Egyptian Nursing Journal

ORIGINAL ARTICLE
Year
: 2019  |  Volume : 16  |  Issue : 3  |  Page : 115--127

Effect of an educational guideline on nurses’ performance caring for patients post liver transplantation


Sarah F Mahmoud Karaly1, Enas E Elsayed Abo Elfetoh2,  
1 Department of Critical Care Nursing, Faculty of Nursing, Ain Shams University, Cairo, Egypt
2 Department of Medical-Surgical Nursing, Faculty of Nursing, Helwan University, Helwan, Egypt

Correspondence Address:
Enas E Elsayed Abo Elfetoh
Department of Medical-Surgical Nursing, Faculty of Nursing, Helwan University, Helwan
Egypt

Abstract

Background Care of the liver transplant (LT) patients presents the critical care team with one of the more complex and challenging endeavors. Aim This study aims to assess the effect of an educational guideline on nurses’ performance caring for patients post-LT. Design A quasi-experimental design was used. Setting This study was conducted in the critical care unit at Ain Shams Specialized Hospital at Cairo in Egypt. Patients and methods A convenient sample of all available nurses’ (30) caring for patients post-LT in the previously mentioned unit. Data collection tools Nurses’ knowledge self-administered questionnaire sheet and nurses’ practice observational checklist. Results The present study revealed that most of the nurses had got unsatisfactory level of performance (knowledge and practice) regarding caring for patients post-LT in the critical care unit as per the educational guidelines implementation (16.6 and 33.3%, respectively). Meanwhile the majority of the study sample had a statistically significant improvement in their knowledge and practice regarding caring for patients post-LT in the critical care unit after the implementation of the educational guidelines (96.6 and 93.3%, respectively), while this improvement lowered slightly post 3 months at follow-up (90 and 86.6%, respectively). Conclusion This study concluded that the educational guideline for nurses in the critical care unit is effective in improving their performance regarding caring for patients post-LT. Recommendations The importance of conducting periodic in-service training advanced care programs for nurses in critical care units for improving their performance and quality of care that is provided to the patients post-LT.



How to cite this article:
Mahmoud Karaly SF, Elsayed Abo Elfetoh EE. Effect of an educational guideline on nurses’ performance caring for patients post liver transplantation.Egypt Nurs J 2019;16:115-127


How to cite this URL:
Mahmoud Karaly SF, Elsayed Abo Elfetoh EE. Effect of an educational guideline on nurses’ performance caring for patients post liver transplantation. Egypt Nurs J [serial online] 2019 [cited 2020 Sep 30 ];16:115-127
Available from: http://www.enj.eg.net/text.asp?2019/16/3/115/292499


Full Text



 Introduction



Liver transplantation (LT) has become a common surgical procedure worldwide. For patients with end-stage liver disease or acute liver failure who has not responded to conventional medical or surgical intervention, for those with end-stage liver disease, acute liver failure as well as for those who are suffering from liver damage caused by hepatitis C infection (Aitken et al., 2015), LT may be the best hope.

The tremendous developments in the field of LT throw light to the humans which are in need of survival. Prediction of survival is an important factor used to determine the success of LT surgery (Hinkle and Cheever, 2014). Surgical consequences in LT depends on various factors like disease severity, availability of donor organs, immunosuppressants and forecasting the survival. In medicine, the medical experts get the judgment of the outcome of LT based on the Model for End-Stage Liver Disease (MELD) score (Raj and Chandra, 2016).

The early postoperative period for patients with LT is a crucial time when strict monitoring and sustainment of cardiorespiratory function, frequent assessment of allograft performance, timely recognition of unexpected complications and prompt treatment of extra hepatic organ system dysfunction are mandatory (Morton and Fontaine, 2013). Intensive care management of LT patients mainly centers on rapid hemodynamic stabilization, correction of coagulopathy, early weaning from mechanical ventilation, proper fluid administration, kidney function preservation, graft rejection prevention, and infection prophylaxis (Woodruff, 2016).

Care of LT patients presents the critical care team with one of the more complex and challenging endeavors. Proper management and early recognition of complications and communication of these findings allow for prompt intervention and progress toward optimal outcomes for these patients who underwent LT (Good and Kirkwood, 2018).

In this context, the nurse, as a member of the multidisciplinary team, plays a vital role in the success of the transplant program, and needs to continually update their knowledge and skills in this very specific and complex area (LeMone, 2014). Competent nursing is understood as a set of knowledge and skills that enable nurses to act in an appropriate manner at all times. Nursing care requires the development of skills in order to provide quality to customer needs, families, and communities in physiological, pathological, and psychosocial aspects (Negreiros et al., 2017).

