الفهرس 
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Abstract
Upper GI endoscopy it is a diagnostic and therapeutic procedure that provide good view of the mucosal surfaces of the upper GI tract and management of many GI conditions. The nurse endoscopist should be offer a holistic package of care to patients undergoing GI endoscopy throughout the procedure. The role of an endoscopy nurse has been expanded still further. As a result of the expanded duties and responsibilities being placed on endoscopy nurses, task-specific training is critically important. Every endoscopy unit should implement a performance improvement programs for nurses to improve nurses’ performance and patients’ outcomes (Tan et al., 2018).
Moreover ”outcomes” has become a popular word in contemporary health care. This emphasis on identifying and measuring the results of interventions and practice is noteworthy, necessary and has important implications for upper GI endoscopic patients. Improving the outcomes of upper GI endoscopic patients requires the best efforts of nurses in multiple settings and roles, working collaboratively with families, patients and other health team (Williams & Hopper, 2015).
Aim of the study:
This study aimed to evaluate the outcome of designed guidelines for nurses caring for upper gastrointestinal endoscopic patients through the following:
1. Assessing level of performance (knowledge and practice) for nurses caring for upper gastrointestinal endoscopic patients.
2. Designing and implementing guidelines for nurses caring for upper gastrointestinal endoscopic patients.
3. Evaluating the effect of implementing the designed guidelines on nurses’ level of performance (knowledge and practice).
4. Evaluating the effect of implementing the designed guidelines on patients’ outcome (complications and satisfaction).
Research Hypothesis
The current study hypothesized that:
The designed guidelines will improve nurses’ performance (knowledge and practice) and outcomes (complications and satisfaction) of the patients undergoing upper gastrointestinal endoscopy procedure.
Operational Definitions
Outcomes: it meant consequences of designed guidelines implementation on the studied nurses’ performance regarding caring of patients undergoing upper GI endoscopy that was measured by self-administered questionnaire and practice observational checklist. In addition to its consequence on the studied patients′ complications occurrence rate and their satisfaction level regarding the received care in both control and study groups which were measured by patients’ outcome evaluation sheet.
Designed guidelines: were developed by the researcher based on recent relevant literatures, which covered the nurses’ role regarding caring of patients undergoing upper GI endoscopy (pre, during and after the procedure). An Arabic and English booklet were designed included the nursing guidelines.
Subjects and methods:
1-Technical Design:
The technical design included research design, setting, subjects and tools used for data collection.
Research design:
A quasi-experimental design was utilized in this study.
Setting:
The study was conducted at GI endoscopy unit at Ain Shams University Hospital.
Subjects:
A convenient sample of all staff nurses working in GI endoscopic unit. In addition, a purposive sample of 60 adult patients undergoing upper GI endoscopic procedure was selected according to certain inclusion criteria. This sample was divided into two equal groups of patients: control group of patients pre the designed guidelines implementation and study group of patients post the designed guidelines implementation with Mean ± SD of age 37.96±9.54 for the control group and 38.92±10.36 for the study group.
Inclusion criteria:
The studied patients were selected according to the following criteria: Adult patients, their ages ranged from 18 to 60 years, from both genders, with different educational level, undergoing upper GI endoscopy, with no critically or psychotic disorders, able to comprehend instructions, not exposed before for any educational or learning experience and who agreed to participate in the study.
Tools for data collection:
I- Self-administered questionnaire for nurses (Appendix I): The self-administered questionnaire was used to assess nurses’ level of knowledge regarding caring for patients undergoing upper GI endoscopy pre and post the designed guidelines implementation. It was developed by the researcher after reviewing the related literature: (Lichtenstein & Alfa, 2019; Decristoforo et al., 2018; Treuting et al., 2018; Brown et al., 2017; Society of Gastroenterology Nurses and Associates (SGNA), 2017; American Society for Gastrointestinal Endoscopy (ASGE), 2015). It was prepared by the researcher in simple Arabic language. This tool covered two parts:
• The 1st part: It concerned with the demographic characteristics of nurses under study as regards; age, gender, qualification, years of experience and training courses regarding caring for patients undergoing upper GI endoscopy.
• The 2nd part: It concerned with assessing the nurses’ knowledge level regarding caring of patients undergoing upper GI endoscopy.
