الفهرس 
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Abstract
Becoming a patient in the intensive care unit represents considerable crisis in the lives of the critically ill patient and his family, especially patient undergoing cardiac surgery typically experience physical and psychological stress. The postoperative period of cardiac surgery is associated Psychological symptoms such as anxiety and depression which leads to multiple physiological complications namely pain, delay weaning from mechanical ventilator, increase length of stay and increase incidence of infection. Therefore, those patients require cared by caring behavior.
Caring behavior also can be divided in to caring and helpful (Polite, respect individuals, welcoming, helpful, kind, supportive, don’t wait to be asked, listening, informing, communicating. Safe and vigilant (Be professional, honest, will speak up if needed, provide comfort and safe environment. Excellent (compassionate, gentle and provide health teaching). Caring behavior is defined as behaviors provided by nurses while provide caring for patients. It is not only to cure the patients. But also, to keep balances while him suffering from a stressful situation. Active listening, comforting environment, honesty, patience, responsibility, providing information, therapeutic touch, sensitivity, respect, calling the patient by preferred name are mainly top caring behavior perceived by patients.
Aim of the study:
To assess the effect of caring behavior protocol on mechanical ventilation weaning for post-operative cardiac patients.
Research hypothesis:
• Patients who are subjected to the caring behavior protocol exhibit more weaning criteria than those who are not.
• Patient who are subjected to the caring behavior protocol exhibit less signs of weaning intolerance rather than who do not.
• Patients who are subjected to the caring behavior protocol exhibit more satisfaction than patients who are not.
Setting
This study was conducted at Open Heart Surgery Intensive Care Unit, Department of Cardiothoracic Surgery, Alexandria Main University Hospital.
Subjects
A convenience sample of 60 newly admitted adult postoperative cardiac patients to open heart surgery intensive care unit was included in the current study.
Tools
Three tools were used by the researcher to collect data after extensive reviewing the relevant literature
Tool I: “Caring Behavior Protocol”
This tool was adapted from Elbahnasawy et al. (2016); Shalaby et al. (2018); Wassif (2007); Watson (1985), and it was used to provide caring behavior for post-operative cardiac patients. It includes ten categories include the following Humanism, Establish trust relationship, Presening Sharing\Reassurance, Giving a sense of control , Inspiring hope, Fostering orientation, Supporting the patient’s family, Spiritual care, Comforting and Therapeutic relationship
Tool II: Patient satisfaction assessment tool.
This tool was adapted from Bucco (2015); Palese et al. (2011); Wassif (2007). It was used to assess patient’s satisfaction toward caring behavior protocol which provided for them. It includes five categories which cover thirty eight items of caring behavior protocol.
Tool III: “Weaning Assessment tool”.
This tool was used to assess mechanical ventilation weaning criteria and presence of weaning intolerance signs for post-operative cardiac patients. It was composed of two parts.
Part one: Spontaneous breathing trial (SBT) safety screen.
This part was adopted from Hooper and Girard (2009). This part was used to assess mechanical ventilation weaning criteria for post-operative cardiac patients. Patient’s eligibility for SBT will be assessed for oxygenation parameters such as SpO2 ≥ 88%, FiO2 ≤ 50%, PEEP < 8 cmH2o, ventilation parameters such as respiratory rate, minute volume, neurological parameters such as GCS and agitation score, hemodynamic parameters such as heart rate, temperature, mean arterial pressure. The response format was measured by using scale of Yes (present), No (not present). If any of the SBT safety screen criteria is absent, the researcher was concluded that the patient is not ready for SBT.
Part two: Signs of weaning intolerance.
This part of tool was adopted from (Elcokany et al., 2013). This part was used to assess and document the presence or absence signs of weaning intolerance while the patient was passed SBT. Items in this part included an assessment signs of weaning intolerance as (level of consciousness, restlessness, agitation, diaphoresis, use of accessory muscles, SpO2< 90%, respiratory rate > 35 breaths/min, heart rate > 120 b/min or > 20% from baseline, systolic arterial pressure > 180 mmHg or < 90 mmHg or variation > 20%, from the baseline).
Methodology
• Approval of the Ethics Committee of the Faculty of Nursing, Alexandria University was obtained.
• An official letter from the Faculty of Nursing was delivered to the hospital authorities in the Alexandria Main University Hospital and approval to conduct this study was obtained after providing explanation of the aim of the study.
• Content validity of data collection tools were established by eight experts in the field of the study divided on four experts in the critical care nursing, two experts in the psychiatric nursing and two experts in the critical medicine. The necessary modifications were done accordingly.
• Reliability of the tools were done by using Cronbach’s alpha test, the reliability test result were (r = 0.895 for tool one and 0.98 for tool two).
• A pilot study was carried out on 10% of the total subjects to assess the clarity and applicability of the research tools. Patients who met the inclusion criteria were divided into two groups; group A ”the control group” and group B ”the study group”.
• Data were collected from group A first then from group B.
• group A received routine nursing care.
• group B were cared by caring behavior protocol.
• All enrolled post-operative cardiac patients were assessed for appearance of weaning criteria by using tool three.
• All enrolled post-operative cardiac patients were assessed for their satisfaction by using tool two
• Statistical analyses were performed using Statistical Package for the Social Science (SPSS) version 23.
The main findings of the current study revealed that
It was noted that patients’ age 36.7% and 23.3% of control and study group respectively were lied in age35 – <45. According to gender and level of education 56.7 % of both control and study group were female, 23.3% and 33.3% of control and study group respectively were graduated from university.
Regarding the studied procedures, it was found that weaning criteria appeared at (33.3%, 53.3% and 13.3%) of study group after two ,four and six hours of applying caring behavior, with significant differences between two groups (p value = zero for all).Moreover, there were increasing in the signs of weaning intolerance with significant differences between two groups (P=0.00*) for all. Also it can be noticed that that there were positive statistical significant correlation between weaned patients in the study group and their satisfaction p =zero for all.
It can be concluded from the present study that.
Caring behavior protocol was found to be effective in the following early successful weaning for postoperative cardiac surgery patients, reduces signs of weaning intolerance among study group and increase patients’ satisfaction for postoperative cardiac surgery.
It can be recommended from the present study that
Critical care nurses should apply caring behavior protocol to enhance MV weaning for post-operative cardiac patients, reduce signs of weaning intolerance for post-operative cardiac patients and enhance patients’ satisfaction. Caring behavior protocol should be published at open heart surgery intensive care unit of Alexandria Main University Hospital. Moreover additional researches are needed to assessing the caring behavior of critical care nurses and assess factors affecting of caring behavior of critical care nurses at ICU.