The quality of nursing care is influenced by the level of knowledge, skills, values, and judgment of those participating in providing care for patients, and the nurses’ cognitive to decide on a plan of action that depends on other factors as their educational level, experience, and training course in caring for those patients. Therefore, the quality of care that is given to the patients and patients’ outcomes depend on the nurse (McSherry et al., 2012).

Significance of the study

The primary goal of LT is to relieve limitations resulting from liver disease or failure. However, active participation in the care of patients post-LT must be taken in action, as the care of patients post-LT is an independent function of nursing practice and primary nursing responsibility. All nursing care is directed toward promoting, maintaining, restoring health, preventing complications, and helping patients adapt to the residual effect of illness. Therefore, it is necessary to evaluate the effect of an educational guidelines on nurses’ performance regarding caring for patients post-LT in the critical care unit. Patient and graft outcomes are closely monitored on a national level and 1-year survival is between 80 and 92% (Subramaniam and Sakai, 2017).

In Egypt, there is no doubt that chronic liver diseases are a major health concern. By the end of 2014, the total number of LT patients reached 2406; the number comprised 2246 adult cases and 160 pediatric cases (Amer and Marawan, 2016). In 2018, the total number of cases were 35 cases at Ain Shams Specialized Hospital: Statistical Department, Archive, Post-Liver Transplantation Unit, Cairo, Egypt, 2018.

 Aims



This study aims to assess the effect of an educational guideline on nurses’ performance caring for patients post-LT through the following:Assessment of nurses’ level of performance (knowledge and practice) caring for patients post-LT.Developing and implementing an educational guideline for nurses caring for patients post-LT based on their needs.Evaluating the effect of an educational guideline on nurses’ level of performance (knowledge and practice).

Research hypothesis

To achieve the aim of this study, it was hypothesized that the implementation of an educational guideline regarding caring for patients post-LT will lead to a significant positive improvement on nurses’ level of performance (knowledge and practice).

 Patients and methods



Research design

A quasi-experimental design was used in this study.

Study setting

This study was conducted in the critical care unit at Ain Shams Specialized Hospital at Cairo in Egypt.

Sample

A convenience sample of all available nurses willing to participate in the study (30), caring for patients post-LT, and having experience of not less than 6 months for working in critical care in the previously mentioned unit.

Tools applied

The researchers will use two tools to evaluate the effect of an educational guideline on nurses’ performance caring for patients post-LT

Tool 1: nurses’ structured self-administrated questionnaire was developed by the researchers and include two parts:Part I

Assesses demographic characteristics such as age, sex, qualification, marital status, years of experience, and training courses about LT. There are six close-ended questions.Part II

Assesses the level of knowledge regarding caring for patients post-LT.

This questionnaire consisted of 75 questions in the form of multiple choice questions (MCQ), and true/false questions which were distributed into two parts as the following:It was used to assess nurses’ knowledge regarding LT; it included 50 questions which were distributed into seven items as the following:

Anatomy and physiology of the liver (six true/false questions), indication and contraindication for LT (five MCQ questions), waiting list and MELD score for LT (five true/false questions), donor and criteria for selection for LT (four MCQ questions), immunosuppressive medication for LT (six true/false questions), infection control precautions and prevention for LT (13 true/false questions), and complication after LT (11 MCQ questions).It was concerned with the assessment of nurses’ knowledge regarding nursing care after LT: it included 25 questions which were distributed into seven items as the following:

Vital signs (five MCQ questions), mechanical ventilator (eight MCQ questions), blood gases (two MCQ questions), central venous catheter (three MCQ questions), arterial cannula (two MCQ questions), nasogastric tube (two MCQ questions), and urinary catheter (three MCQ questions).

Scoring system

The total score of knowledge was 75 grades. Each correct answer was given one mark and the incorrect answer was given zero. Based on the critical care approach. It was considered that:More than or equal to 85% was satisfactory level of knowledge (≥64 grades correct answers).Less than 85% was unsatisfactory level of knowledge (< 64 grades correct answers).

Tool 2: Nurses’ practice observational checklist

It was used to assess the nurses’ level of practice regarding caring for patients post-LT. This tool was developed by the researchers after reviewing the related literature (Wiegand, 2017; Good and Kirkwood, 2018; Perry et al., 2018) and is written in English. This tool was focused on assessment of nurses’ practice post-LT in the critical care unit including the following procedures:Immediate care (ABCDE) (21 steps).Care of the patient on mechanical ventilator (17 steps).Wound dressing (26 steps).Central venous catheter care (21 steps).Urinary catheter care (24 steps).Nasogastric tube care (18 steps).Care of arterial pressure line (14 steps).Sampling of arterial blood gas from an indwelling arterial catheter (28 steps).Measuring intake and output (15 steps).Infection control precautions (17 steps).

