الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Medication administration is an important aspect of professional nursing practice. It is a cognitive and interactive aspect of nursing care that consist of four phases which are: assessment, planning, implementation and evaluation. Medications must be given with caution to patients with decompensated cirrhosis. Administrations of correct medication and dosage by the specified route using proper technique and taking appropriate precautions all that was expected from a nurse.(25) The current study aimed to determine the effect of implementing safety guidelines for nurses about drug administration for liver cirrhotic patients. A quasi-experimental research design was used in the present study. The study was conducted at Tropical Medicine and Medical Departments in Main Tanta University Hospital A convenience sampling consisted of sixty nurses and sixty patients who have attended the above previously mentioned settings, and consisted of two groups as follow: (60) nurses participate in the study. (40) nurses from Tropical Medicine and (20) nurses from Medical Department. (60) patients who are diagnosed with liver cirrhosis. (40) patients from Tropical Medicine Department and (20) patients from Medical Department. Divided randomly into two equal groups. group one: Control group (20) patients from Tropical Medicine Department and (10) patients from Medical Department diagnosed with liver cirrhosis. This group was received medication by routine way of the hospital nursing staff. group two: Study group, (20) patients from Tropical Medicine Department and (10) patients from Medical Department diagnosed with liver cirrhosis The inclusion criteria of nurses included the following: All nurses working in the departments and providing direct care for liver cirrhotic patients. Inclusion criteria for the patients: age from 21:55 years, both sexes, diagnosed with liver cirrhosis (stage I, II) and conscious without chronic diseases such as heart failure , multiple trauma patients Tools of data collection: Three tools were used in the current study as the following: Tool I: An interview questionnaire: It consisted of three parts: Part (1): Socio-demographic data of the nurses as age, qualification, place of work, position, years of experience, and attendance of relevant training programs. Part (2) Nurses’ knowledge assessment tool to assess the nurse’s knowledge regarding safety guidelines about drugs administration for liver cirrhotic patients Part (3): Socio-demographic data of the patients as patient name, age, marital status, educational level and occupation. Tool II: Observational checklist for nurse’s performance of drug administration: to assess nurse’s practices regarding safety guidelines about drug administration for liver cirrhotic patients using 140 steps as (Prepare the medication following twelve medication right, administration of medication, documentation and evaluation ). Tool III: Patient’s outcomes assessment tool: It consisted of two parts: Part (A) Modified Child-Turcotte-Pugh Score (CTP): to assess the prognosis of liver cirrhosis and evaluate effects of post implementation guidelines on patient‟s outcomes. This score incorporates five parameters: two clinical parameters (encephalopathy and ascites) and three laboratory values (total bilirubin, serum albumin, and prothrombin time). Part (B) Laboratory investigations: as liver function tests, blood ammonia test, alpha-fetoprotein blood test and serum Creatinine and Urea. The main results of the present study: - Regarding the age and experiences of nurses, it was evident that more than half of the nurses (63.3%) were age range between twenty-nine to thirty-nine years and with a mean age of 33.80 ± 6.28 years and had eleven to twenty years‟ experience. - As regard of occupational position, it was observed that the majority of nurses (90.0%) were bedside nurse either bacholer , secondary school or institute . - It was clarified that there was a statistically significant difference for nurses‟ knowledge about structure and functions of liver, stages , types, manifestations and complication of liver cirrhosis throughout the period of the study. - It was clarified that there was a statistically significant difference for nurses‟ knowledge about medical treatment, medication administration for liver cirrhosis and medication administration errors throughout the period of the study - It was found that there was a statistically significant difference for nurses‟ knowledge about safety guidelines for medication administration for liver cirrhotic patients - It was obvious that the mean score of nurses‟ knowledge were 46.30±7.66, 93.91±1.75, 93.01±3.17, and 89.13±4.94 before, immediate, two weeks, and two months post the sessions respectively. - It was clarified that There was a statistically significant difference for nurses‟ knowledge levels regarding safety guidelines about drugs administration for liver cirrhotic patients before, immediate, two weeks, and two months post the sessions - It was obvious that there was a statistically significant difference for nurses‟ performance of safe administration of oral medication, I.M and I.V injection, I.V infusion, S.C injection, throughout the period of the study. - It was found that there was a statistically significant difference for nurses‟ performance regarding safety guidelines about drugs administration for liver cirrhotic patients throughout the period of the study. - It was cleared that the mean score of nurses‟ performances were 167.8±9.06, 248.0±0.00, 239.8±4.21 and 234.3±5.83 throughout the period of the study. - It was found the mean of age were 38.70±6.99 and 35.70±6.51 tropical medicine department and medical department respectively for control group while 39.50±6.98 and 37.10±6.36 tropical medicine department and medical department respectively for study group. - Regards to stage of liver cirrhosis, two-thirds (66.7%) and (56.7%) of control and study groups had second stage respectively. - Regarding hepatic medication, 43.3% of control study and 33.3% of the study group take three types, - As regard to Modified Child-Turcotte-Pugh Score, the mean of total score were 9.60±2.17, 9.7±1.14, and 8.9±1.34 immediate, first and fourth week post the sessions respectively. - It was found that there was a statistically significant difference between control and study group one week post the sessions for all lab investigations - It was cleared that that there strong positive correlation with statistically significant difference correlation between total knowledge and performances scores two months post the sessions. It was found that there was a statistically significant difference between scores of total nurses‟ knowledge and their age, educational level and years of experience immediate, two weeks and two months post the sessions. - It was noticed that there was a statistically significant difference between scores of total nurses‟ performance and their age immediate post the sessions. - It was found that there was a statistically significant difference between patients‟ age and educational level and Modified Child-Turcotte-Pugh Score of the study group data immediate, first week and two months post the sessions. - It was clarified there was a statistically significant difference between patients‟ educational level and liver function of the study and control group immediate, first week and two months post the sessions. - It was cleared that there was a statistically significant difference between patients‟ occupation and blood ammonia test of the study and control group immediate and two months post the sessions. - It was found that there was a statistically significant difference between patients‟ residence and alpha-fetoprotein blood test of the study group immediate, first week and two months post the sessions - It was noticed that there was a positive correlation with a statistically significant difference between patients‟ age and receiving antibiotic of the study and control group. - It was cleared that there was positive correlation with a statistically significant difference between patients‟ age and receiving diuretics of the study group. - As regard to receiving anti-inflammatory, there was positive correlation with a statistically significant difference between patients‟ residence and educational level of the study and control group. The study concluded that nurses knowledge and practice improved post implementation of teaching session about safe drug administration for liver cirrhotic patients . Patients with liver cirrhosis showed an improvement in their outcomes assessment related to Modified Child-Turcotte-Pugh Score and being free from complications after the implementation of the guideline . The study recommended that: 1-Recommendation For nurses 4- Continuing long term education and training for nurses about safety guidelines of medication administration for liver cirrhotic patients 5- Raising awareness about safety culture among health care workers especially nurses 6- Integration between Medical Surgical nursing staff and hospital staff to fulfill the gab between the theory and practice through sharing knowledge and performance using Journals, Computers , smart phones Internet and all tools of telenursing . 2-Recommendation for patients Provide manual handbooks for the patients containing all necessary knowledge regarding liver cirrhosis. 3-Recommendation for future research 1- The study should be replicated on large sample and different hospitals setting in order to generalize the results. 2- Health informatics (HI) including computerised drug administration systems, by doctors and nurses.