الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 369 |  |  |
| | | from | 369 | | |
Abstract
Meconium aspiration syndrome (MAS) is a severe respiratory disorder in neonates, for which there is no specific remedy. MAS is a common problem seen in the DR and newborn units as an important cause of RD in neonates, sometimes leading to RF and even death (Kattwinkel et al., 2010).
Approximately 1.2-1.6% of newborn infant develops MAS involving progressive respiratory distress, hypoxia, hypercapnia and acidosis, and need intensive respiratory therapy. Mortality rates for MAS generally range from seven to 15.8% (Dawson et al., 2010).
The aim of using clinical practice guidelines is to improve the quality of nursing care delivered and neonates’ outcomes, and provide neonatal nurses with an evidence-based guide to practice, and care of neonates having MA. Meanwhile, guidelines establish care/treatment parameters by which practice differences can be minimized, and maximize neonatal safety and desirable clinical outcomes. However, the use of Guidelines represents a truly cost-effective alternative approach for providing care for neonates suffering from MA (Velaphi & Vidyasagar, 2006).
Aim of the study
This study aimed to implement the instruction guidelines for enhancing nursing performance caring of neonates suffering from MA through:
1. Assessing nurses’ performance caring for neonates suffering from MA.
2. Designing, implementing and evaluate the outcomes of the instructional guidelines for nurses’ performance caring for neonates suffering from MA based on nurses need assessment.
Research Hypnosis:
• Nurses in the NICUs have inadequate knowledge and incompetent practice regarding care of neonates with MA. Accordingly, the implementation of instruction guidelines for caring of neonates suffering from MA will improve their knowledge and practice.
Subjects and Methods
Research setting
The study was carried out at the NICUs belonging to HIHs. These were five units (Nasr city, Atfal Masr, 6 October, Mokattam & El Nile), where the five settings having the highest capacity of nurses and neonates suffering from MA.
Sample size and characteristics
A purposive sample comprised of 50 nurses with different categories selected out of 100 nurses working in the previously mentioned settings, and one hundred and fifty neonates under the following inclusive criteria:
50 nurses with different categories working in the NICUs in the previously mentioned settings regardless their age, experience and level of education.
All neonates who were available in the time of data collection (150) from January 2014 to end week of March 2015, and diagnosed as MA were included in the study sample.
Technical design
Tools and technique of data collection
Data were collected through use the following tools:
1- A Questionnaire Format: It was designed in simple Arabic language by the researcher after reviewing of relevant literature regarding to care of neonates with MA. It consists of the following three parts:
Part I: It was concerned with the characteristics of the studied nurses, as regards their age, level of education, years of experience and attendance of previous training programs about management of MA.
Part II: It was dealt with the characteristics of the studied neonates as regards their age, gender, birth weight, GA, type of delivery, and immediate resuscitation in DR.
Part III: It was related to assessing nurses’ knowledge regarding the following items: neonatal resuscitation in DR, and role of nurse before, during and after delivery, MA, definition, causes, management of neonates including care of neonate suffering from MA receiving O2 therapy, suctioning , ET tube intubation, care of neonate on CPAP, care of neonates on mechanical ventilation (which includes care of ET tube, ventilator alarms & suctioning, physiotherapy, weaning from mechanical ventilators & extubation of ET tube), and finally application of infection control measures.
2-Observation Checklists: It was adapted from Witt, (2008), it was used to assess nurses’ performance for caring of neonates suffering from MA, as regards immediate care of the newborn, suctioning (nasopharyngeal, oropharynges and endotracheal), administration of O2 therapy, care of neonate on nasal CPAP, application of chest physiotherapy, taking CBGs and care of neonate on mechanical ventilator, and application of infection control measures.
Operational Design
Pilot study:
A pilot study was carried out from 1 September (2013) to the end of December (2013). It was conducted to test the clarity and applicability of the study tools. The pilot study was conducted on 10% of total study population, involving 5 nurses and 15 neonates. Some modifications in the form of rephrasing were done for the study tools according to the obtained results from the pilot. Nurses and neonates included in pilot study were not included in the study sample.
Fieldwork:
The actual fieldwork carried out for data collection has consumed 6 months started from beginning of January 2014 up to the end of June 2014. After 6 months follow up started from December 2014 to the end of May 2015. Each week (Saturday, Monday and Wednesday), the researcher was visiting the five NICUs. Time stay in each unit was 3hour per day. The researcher was observing 7-13 nurses per day divided them to three groups during performances’ care for neonates suffering from MA. Each nurse was observed for three shifts. The researcher was distributing the questionnaire after all observations for all selected nurses in the unit. The aims of the study were explained. Nurses’ informed consents were obtained, Confidentiality of data, and results were considered and they were assured about their rights to withdrawal from the study at any time without giving any reason. The sessions for implementation of the instructional guidelines started after collection of the observation checklists and questionnaire formats to all subjects in the study. The sessions are theoretical and practical.
Evaluation:
The same tools used for the assessment (a questionnaire format and observation checklists) of the nurses’ knowledge and performance were used to evaluate the effect of the implementation of guidelines immediately after and at follow-up.
Results:
The Findings of the current study can summarized as:
1. The mean age of the studied nurses was 27.4±2.8 years and the mean years of experience was 6.9±1.7 years. Most of them (80%) had diploma in nursing (secondary schools) and the majority of nurses (88%) had not attending previous training programs.
2. The mean GA of the studied neonates was 35.1±0.9 weeks, with birth, weight was 2300.12±127.71 grams and more than half of them (58.0) were males.
3. All neonate (100%) need for suction and O2 therapy in immediate resuscitation after delivery.
4. More than half nurses (52.0%) improved in their knowledge immediately after implementation of the guidelines while, less than half of them (42.2%) still improved at follow-up.
5. Majority of nurses (82%) improved in their practice immediately after implementation of the guidelines while, about three quarter of them (72%) stilt improved at follow-up.
6. There was highly statistically correlation between knowledge and practice at the level of 0.001 regarding immediate resuscitation care.
7. There was highly statistically correlation between knowledge and practice at the level of 0.001 regarding suctioning.
8. There was highly statistically correlation between knowledge and practice at the level of 0.001 regarding O2 therapy.
9. There was highly statistically correlation between knowledge and practice at the level of 0.001 regarding ET.
10. There was highly statistically correlation between knowledge and practice at the level of 0.001 regarding nasal CPAP.
11. There was highly statistically correlation between knowledge and practice at the level of 0.001 regarding mechanical ventilator.
12. There was highly statistically correlation between studied total nurse’s practices and their total knowledge pre & post implementation of guidelines regarding to total care of newborn having MA.