Scoring system

The total score of nurses’ practice was 201 marks, each step done correctly was given one mark and zero for the step which was not done or done incorrectly. Based on the critical care approach it was considered that:More than or equal to 85% was satisfactory level of practice (≥171 correct actions).Less than 85% was unsatisfactory level of practice (171< correct actions).

Validity and reliability

Testing validity of the tools was reviewed by a panel of five experts in the Medical-Surgical Nursing faculty staff to ascertain their clarity, relevance, comprehensiveness, simplicity, and applicability; minor modification was done. Testing reliability of the proposed tools was done statistically by alpha Cronbach test for nurses’ knowledge was 0.791 and for nurses’ practice was 0.806 that indicate high reliability of the used tool.

Research implementation

Administrative design

The necessary official approvals were obtained from the director of Ain Shams Specialized Hospital for conducting the study.

Ethical considerations and human rights

Explain the aim of the study to the hospital director to apply this study for nurses included in the study.Explain the aim of the study to each nurse included in the study and take approval regarding participation in the study.Assured that the obtained information will be confidential and used only for the purpose of the study.The researchers approached the nurses individually at the critical care units at the Ain Shams Specialized Hospital, explaining the purpose of the study, and the importance of the educational guideline to improve their level of performance regarding caring of patients post-LT.Nurses were informed that they allowed choosing to participate or not in the study and they had the right to withdraw from the study at any time without giving any reasons.Confidently of all information was secured. The study tools could not cause any harmful effects on the patients. Professional help was provided to all participants whenever needed.

Pilot study

A pilot study was carried out on 10% of the total number of the study sample to test the applicability, clarity, and efficacy of the study tools. No modifications on tools were done, so that the nurses who included in the pilot study were included in the main study group.

Field work

The tools were developed by the researchers based on reviewing the recent and related literature.Data collections took about 6 months which started from January until June 2018. The methods of teaching used were lecturing followed by focus group discussion in addition to audiovisual materials.Two tool sheets were used to assess nurses’ level of performance regarding caring for patients post-LT.Once the approval was taken to carry out the study, the researchers started to collect data and implement the educational guideline in the following way.At the beginning of educational guidelines, the need of the studied nurses should be assessed by the researchers regarding their practice and knowledge concerning caring for patients post-LT.Then, the studied nurses receive a booklet about an educational guideline regarding caring for patients post-LT in the critical care unit at Ain Shams Specialized Hospital, which is illustrated and applicable by two researchers using handout in power point.Educational guideline sessions were conducted by the researchers which included four sessions (two sessions for the theoretical part and two sessions for the practical part). The sessions were conducted in the morning and afternoon shifts.The total number of the studied nurses’ was about 30 nurses; it was difficult to gather all the nurses at one time, so the nurses were divided into six groups, each group of about five nurses and the educational guidelines were implemented on 2 days for each group separately in the same suitable time for each one of them.The observational checklist was used prior to administration of the questionnaire to ensure maximal realistic observations of the nurses’ performance and minimize the possibility of bias. The nurses’ practice was assessed by the researchers while the nurses are caring for patients post-LT, the time allowed for filling the checklist took about 20–30 min.Nurses’ structured self-administered questionnaire was filled by the nurses themselves during their free time before an educational guideline implementation to assess their demographic characteristics and their level of knowledge regarding caring for patients post-LT, it took about 20–30 min to be fulfilled.The study tools were filled three times before the implementation of educational guidelines, immediately after the educational guideline implementation, and at 3 months later (follow-up).The educational guideline, a booklet in Arabic language, based on recent medical and nursing knowledge derived from Hinkle and Cheever (2014), Good and Kirkwood (2018) gives insight for nurses’ work in the critical care unit about caring for patients post-LT.

