الفهرس 
Nasal continuous positive airway pressureOnly 14 pages are availabe for public view
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Abstract
C
aring for the neonate connected to NCPAP is a challenge and respiratory support is vital care in first few hours of neonatal life. Consequences of respiratory support are still major issues, morbidities such as BPD, oxygen toxicity and associated injuries of preterm neonate need a great avoidance by focusing on providing respiratory support for survival with minimal complications and utilization from quality improvement programs at NICU (Islam et al., 2015). Nurses are the principal caregiver within health care institutions, quality of nursing care requires having the basic knowledge, practices related to NCPAP and skills of accurate assessment, feeding, positioning and developmental care of neonates on NCPAP to achieve an optimum utilization with minimal complications (Hanin et al., 2015).
Aim of the study:
This study aimed to assess the quality of nursing interventions to neonates with nasal continuous positive airway pressure through the following hypothesis:
Research question:
1- Was there an association between the characteristics of neonatal nurses and their NCPAP practice?
2- Was there a relation between knowledge and skills of nurses and quality of nursing care given to neonates on NCPAP?
The subject and methods of current study was illustrated under the following four designs:
I. Technical Design
II. Operational Design
III. Administrative Design
IV. Statistical Design
I. Technical Design: it included
The technical design included research design, setting, subject and tools of data collection.
Research design:
A descriptive study was used to conduct this study.
Study settings:
This study was conducted at Neonatal Intensive Care Units at Pediatric and Maternity Hospitals affiliated to Ain Shams University Hospital and Al-Mahalla General Hospital affiliated to Ministry of Health and Population.
Subject:
A purposive sample of the available nurses employed in the previously mentioned study settings, it consisted of 80 nurses, 53 nurses from Ain Shams University Hospitals and 27 nurses from Al Mahalla General Hospital. Also, the study involved the available neonates who connected with NCPAP during the data collection, they consisted of 50 neonates.
Tools of data collection:
The following tools were used to collect the data needed for the current study, they involved:
I. Neonatal Assessment Sheet (Appendix І):
This tool was designed in a simple Arabic language by the researcher after reviewing of relevant literature, it included the characteristics of the studied neonates on NCPAP that was adopted from a relevant NCPAP questionnaire Hamdy (2008) and the data included gender, gestational age, birth weight, current weight, date of admission, diagnosis, number of days on NCPAP and present complication after connecting to NCPAP.
II. Pre-Designed Questionnaire Sheet (Appendix ІІ):
This tool was designed in a simple Arabic language by the researcher after reviewing of relevant literature to assess the nurse’s characteristics and their knowledge about the nursing care given to neonates, it consisted of two parts:
Part one: it is concerned with the characteristics of the studied nurses as regard to their age, level of education, years of experience and marital status.
Part two: this part is related to the assessment of nurses’ knowledge about the nursing care given to neonates connected with NCPAP that adopted from Hamdy (2008), it included twenty questions in a form of closed and open ended questions.
Nursing Attitude Scale (Appendix ІІІ):
This tool was aimed to assess nurse’s attitude regarding to NCPAP. The tool was developed by Liversedge et al., (2018) and adopted by the researcher to be applied in the current study. It had Likert Rating Scale and consisted of 9 items.
III. Nasal Continuous Positive Airway Pressure Observational Checklist (Appendix ІV):
The following tools were used to assess the nurse’s practice related to the care of neonates connected with NCPAP as: preparation and initiation of NCPAP, maintenance and ongoing care of NCPAP, care of NCPAP machine, nasal suctioning, oral suctioning and prevention of facial and nasal skin pressure.
Preparation and initiation of NCPAP checklist: it was adopted from Chen et al., (2017) to assess the nurse’s practice related to preparation and initiation of NCPAP.
Maintenance and ongoing care of NCPAP checklist: it was adopted from Chen et al., (2017) to assess the nurse’s practice related to maintenance and ongoing care of NCPAP.
Care of NCPAP machine checklist: it was adopted from Sweet et al., (2010) to assess the nurse’s practice related to care of NCPAP machine.
Nasal suctioning checklist: it was adopted from Perry and potter (2014) to assess the nurse’s practice related to nasal suctioning.
Oral suctioning checklist: it was adopted from Perry and potter (2014) to assess the nurses’ practice related to nasal suctioning.
