and overcome these challenges is essential in retaining them. Study was aimed to assess the challenges and work crisis facing critical care nurses. Subjects and Methods Research design : A descriptive, exploratory, qualitative research design was used. Setting Trauma ICU, ICC unit, and general ICU at Assiut University Hospital. Subjects (45) staff nurses. Tool of data collection A structured interview questionnaire consists of two parts; Personal characteristics and Challenges and Crisis Questionnaire Assessment tool through 2016. Results About 68.88% of the study sample were aged between 20 and 30 years and were married, and 44.44% had experience of 1–5 years. 88.88% of them reported large number of patients in ICUs, 82.22% reported increase in workload and increased numbers of night shifts. 97.8% fear of the possibility of infection from patients and 73.3%, have conflict between nurses and doctors. (84.5%) recorded working atmosphere filled with tension and stress. (93.3%) have sense of responsibility for some of the equipment and materials, and some critical cases. (91.1%) had family life at risk. Conclusion Admission of a large number of patients in the ICUs, increase in workload, exposure means for family life owing to choose the profession of nursing, and stability in family life disorder because of increased working hours and long shift were the most common challenges facing nurses. Recommended Training programs should be provided to develop coping skills among staff, and nurses’ mangers should take active steps to create positive work environment.
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Cultural variation influences on the learning experience of international nursing students p. 242
Samar El-Hoseiny Abd El-Raaouf, Rabab El-Sayed Hassan El-Sayed
DOI:10.4103/ENJ.ENJ_37_17  
Background Through their perspectives, various scholars have explored the academic and social challenges foreigner students face in their experience of learning. Understanding the positive impacts and the challenges of international nursing students can lead to a greater awareness of the obstacles and benefits that come from their scholarship experience. The current study aimed to recognize perspectives of Nigerian students about the influences of cultural variation on their learning process, and rating the students’ satisfaction with the nursing scholarship experience. Method Both descriptive exploratory and grounded theory research designs were utilized to conduct the quantitative and qualitative parts of this study respectively. The study was conducted in the Faculty of Nursing, Mansoura University, Egypt. A purposive sample of all (n=51) first year Nigerian students who registered at the academic year 2013–2014 2nd semester and studying the course of research methodology-credit hours system were requested to participate in this descriptive cross-sectional study. Tools of data collection were included; self-administered, and semi-structured interview questionnaire, in addition to four points of Likert scale. Results The study results revealed that communication barrier, combined use of local language, and different language barrier were cited by around three quarters of Nigerian students as cultural variation related obstacles that influenced teaching process as well as students’ learning. However, less than half of Nigerian students considered know about different cultural background as a motive in their process of learning. Conclusion This study concluded that, cultural variation has both positive and negative influences on Nigerian nursing students’ learning experience. It is recommended that, recognition of Nigerian nursing students’ perspectives are needed to support their scholarship learning experience in a new environment of different culture.
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Effect of nursing care standards on nurses’ performance in caring for patients with cardiac arrhythmias p. 251
Rawia A Ibrahim, Kamelia F Abd-Allah, Osama S Arafa, Sabah S Mohammed
DOI:10.4103/2090-6021.233665  
Background Nursing care should be guided by clearly defined standards to ensure a high quality of care. Standards of care are authoritative statements that describe a common or acceptable level of patient care or performance. Aim The aim of this study was to evaluate the effect of nursing care standards (NCSs) on nurses’ performance in the care of patients with cardiac arrhythmias in the coronary care unit (CCU) at Benha University Hospital. This research was based on the hypothesis that the mean score of nurses’ knowledge and practice level after NCS implementation may be higher than their score before NCS implementation. Participants and methods A quasi-experimental research design was utilized. This study was conducted in the CCU at Benha University Hospital. Two groups of participants were included in the study: experts and staff nurses working in the CCU. Three data collection tools were used in the different phases of this study: first tool, an experts opinion sheet was designed to test the face and content validity of the designed NCSs; second tool, a self-administered questionnaire was administered to nurses to assess their knowledge; and third tool, a nurses’ practice observational checklist based on the designed NCSs was completed. Results The results of the study showed that the majority of the jury was satisfied with the general form (face and content validity) of the NCS. The jury agreement ranged between 85.7 and 100%. Furthermore, the findings revealed a statistically significant improvement in the total mean knowledge scores of nurses in all items of the study after implementing the standards (P=0.000) as compared with the preimplementation period. There was also statistically significant improvement in the total mean practice scores of nurses in all items of the study after implementing NCSs (P=0.000). Conclusion There is a statistically significant improvement in nurses’ performance in the care of patients with cardiac arrhythmias in the CCU after NCS implementation. The study recommends that NCSs for management of patients with cardiac arrhythmias should be revised, updated, and available in the CCU in both Arabic and English language.
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Vascular complications and risk factors among patients undergoing cardiac catheterization p. 259
Mohamed El Sayed Ebeed, Nahla S Khalil, Manal S Ismaeel
DOI:10.4103/2090-6021.233668  
Aim and objectives The aim of the present study was to investigate the incidence of vascular complications and risk factors for vascular complications among patients undergoing the cardiac catheterization procedure. Background Cardiac catheterization is one of the most crucial methods to assess and manage coronary artery diseases. Although it has a reduced morbidity and mortality, this invasive procedure is not free of complications. Methods The descriptive exploratory design was used in this study. Demographic data, medical history and vascular complication assessment data were collected from a convenience sample of 100 patients, who underwent cardiac catheterization via the femoral artery. Results Incidence of minor vascular complications revealed that the studied individuals had femoral oozing before sheath removal and femoral ecchymosis after sheath removal. Regarding the incidence of major vascular complications, the studied individuals had femoral haematoma after sheath removal. The common factors that placed patients at a greater risk for developing vascular complications were old age, female sex, illiteracy, and non-ST elevation myocardial infarction. Conclusion The current study concluded that the most common vascular complications were oozing before sheath removal, and ecchymosis and haematoma after sheath removal, and the common risk factors for vascular complications were old age, female sex, increased BMI and femoral sheath size.
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