Guideline sessions

The sessions of educational guidelines were directed toward theoretical knowledge as in the following:The first session: in which nurses’ structured self-administrated questionnaire was filled by the nurses themselves and gives an overview about LT. Anatomy and physiology of the liver, indication and contraindication for LT, waiting list and MELD score for LT, donor and criteria for selection for LT, immunosuppressive medication for LT, infection control precautions and prevention for LT, complication after LT are looked into. It took about 45 min.The second session: it was concerned with the nursing care for patients post-LT which included vital signs, mechanical ventilator, blood gases, central venous catheter, arterial cannula, nasogastric tube, and urinary catheter. It took about 45 min.The third session: focused on nurses’ practice post-LT in the critical care unit including the following procedures: immediate care (airway, breathing, circulation, disability, and exposure), care of the patients on mechanical ventilator, wound dressing, central venous catheter care, and urinary catheter care. It took about 45 min.The fourth session: focused on nurses’ practice post-LT in the critical care unit including the following procedures: nasogastric tube care, care of arterial pressure line, sampling of arterial blood gas from an indwelling arterial catheter, measuring intake and output, and infection control precautions. It took about 45 min.The researchers were available in the morning and afternoon shift 3 days per week for 4 weeks in parallel.Nurses were handled the educational guideline booklet, with some explanations from the researchers regarding its importance. At the end of the educational guideline, its effectiveness was evaluated through assessing of nurses’ knowledge and practice regarding caring for patients post-LT.

Methods of teaching

Presentation: this method has greater possibility of tasks completed on time as well as a greater potential lesson to be executed as planned.Group discussion: this method of teaching has the greatest potential to build learner self-esteem and therefore enhance their performance.

Media of teaching

Illustrated booklet.

Computer and board.

Statistical analysis

All data were collected, coded, tabulated, and subjected to statistical analysis. Statistical analysis is performed by the statistical package SPSS version 22 for Windows Data Editor (International Business Machines Corporation IBM, Armonk, New York). Microsoft Office Excel is used for data handling and graphical presentation. Qualitative categorical variables are described by percentage and proportions. Descriptive statistics are used to analyze the response to individual items and the respondents’ characteristics. Friedman’s test and P value test were used to test the correlation.

 Results



[Table 1] shows that 56.7% of the studied nurses were of age more than or equal to 35 years. Concerning sex and marital status, 86.7 and 80% of the studied nurses were women and married, respectively. Regarding their educational level and years of experience, 80% of the studied nurses had nursing secondary school diploma and had experience of more than or equal to 10 years. Moreover, 96.7% of the studied nurses did not attend training courses about LT.{Table 1}

[Table 2] shows that there was statistically significant improvement in total nurses’ knowledge regarding LT of the studied nurses postphase and follow-up phase of educational guidelines implementation with P value less than or equal to 0.05.{Table 2}

Data in [Table 3] shows that there was statistically significant improvement in total nurses’ knowledge regarding nursing care post-LT, postphase and follow-up phases of educational guidelines implementation with P value less than or equal to 0.05.{Table 3}

Regarding immediate care post-LT prephase, postphase and at follow-up phases of educational guidelines implementation data in [Table 4] shows that the studied nurses had a satisfactory level of total practice with statistically insignificant difference at P value more than 0.05.{Table 4}

Concerning infection control precautions post-LT postphase and at follow-up phases of educational guidelines implementation [Table 5] shows that the studied nurses had a satisfactory level of total practice with statistically significant difference at P value less than or equal to 0.05.{Table 5}

[Table 6] shows that there was improvement in total practice regarding nursing care post-LT of the studied nurses postphase and at follow-up phases of the educational guidelines implementation with statistically significant difference at P value less than or equal to 0.05.{Table 6}

[Figure 1] shows that 83.4% of the studied nurses had an unsatisfactory level of knowledge regarding LT at pre-educational guidelines implementation, while 96.60% of them had a satisfactory level of knowledge regarding LT at post-educational guidelines implementation. Also, 90% of them had satisfactory scores of knowledge regarding LT at follow-up of educational guidelines implementation.{Figure 1}

[Figure 2] shows that 66.7% of the studied nurses had an unsatisfactory level of practice regarding LT at pre-educational guidelines implementation, while 93.3% of them had a satisfactory level of practice regarding LT at post-educational guidelines implementation. Also, 86.6% of them had a satisfactory level of practice regarding LT at follow-up of educational guidelines implementation.{Figure 2}

[Table 7] shows that there was statistically significant relation between total knowledge regarding LT of the studied nurses and their sex, marital status, and qualification at P value of 0.02, 0.26, and 0.34, respectively, while there was a statistically insignificant relation between total nurses’ knowledge regarding LT and their age and years of experience at P value more than or equal to 0.070 and 0.89, respectively.{Table 7}

[Table 8] shows that there was statistically significant relation between total practice regarding LT of the studied nurses and their sex, marital status, and qualification at P value of 0.10, 0.31, and 0.37, respectively, while there was statistically insignificant relation between total practice regarding LT of the studied nurses and their age and years of experience at P value more than or equal to 0.60 and 0.064, respectively.{Table 8}

[Table 9] illustrates that there was a positive correlation between total knowledge and total practice of the studied nurses regarding LT.{Table 9}

 Discussion



Regarding the study nurses’ characteristics, the results of the present study revealed that more than half of the study nurses’ age were more than 35 years. This finding is consistent with what was reported by Marold (2015), who mentioned that most of the nurses who work in ICU and anesthesia care unit are more than 35 years old.

