الفهرس 
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Abstract
Endoscopy services are the cornerstone for diagnosis and treatment in gastroenterology. Gastrointestinal (GI) endoscopy is a diagnostic and therapeutic procedure that provides a good view of the mucosal surfaces of the gastrointestinal tract. Also, it is an integral tool in the evaluation and management of many gastrointestinal conditions. Endoscopy nursing has been developed as a discipline with highly qualified nurses working alongside endoscopist. The role of the endoscopic nurse is very relevant to the outcomes of endoscopy procedures.
The endoscopy nurse should be offered holistic of care to patients undergoing gastrointestinal endoscopy before, during, and after endoscopy procedure to prevent any hazards or complications and improve patients’ satisfaction. Also, the nurse must have the skills and knowledge to assess the needs of each individual attending for endoscopy from admission to discharge. The nurses provide the patient with health instruction from the time of admission until discharge; ensure the safe delivery of endoscopic equipment.
The aim of this study was
To assess nurses’ knowledge and performance in the care of patients undergoing gastrointestinal endoscopy.
Material and methods:
Research design: the study followed a descriptive research design.
Setting: The present study was conducted in three settings at Alexandria Main University Hospital, Medical Research Institute in the Gastrointestinal Endoscopy Units, and another private hospital; Specialized Hospital for Gastroenterology & Hepatology.
Subjects: A convenience sample of 70 nurses who are providing direct care for patients undergoing gastrointestinal endoscopy working in the above-mentioned settings.
Tools of the study
To fulfill the aim of the study, two tools utilized for data collection. Tool I: Self-administered Nurses’ Knowledge for Gastrointestinal Endoscopy Interview Schedule. This tool developed by the researcher and translated into a simple Arabic language based on a review of relevant recent literature [Amer, et al., 2015; Abd-Elhamid, et al., 2016] to assess the nurses’ knowledge for gastrointestinal endoscopy. It consisted of four parts as the following: Part I: Nurses’ Socio-demographic characteristics and Clinical Data Part II: This part included questions used to evaluate nurses’ knowledge regarding gastrointestinal endoscopy apparatus, indication, contraindication of GI endoscopy and the complication of GI as well as the emergency cases nursing interventions. Part III: This part contained questions used to assess nurses’ knowledge regarding practice pre, intra, and post-gastrointestinal endoscopy.
Part IV: This part included questions used to assess nurses’ knowledge regarding general and standards precaution in the endoscopy unit. Tool II: Nurses’ Performance Observational Checklist.
This tool developed by [Taylor, Lynn & Bartlett, 2018; Wittren, Gregor & Niesen, 2019] and adapted by the researcher with based on a review of recent relevant literature to assess the nurses’ performance for gastrointestinal endoscopy. It consisted of two main parts as the following: Part I: It concerned with the gastrointestinal endoscopy insertion. It covered in four sections that were Part I-a: Pre-gastrointestinal endoscopy insertion Part I-b: Intra-gastrointestinal endoscopy insertion Part I-c: Post-gastrointestinal endoscopy insertion Part I-d: Patients’ health teaching and discharge instructions of gastrointestinal endoscopy Part II: It included a checklist to assess nurses’ practice regarding infection control for GI endoscopes. It covered in five parts:
Part II-a - Pre-procedure, during and post-procedure, and pre-cleaning for infection control.
Part II-b: Leakage testing.
Part II-c: Manual cleaning Part II-d: High-level disinfectant (HLD) Part II-e: Manual disinfecting.
Development of Study Tools
Tool I developed by the researcher based on the recent review the literature (Amer, et al., 2015; Abd-Elhamid, et al., 2016).
Tool II adapted by the researcher based on the recent review of literature (Taylor, Lynn & Bartlett, 2018; Wittren, Gregor & Niesen, 2019).
Tool I and tool II tested for reliability using Cronbach‘s Alpha test.
Method of the study:
The endoscopic nurses interviewed individually once by the researcher, the time of each interview within approximately 30-45 minutes to collect the necessary data using tool I after an explanation of the purposes of the study.
The interview schedule conducted every day at the end of the morning shift for nurses working who were in the morning shift.
The endoscopic nurse was observed at the endoscopy unit by the researcher to collect the data related to nurses‘ performance in the care of patients undergoing gastrointestinal endoscopy using tool II.