II- Nurses’ practice observational checklist (Appendix II): It was used to assess nurses’ level of practice regarding caring for patients undergoing upper GI endoscopy pre, during and post the designed guidelines implementation. It was developed by the researcher after reviewing the related literature: (Decristoforo et al., 2018; Tan et al., 2018; Society of Gastroenterology Nurses and Associates (SGNA), 2017; American Society for Gastrointestinal Endoscopy (ASGE), 2015). This tool was written in English language. This tool was divided into four phases as the following:
The 1st part: for assessing the nurses’ practice pre the procedure.
The 2nd part: for assessing the nurses’ practice during the procedure.
The 3rd part: for assessing the nurses’ practice post procedure.
The 4th part: for assessing the nurses’ practice regarding reprocessing of GI endoscope.
III- Patients’ outcome evaluation tool (Appendix III): was used for assessing the studied patients’ outcome regarding complications occurrence and satisfaction level in both study and control groups. It was developed by the researcher after reviewing the related literature: (Bistritz et al., 2018; Moorhead et al., 2018; Yoon et al., 2018; Hucl et al., 2016). It was written by the researcher in simple Arabic language. It was filled by the studied patients. This tool covered the following parts:
The 1st Part: concerned with assessment of demographic characteristics of the patients under study such as patients’ gender, age, residence, marital status, level of education, employment and income
The 2nd Part: concerned with patients’ clinical data such as medical diagnosis, complain on admission, type of endoscopy, past medical history for patient and his family.
The 3rd Part: concerned with the assessment of complications and discomforts among the studied patients undergoing upper GI endoscopy.
The 4th Part: concerned with the assessment of satisfaction level of patients undergoing upper GI endoscopy
IV- Training program conducted by the researcher to the studied nurses caring for patients undergoing upper GI endoscopy in the selected setting. Its main purpose is to ensure that each nurse has the capability to apply the designed nursing guidelines for such group of patients. The designed nursing guidelines developed by the researcher based on recent literature reviews and the studied nurses’ needs assessment.
Results:
The results of this study showed the following:
• Total nurses’ performance (knowledge and practice) satisfactory level regarding caring of patients undergoing upper GI endoscopy significantly improved post the designed guidelines implementation compared to pre (66.7% versus 23.3%) and (56.7% versus 16.7%) respectively with statistically significant differences.
• Total satisfactory level of patients undergoing upper GI endoscopy regarding the received care in the study and control groups significantly improved post the designed guidelines implementation compared to pre (63.3% versus 40.0%).
• There was no statistically significant difference between the patients in the control and study groups regarding complications occurrence rate.
• There was statistically significant relation between total nurses’ knowledge mean score and educational level pre the designed guidelines implementation P<0.05. While, there was statistically significant relation between their knowledge mean score and their demographic characteristics including age, educational level, years of experience and training courses post the designed guidelines implementation (P<0.05).
• There was statistically significant relation between total nurses’ practice mean score and their years of experience pre the designed guidelines implementation. While, there was statistically significant relation between their practice mean score and their demographic characteristics including age, educational level, years of experience and training courses post the designed guidelines implementation of (P<0.05).
• There was positive correlation between total nurses’ knowledge level regarding caring of patients undergoing upper GI endoscopy and their total practice level and patients’ satisfaction, while there was negative correlation between total nurses’ knowledge level and patients’ complications occurrence rate pre and post the designed guidelines implementation. As well as, there was positive correlation between total nurses’ practice level regarding caring of patients undergoing upper GI endoscopy and patients’ satisfaction level, while there was negative correlation between total nurses’ practice level and patients’ complications occurrence rate pre and post the designed guidelines implementation.
Conclusion:
The results of this study concluded that:
• The designed guidelines had statistically significant positive effect on outcome of the studied nurses’ performance (knowledge and practice) regarding caring of patients undergoing upper GI endoscopy and on the satisfaction level of such group of patients, but the results didn′t reveal any statistically significant difference between the control and study groups regarding complications occurrence rate.
Recommendations:
The result of this study projected the following recommendations:
• The importance of conducting in-service training programs for the nurses caring of patients undergoing upper GI endoscopy to keep them almost abreast with updated knowledge and evidence-based practice related to caring of such group of patients.
• Implementation of an educational program for the patients undergoing upper GI endoscopy regarding the designed nursing guidelines to improve their outcomes.
• Replication of the current study on larger probability sample and different hospitals settings is recommended to evaluate the impact of the designed nursing guidelines regarding caring of patients undergoing upper GI endoscopy on the nurses’ performance and consequently on the patients’ outcome on the long run