Related to sex, the present results have shown that the majority of the study nurses were women. This is may be due to the fact that the greater fraction of the nurses in Egypt was women. This finding is consistent with Wright (2013) who stated that most critical care nurses were women.

Concerning educational level, the present study results indicated that most of the studied nurses graduated from secondary school nursing diploma. This result is on the same line with Seliman (2014) who reported that only 6% of his study participants were graduated from technical nursing institute, while the majority of them (94%) were graduated from secondary school nursing diploma.

On the other hand, American Association of Colleges of Nursing (AACN, 2015) believes that education has a significant impact on the knowledge and competencies of the nurse clinician, as it does for all health-care providers. Clinicians with Bachelor of Science in Nursing degrees are well prepared to meet the demands placed on today’s nurse. Bachelor of Science in Nursing nurses are prized for their skills in critical thinking, leadership, case management, and health promotion, and for their ability to practice across a variety of inpatient and outpatient settings.

As regards nurses’ marital status, most of them were married. This finding was contradicted with Mohamed (2016) who conducted a study about assessment performance of nurses caring for patients with kidney transplantation on nurses had been working in the unit of transplantation affiliated to Ghonim Center at Mansoura University and found that the majority of the studied nurses were single.

Regarding years of experience, the current study showed that most of the study nurses had an experience of more than 10 years because they had to have a certification to practice in their field as a nurse since their graduation from secondary school nursing diploma. This finding is in accordance with what was reported by Khalil (2013) who found that less than two-third of nurses had an experience of more than 10 years in his study titled with ‘Impact of implementing a designed nursing intervention protocol on nurses’ knowledge and practice regarding patients undergoing blood transfusion.’

The finding of the current study revealed that the majority of the studied nurses had an unsatisfactory score of knowledge regarding anatomy and physiology of the liver, donor and criteria for selection and complications post-LT at pre-educational guideline implementation and the satisfactory score improved post its implementation, while this improvement lowered slightly in the follow-up phase. This could be attributed to the effectiveness of conducting the educational guideline. This finding was in the same line with Elpasiony (2013), who found that the majority of the studied nurses had unsatisfactory knowledge regarding anatomy and physiology of the liver and more than two-third of them had unsatisfactory knowledge regarding donor selection criteria as per the suggested nursing guidelines.

Fullwood et al. (2011) emphasized that the nursing team responsible for care of patients undergoing LT must be able to recognize complications and manage them appropriately.

As regards nurses’ knowledge about LT regarding MELD score, the results of this study showed that all of the study sample had an unsatisfactory score of knowledge regarding MELD score and immunosuppressive medications before educational guideline implementation and the satisfactory score improved post its implementation, while this improvement lowered slightly in the follow-up phase. This might be due to their beliefs that these aspects should be acquainted by the physician and lack of their awareness about the importance of these aspects and retention of knowledge with the time factor. This result was in the same line with Kroning (2014), who found that more than two-third of the studied nurses had unsatisfactory knowledge regarding MELD score, but this finding disagrees with Thomas et al. (2017), who found that the majority of the nurses had satisfactory knowledge regarding immunosuppressant drugs.

The present study revealed that half of the studied nurses had a satisfactory level of knowledge regarding infection control precautions, before educational guidelines implementation and the satisfactory level improved after its implementation, while this improvement lowered slightly in the follow-up phase. As well as nearly two-third of them had a satisfactory score of knowledge about blood gases before the implementation of educational guidelines and the satisfactory score was improved post its implementation and follow-up phase This could be attributed to the effectiveness of conducting educational guidelines. This results are contradicted with Youssef (2013) who conducted a study about intensive care nurses’ knowledge and practice regarding infection control standard precautions at a selected Egyptian Cancer Hospital. His study revealed that the studied sample had an unsatisfactory level of knowledge regarding infection control precautions and sampling of arterial blood gases.

The majority of nurses included in the study had an unsatisfactory score of knowledge regarding postoperative nursing care at the pre-educational guideline implementation phase because most of the studied nurses were diploma graduates and did not attend any in-service training program, while the satisfactory score improved post-educational guidelines implementation and in the follow-up phase. This could be attributed to the effectiveness of conducting the educational guidelines. These findings were in the same line with Vlaisavjevic et al. (2014) who emphasized the importance of presence of knowledgeable nurses to provide continuous nursing care post-LT as patients at this period are intubated, need close monitoring, receive immunosuppressive therapy, with significant postoperative complications, and require several care procedures.