Observations were continuous, every day. Each nurse was observed in the morning shift, for pre-procedure, during the procedure and post-procedure GIT endoscopy, three times, and the mean (±SD) of these observations was estimated to assess the nurse’s performance. Also, the researcher observed the nurses’ practical skills in studied procedures. The time needed to complete the observational checklist ranged from 45 to 60 minutes.
After data collection these data were checked, entered, and analyzed by the SPSS statistical test to assess nurses’ knowledge and performance in the care of patients undergoing gastrointestinal endoscopy.
Statistical analysis:
Data were fed to the computer and analyzed using IBM SPSS software package version 20.0. (Armonk, NY: IBM Corp) Qualitative data were described using numbers and percentages. The Kolmogorov-Smirnov test was used to verify the normality of distribution. Quantitative data were described using range minimum and maximum, mean, and standard deviation. The significance of the obtained results was judged at the 5% level. The used statistical tests were: ANOVA, Friedman test, Marginal Homogeneity Test, and Paired t-test.
The main result of the study:
The majority of the studied nurses were in the age group ranged from (30<40) years old 41.4%, while 21.4% were in the age group (40<50) years old and 37.1% of them were in the age group (18<30) years old, with mean age (32.70 ± 7.92). All the studied nurses were females.
The majority 71.4% of the studied nurses were married.
Most of them had diploma degrees 55.7%, while 44.3% of them had bachelor’s degrees.
More than one-quarter of them 22.9%of the studied nurses had less than five years of experience, while 54.3% of them had years of experience from 5 to 10. In addition, it was observed that 17.1% (10<20) years of experience, and only 5.7% of them had more than 20 years of experience.
More than half of the studied nurses 61.4% had a fail level of knowledge related to gastrointestinal endoscopy, 15.7% of them had a fair level of knowledge, while 5.7% of them had a good level of knowledge. In addition, only 5.7% of them had a very good level of knowledge and 11.4% of them had an excellent knowledge level.
The mean± SD of the overall knowledge regarding gastrointestinal endoscopy (19.17 ± 5.93), Min. – Max (9.0 – 32.0), the median (18).
The mean± SD percent score of overall knowledge regarding gastrointestinal endoscopy (59.91 ± 18.53), the Min-Max percent score was (28.13 – 100) and the median percent score was (56.25).
The majority of the studied nurses 88.6% had a fail performance level; on the other hand, 11.4%had a fair performance level regarding overall nurses’ performance for gastrointestinal endoscopy.
The mean ± SD percent score was (42.35 ± 10.99) and the median percent score was (38.33) regarding the overall nurses’ performance for gastrointestinal endoscopy.
Statistically significant relationship between the nurses’ knowledge level and the attendance of gastrointestinal endoscopy training program(s) (p= 0.002*). Moreover, it was noticed that there was no significant relationship between nurses’ knowledge level and their age (p=0.560), marital status (p=0.661), educational level (p= 0.476), area of residence (p= 0.723), years of experience in the gastrointestinal unit (p=0.816), and receiving viral hepatitis B vaccination (p=1.000).
No Statistically significant relationship between the overall nurses’ performance level and the age (p=0.711), marital status (p=0.205), educational level (p=1.000), area of residence (p=0.531), years of experience in the gastrointestinal unit (p= 0.309), receiving the viral hepatitis B vaccination (p=1.000), and the attendance of gastrointestinal endoscopy training program(s) (p=0.415).
Highly statistically significant relation between the overall nurses’ knowledge and overall nurses’ performance (p=<0.001).
The main recommendations are:
Recommendations
Based on the findings of the current study, the following recommendations are derived and suggested:
Recommendations for nursing staff:
Periodic assessment of nurses’ knowledge and performance regarding the care of the patients undergoing gastrointestinal endoscopy to continuously update their knowledge and performance.
Periodic in services training to maintain a good level of knowledge and performance and updates nurses working with a patient undergoing gastrointestinal endoscopy.
Recommendations for further studies
Study the effect of implementing educational training programs for nurses on the clinical outcomes of patients undergoing gastrointestinal endoscopy.
Future studies can be conducted in different settings in Egypt necessary to raise the knowledge and performance of nursing care given to patients undergoing gastrointestinal endoscopy.