Prevention of facial and nasal skin damage checklist: it was adopted from Vermont Oxford Network (2007) to assess the nurse’s practice related to prevention of facial and nasal skin damage.
II. Operational Design:
The operational design for this study consisted of three phases namely: preparatory phases, content validity, pilot study and field work.
Preparatory phase
The researcher reviewed the related literature by using periodicals, articles, journals, internet, text books and related studies to be more acquainted with the researcher problem and to develop the study tool.
Pilot study
A pilot study was carried out in March 2019 before the actual data collection and conducted on randomly selected 10% from the study participants (n=10), 10 neonatal nurses and 10 neonates who were fulfilling the previously mentioned criteria to evaluate the study tools for applicability, clarity, legibility, understandability, feasibility to estimate the time required for data collection, filling the sheets, this was estimated to be about 30-45 minutes. According to the results that were revealed from the pilot study, the necessary modifications of some items were omitted from the questionnaire sheet and another item as attitude scale was added. The subjects who shared in the pilot study were not included in the main study subjects.
Field work
Once permission is granted to proceed in the study, actual data collection carried out in the period from April 2019 to July 2019. The researcher visited the study settings and met with the neonatal nurses that cared for the neonates connected with NCPAP that fulfilled the inclusion criteria from the previously mentioned settings. The researcher started the interview with each neonatal nurse individually and explained the aim of the study and expected outcomes. The nurses were asked to fulfill the questionnaires that included: neonatal assessment sheet, the questionnaire sheet and nursing attitude scale so, the researcher read and explained the steps of the study while the neonatal nurses were recording their choices and fulfilling the tools.
The time was consumed to fulfill the full study tools ranged from 30-45 minutes for all questionnaires and the observational checklist. The researcher was available 3 days per week; Saturday, Monday and Tuesday by rotation in the morning and night shifts to collect data at previously mentioned settings. Data collection lasted for 4 months.
Ethical considerations
Approval was obtained from the ethical committee of research committee/Faculty of Nursing /Ain Shams University to conduct this study. The researcher explained aim of the study in a simple and clear manner to be understood by eligible nurses. Written permission was taken from each participant before collecting the data. Participants were informed about their right to withdraw from the study at any time without giving any reasons, they assured that there were no harmful effects on neonates and the information will be confidential.
III. Administrative Design
An official permission to carry out the study was obtained by submission of the official letter issued by the dean of the Faculty of Nursing at Ain Shams University to the directors of these previously mentioned study settings to collect the necessary data for current study after a brief explanation of the purpose of the study in order to obtain their permission for conducting the study.
IV. Statistical design
All data were collected, tabulated and subjected to statistical analysis. Statistical analysis was performed by SpSS in general (version 17), also Microsoft office Excel was used for data handling and graphical presentation. Data were presented by using descriptive statistics in the form of Number, Percentage, Mean score, Standard deviation (SD), Chi square (x 2) and Correlation Coefficient (r), were used to estimate the statistical significance that was considered at P-value < 0.05* and high statistical significance was considered at P- value < 0.001**.
Results:
The findings of the current study can be summarized as:
• The mean gestational age of neonates was 33.8± 4.5 weeks and the mean birth weight of neonates was 1550 ±0.841 gm.
• More than half of nurses had poor knowledge regarding to care of neonate on NCPAP, while one quarter of nurses had good knowledge and less than one quarter of nurses had average knowledge.
• More than two thirds of nurses were incompetent regarding to care of neonate on NCPAP.
• More than half of nurses had positive attitude regarding to care of neonate on nasal continuous positive airway pressure and less than half of them had negative attitude.
• There were highly significant relation between total knowledge of studied neonatal nurses and their educational level.
• There were highly significant relation between total practice of studied neonatal nurses, educational level and years of experience.
• There was positive correlation between total knowledge of nurses and total competency regarding to care of neonate on NCPAP.
• There was highly significant positive correlation between total knowledge, total attitude and total practice of studied neonatal nurses.
• There was no significant relation between total practice of studied nurses and attendance training course and marital status.
Conclusion
Based on the present study findings, it was concluded that, there was highly significant positive correlation between total knowledge, total practice and total attitude of studied nurses regarding to care of neonate on NCPAP. Competent practice and good knowledge were higher among nurses with higher education, more years of experience and training course.