All of the study nurses had an unsatisfactory score regarding their total knowledge at pre-educational guidelines implementation phase, which may be due to unavailability of posters and booklets and training courses while the satisfactory score improved post-educational guidelines implementation, while this improvement lowered slightly in the follow-up phase. This might be due to retention of knowledge with the time factor.

This result is consistent with Kaur et al. (2011), who stated that it is a vital that health-care members such as nurses are familiar with the basic principles of infection control measures especially after surgery and how to direct care for the patients.

Furthermore, Lameira (2014) stated that the nurse caring the patients in early post-transplant period needs specialized knowledge to reduce the problems, prevent, and intervene immediately to maximize the result of long-term graft and provide quality care throughout the hospitalization period. This is because the first 24 h after transplantation represents a critical period, marked by hemodynamic and respiratory instability, and there is a great risk of developing complications, mainly of graft rejection.

The present study finding showed that the majority of nurses included in the study had a satisfactory score about their total practice regarding postoperative immediate care at prephase-, postphase, and follow-up phase of educational guidelines implementation. This may be related to increased years of experience in this field and this is a very vital part in nursing management immediately postoperatively. This result is in the same line with Chaney et al. (2016), who revealed that the majority of nurses under the study had a satisfactory level of practice regarding immediate care of patients with LT in the postoperative period.

More than half of the studied nurses had an unsatisfactory score of their practice about total infection control precautions at the pre-educational guideline implementation phase. This may be due to the difficulties reported by nurses working in patient care in the postoperative period were work overload and lack of training courses for the nursing staff, while the satisfactory score was improved post-educational guideline implementation and follow up phase. This result in the same line with De Oliveira Serra (2015) who revealed that nursing care is not fully offered, lack of resources and nurses have difficulties in using nursing care systematization postoperatively.

Concerning nurses’ practice regarding wound dressing post-LT, the finding of the present study revealed that, near half of the studied nurses had unsatisfactory level of practice about wound dressing at pre-educational guidelines implementation phase, this might be related to lack of qualifications as most of them were nursing diploma, while the satisfactory score was improved post-educational guidelines implementation and follow up phase. This finding are in agreement with Sherief (2012), who stated that majority of the studied nurses had unsatisfactory practice regarding wound care.

While, this result is contradicted with Nkamare et al. (2013), who found that nurses have a very good practice of wound dressing as they applied the concepts/principles of sterile technique in the performance of the procedure.

More than one third of the nurses under the study had unsatisfactory score of practice regarding central venous catheter care at pre-educational guidelines implementation. This may be related the majority of the study sample had unsatisfactory knowledge regarding care of central venous catheter care. While the satisfactory score was improved post its implementation, while this improvement lowered slightly in the follow up phase. This could be attributed to the effectiveness of the conducting the educational guidelines. This finding was on the same line with Gomaa (2013), who found that all studied nurses had unsatisfactory practice regarding care of central venous catheter.

The present study revealed that, about two-third of the studied nurses had satisfactory score of practice about urinary catheter care at pre-educational guideline implementation phase. While the satisfactory score was improved post its implementation phase and follow up phase. This may be due to effectiveness of the conducted training program that affects positively on patients quality of care. This results are contradicted with Vlaisavjevic et al. (2014) who mentioned that, all the studied nurses had satisfactory practice regarding routine nursing procedures as urinary catheter care at postoperative period for patients undergoing LT.

As regards all study nurses had unsatisfactory level of practice regarding nasogastric tube care at pre-educational guideline implementation phase. This might be due to absence of standard of nursing care related to nasogastric tube care. While the satisfactory score was improved post its implementation phase and follow-up phase. This might be due to increasing their awareness regarding the importance of doing nasogastric tube care. This finding goes in the same line with Amer and Marawan (2016) who reported that each medical organization and profession must set standards and objectives to guide team and practitioners in performing safe and effective care. Also not only must standards exist, but leader and managers also must see that subordinates know and understand the standards and employee must be aware that their performance will be measured in terms of their ability to meet the established standards to provide quality of care.

Also this results is in agreement with Marquis and Huston (2015) who reported that each medical organization and profession must set standards and objectives to guide team and practitioners in performing safe and effective care. Also not only must standards exist, but leader and managers also must see that subordinates know and understand the standards and employee must be aware that their performance will be measured in terms of their ability to meet the established standards to provide quality of care.

