الفهرس 
Noninvasive Continuous Positive Airway Pressure (NICPAP)Only 14 pages are availabe for public view
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Abstract
Noninvasive continuous positive airway pressure (NICPAP) has
become a useful modality in management of respiratory problems,
especially in preterm neonates. The acronym NICPAP reflects a
positive pressure applied to the airway of spontaneously breathing
neonate throughout the respiratory cycle. Care of neonates with
respiratory problems involves all the observation and intervention
related to respiratory therapy. So, clinical pathway could be very
beneficial for the patient, physician, nurse, and all health professionals.
A clinical pathway explicitly states of goals and key elements of care
based on evidence based medicine (EBM) guideline by facilitating the
communication, coordinating roles and sequencing the activities of the
multidisciplinary care team, patients and family; by documenting,
monitoring and evaluating variances and by providing the necessary
resources and outcomes (Schmölzer et al., 2013 and Brichard, 2014).
The present study was aimed to assess nurses’ knowledge
regarding to clinical pathway, designing, implementing, and evaluating
the effect of clinical pathway intervention on nurses toward care of
neonates on noninvasive continuous positive airway pressure
(NICPAP).
Subject and method:
Study design
A Quasi -experimental design.
Settings
This study was carried out at the neonatal intensive care units
(NICUs) of the following hospitals:
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1- Children and Maternity & Gynecological Hospitals
affiliated to Ain-Shams University.
2- El-Fayoum University Hospital.
3- El- Fayoum Teaching Hospital.
4- El-Fayoum Health Insurance Hospital.
Research subjects
All avilable nurses who cared for neonates on NICPAP, at
NICUs in the previously mentioned settings regardless to their
age, educational qualifications, years of experience, place of
work and attendance of previous program related to clinical
pathway comprised the subjects(N=69 nurse).
All available neonates who were indicated for NICPAP
regardless to their gestational age, birth weight, current
weight, gender, diagnosis and length of hospital stay
comprised the subjects(N=56 neonate). Neonates with
congenital anomalies will be excluded from the study.
Tools of data collection
Tools of the study included:
1 -Pre-designed questionnaire sheet (pre/post test) (Appendix II)
This tool was designed by the researcher in simple Arabic
language, after reviewing the related literature and after reviewing from
the researcher supervisors. It included the following parts:
Part I: characteristics of nurses include age, educational
qualifications, years of experience, place of work, attendance of
previous program related to clinical pathway and care of neonates
on NICPAP.
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Part II: Knowledge of nurses regarding to clinical pathway such
as definition, elements, steps, nursing role in clinical pathway,
benefits of clinical pathway for nurses and for neonates, barriers,
variance, causes of failure for implement the map of clinical
pathway and nurses’ role in clinical pathway .
Part III: Knowledge of nurses regarding to NICPAP such as
components of device, indications, contraindications, complications
and weaning process.
Part IV: Knowledge of nurses regarding to care of neonates on
NICPAP such as suctioning, oxygen administration, blood gases
technique, feeding and nutrition, skin care and prevention of
infection for neonates on NICPAP.
PartV: Knowledge of nurses regarding to multidisciplinary team
management such as role of Physician, imaging technician, lab
technician, line of communication between technician for NICPAP
device check-up and nurses, CSSD and role of infection control
team in NICUs.
Part IV: Knowledge of nurses regarding activities of clinical
pathway such as assessment, diagnostic test, nutrition and
elimination, activity/mobility, skin care, medication,
consultation, nursing documentation, neonates follow up) were
covering the phases of care for neonates on NICPA (preparatory
phase, curative phase, recovery phase, and discharge phase).
II- Assessment Sheet for Neonates (Appendix III): It included data
regarding to the neonate’s diagnosis, gestational age, gender, weight
on admission / grams, period of hospital stay, methods of NICPAP
132delivery as well the recurrence of respiratory problems during the
hospitalization period and comprised (N=56 neonates).
III- Structured observational checklist (AppendixVI) was
developed by the researcher guided by Abd-Elmenem, (2008) and
Abd-Allah, (2013) to assess nurses’ knowledge regarding to
performance, it include assist in extubation, care of neonate after
extubation, NICPAP application, connect neonates on NICPAP, care
of neonates on NICPAP, administration of oxygen therapy by nasal
cannula, oxygen hood and nasal mask, chest physiotherapy, suctioning,
taking capillary blood gases and gavage feeding.
5. The Clinical Pathway Map: It is adopted from National
Health Services (2009). The clinical pathway formats and
contents were modified by the researcher and reviewed by the
researcher supervisors to suit the nature of the study. The
clinical pathway format and contents is care map, which
describes the clinical work of each professional discipline.
This model is mapped for care of neonates on NICPAP using
the grant chart format of clinical pathway care map based on a
time matrix, listing the activities of clinical pathway in one
column and across aligning these data with columns
pertaining of time (days of hospitalization) (appendix VI).
Categorize of multidisciplinary staff actions is listed in the
column on the pathway map with specific actions for each day
of hospitalizations. Activities of clinical pathway in the map
of care covering the phases of neonates on NICPAP from
admission until discharge. The clinical pathway map using
time by hours from 0-2 hr in admission phase, then curative
phase from 1-7 days and recovery phase from 7-15 days until
discharge from NICUs.
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Pilot study
A pilot study was conducted on 10% which constitute (7 nurses and 6
neonates) of the subjects who fulfilled the eligible criteria to evaluate the
effectiveness of the applicability of the study tools and determine the time
consumed & apply the tool. According to the results obtained from the
pilot study, the necessary modifications were done by changing in
questions style from list only to multiple choices, list and discuss to assess
nurses’ knowledge, skills and attitude and added questions to assess
nurses’ knowledge about role of multidisciplinary health team. The
subjects of pilot study were excluded from the study subjects.
Field work