Concerning total level of nurses’ practice, about one third of the study sample had satisfactory level of practice post-LT at pre-educational guideline implementation phase. This may be related to majority of the nurses had diploma degree, and there was lack of in-service training programs. While the satisfactory score was improved post its implementation phase and follow-up phase. This might be due to improving nurses’ practice after application of educational guidelines. This result is consistent with Liddle (2013), who stated that all health professionals must continually update their theoretical knowledge and clinical skills; those working in postoperative care can do this by developing their ability to combine the use of the assessment tools with good observational skills and closely observing their patients.

There were statistically significant correlation between total knowledge and practice of study sample. This might be due to the educational guideline improved level of nurses’ knowledge which affects positively their practice regarding caring for patients post-LT. This findings was conducted previously by Hosseini et al. (2015) who conducted a study on critical care nurses’ knowledge, attitude, and practice toward their role in the organ donation process from brain-dead patients and factors influencing it in Iran at Mashhad University of Medical Sciences, Mashhad, Northeastern Iran and mentioned that there were significant direct correlations between knowledge and practice of the study nurses.

The finding of the present study revealed that there was statistically significant relation between nurses’ performance (knowledge and practice) and their demographic characteristics (sex, marital status, and qualification). This may be due to marital stability and satisfaction, the workload, and facilities available.

This finding was contradicted with Elpasiony (2013), who reported that there was no statistically significant relation between nurses’ performance (knowledge and practice) and their demographic characteristics (age, marital status, educational level, years of experience, and attendance of training courses).

In contrast, Abdulla and Abdulla (2014) reported that there was a positive significant statistical relation between age and knowledge of nurses’ staff (increased knowledge with increased age of nurses). Also, Eskander (2013) reported that there was a statistically significant relation between total nurses’ knowledge and their age and years of experience. Also, Mohamed (2016) who conducted a study about assessment performance of nurses caring for patients with kidney transplantation on nurses who had been working in unit of transplantation affiliated to Ghonim Center at Mansoura University and found that there were no statistically significant differences between educational level and total level of practical knowledge among nurses under the study.

In summary, the results of this study revealed that there is a need to focus on the development of nursing staff knowledge and practice regarding caring for patients post-LT, so effort should be directed toward enhancing creativity among nurses. Nurses must have access to updated information, learning resources, and continuous educational opportunities.

 Conclusion



This study concluded that the educational guideline for nurses’ in the critical care unit was effective in improving their performance regarding caring for patients post-LT.

Recommendations

Critical care units should be supplied by a protocol of nursing care for managing of patients post-LT.

The importance of conducting periodic in-service training advanced care programs for nurses in critical care units for improving their performance and quality of care that is provided to the patients post-LT.

Implementing the educational guideline on a wider field including all governmental hospitals is necessary to raise the efficiency of nursing care given for patients post-LT.[37]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Abdulla S, Abdulla Z (2014). Effect of an educational program on nurses’ knowledge and practices toward hepatitis B virus in emergency hospital in Erbil. Zanco J Med Sci 18: 623.
2Aitken L, Marshall A, Chaboyer W (2015). Critical care nursing. 3th ed. China: Elsevier Company. 668–669.
3Amer K, Marawan I (2016). Evolution of living donor liver transplantation in Egypt. 6th International Conference entitled ‘Living Donor Abdominal Organ Transplantation: State of the Art.’ Available at: www.regonline. com/builder/site/Default.aspx?EventID=1082074. [Accessed Januray 6, 2019].
4American Association of Colleges of Nursing (AACN) (2015). The impact of education on nursing practice. Available at: https://greenville.org › Clemson. [AccessedJune 6 2019].
5Chaney AJ, Harnois DM, Musto KR, Ngugen JH (2016). Role development of nurse practitioners and physician assistants in liver transplantation. Progr Transplant 26:75–81.
6De Oliveira Serra MAA (2015). Nursing care in the immediate postoperative period: a cross-sectional study. Braz J Nurs 14:63–69.
7Elpasiony NMA (2013). Assess nurses’ performance for caring of patients undergoing liver transplantation and suggest nursing guidelines for care [unpublished, master thesis]. Benha, Egypt: Faculty of Nursing, Benha University.
8Eskander H (2013). Intensive care nurses’ knowledge and practice regarding infection control standard precautions at a selected Egyptian Cancer Hospital. J Educ Pract 4:1735–2222.
9Fullwood D, Jones F, Walker ML (2011). Caring of patients following liver transplantation. Nurs Stand J 25:50–56.
10Gomaa AAI (2013). The effect of implementing a nasocomial infection control prevention strategy on the occurrence of infection among liver transplant recipients [unpublished, doctoral thesis]. Menoufia, Egypt: Faculty of Nursing, Menoufia University.
11Good V, Kirkwood P (2018). Advanced critical care nursing. 2nd ed. Canada: Elsevier Company. 420–430.
12Hinkle JL, Cheever KH (2014). Medical surgical nursing. 13th ed. China: Lippincott Company. 1337–1381.
13Hosseini STM, Manzari Z, Khaleghi I (2015). ICU nurses’ knowledge, attitude, and practice towards their role in the organ donation process from brain-dead patients and factors influencing it in Iran. Int J Organ Transplant Med 6: 105–113.
14Kaur V, Datta P, Bulstrode C (2011). How to pass the MRCOSCE. 10th ed. Austria: Oxford University Press Company. 286.
15Khalil SH (2013). Impact of implementing a designed nursing intervention protocol on nurses’ knowledge and practice regarding patients undergoing blood transfusion. Med J 81:163–171.
16Kroning M (2014). The importance of integrating active learning in education. Nurse Educ Pract 14:447–448.
17Lameira T (2014). Integrative review on the role of nurses in post-kidney transplantation. Cogitare Enferm 19:553–558.
18LeMone P (2014). Medical surgical nursing critical thinking for person- centred care. 2nd ed. China: Pearson Australia Company. 2:815.
19Liddle C (2013). Principles of monitoring postoperative patients. Nurs Times Net 109:24–26.
20Marold J (2015). Improving the effectiveness of group decision- making. 1st ed. France: FoNCSI Company. 19.
21Marquis BL, Huston CJ (2015). Leadership roles and management functions in nursing: theory and application. 6th ed. China: Lippincott Williams & Wilkins Company. 575.
22McSherry W, McSherry R, Watson R (2012). Care in nursing: principles, values and skills. 1st ed. Italy: Oxford University Press Company. 4–6.
23Mohamed SM (2016). Assessment performance of nurses caring for patients with kidney transplantation [unpublished, master thesis]. Cairo, Egypt: Faculty of Nursing, Ain Shams University.
24Morton PG, Fontaine DK (2013). Critical care nursing, a holistic approach. 10th ed. China: Lippincott Williams & Wilkins Company. 1051–1056.
25Negreiros FDS, Pequeno AMC, Garcia JHP, Aguiar MIF, Moreira TR, Flor MJN (2017). Multi-professional team’s perception of nurses’ competences in liver transplantations. Rev Brasil Enfer 243:246.
26Nkamare M, Nonodimele AO, Edith O (2013). An assessment of wound dressing by nussing professional at Olabisi Onabanjo University Teaching Hospital,Shagamu, Ogun State, Nigeria. Continental J Nurs Sci 5:21–29.
27Perry A, Potter P, Ostendorf W (2018). Clinical nursing skills and techniques. 9th ed. USA: Elsevier Company. 306.
28Raj CG, Chandra SSV (2016). Artificial neural networks in prediction of patient survival after liver transplantation. J Health Med Inform 7:2157–7420.
29Seliman A (2014). Impact of a designed head trauma nursing management protocol on critical care nurses’ knowledge and practices at emergency hospital Mansoura University. J Am Sci 10 (12s):19–20.
30Sherief HE (2012). Assessment of nurses’ performance in caring for patients with bone marrow transplantation [unpublished, master thesis] Benha, Egypt: Faculty of Nursing, Benha University.
31Subramaniam K, Sakai T (2017). Anesthesia and perioperative care for organ transplantation. 1st ed. New York: Springer Company. 30–365.
32Thomas ED, Lochte HL, Lu WC, Ferrebee JW (2017). Intravenous infusion of bone marrow in patients receiving radiation and chemotherapy. Available at: www.research gate.net/ …/10101446_Intravenous_Infusion_of_Bone_Marrow_in. [Accessed November 5, 2019].
33Vlaisavjevic Z, Milutinovic D, Milicic B, Vukicevic RJ (2014). Attitudes and knowledge of nurses on organ legacy and transplantation. Available at: www.research gate.net /…knowledge…nurses…transplantation/…/attitudes-and-…, 216. [Accessed January 8, 2019].
34Wiegand D (2017). AACN procedure manual for high acuity, progressive, and critical care- E- Book. 7th ed. USA: Elsevier Company. 530–540.
35Woodruff DW (2016). Critical care nursing, made incredibly easy. 4th ed. China: Wolters Kluwer Health company; 465–469.
36Wright J (2013). The miracle of kathleen: the kathleen wright story. New York: Jerry Wright Company. 48.
37Youssef W. (2013). Intensive care nurses' knowledge and practices regarding infection control standard precautions at a selected Egyptian Cancer Hospital. Professor of critical and emergency nursing-faculty of nursing, Cairo University.