الفهرس 
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Abstract
Quality of trauma care is the adequate standardized implementations by trauma nurses who are possessing a specialized body of knowledge for caring for the trauma patient. They are a fundamental component of direct trauma care and the operation of trauma center and trauma system. Standards are authoritative statements by which the nursing profession describes the responsibilities for which its practitioners are accountable. They define nursing profession’s accountability to the public and the outcomes for which registered nurses are responsible. The standards of nursing care describe a competent level of trauma nursing care as determined by the critical thinking module known as the nursing process.
The aim of this study was designing and validating standards of nursing care for trauma patient. This was done through assessing the performance of nurses working in the trauma center, designing standard of nursing care for trauma patient based on national and international sources and the collected data and assessing the validity of the proposed standards based on expertsviewpoints, and assessing applicability of the developed standards.
A methodological study design was used for assessment and development of the standards. Subjects of the study involved three groups of subjects: a group of 40 staff nurses, a jury group of twenty nursing faculty members, thirty medical faculty members, and ten nurse managers in the field of trauma nursing, and 20 head nurses /assistant head nurses from El-galaa Military Medical complex. The data collection tools included jury opinionnaire sheet for validating the proposed standards, an observation checklist to assess staff nurses’ performance, and structure inventory checklist for assessment of the settings to determine readiness to apply standards.
Fieldwork
The actual fieldwork of the study started on the beginning of January 2016 and ended in March 2017.
After securing official permissions, the researcher started the observation process. This was done using the designed observation checklist, and before disseminating the proposed standard. Each staff nurse was observed during her routine work for all the criteria of the process standard. This was done in two shifts. Each nurse was observed until the checklist items were totally fulfilled, the duration of observation was about five months.
Upon ending with the staff nurses’ observation, testing of the validity of the proposed standard was done. The researcher met with the jury group members to obtain their opinions and suggestions regarding the proposed standard. According to the comments and recommendations of jury members, the standard was modified and returned again to the jury to approve the final version. Then the proposed standard was considered valid. Then, assessment of staff nurses’ performance was done again after disseminating the standard using the same observation checklist.
Standard development and validation
Based on the validity and applicability data obtained from various study tools, the nursing care standard was proposed. The researcher divided the proposed standard of nursing care for trauma patient according to Donabedian’s models into two parts, namely structure standards and process standards. Then upon ending with the staff nurses’ observation, testing of the validity of the proposed standard was done. The researcher met with the jury group members individually, explained the objectives of the study for each one, and asked them to express their opinions and suggestions regarding the proposed standard. They gave some comments on the clarity of some criteria of the constructed standard and its coverage of all aspects related to process and structure. According to the comments and recommendations of jury members, the standard was modified and returned again to the jury to approve the final version. Then the proposed standard was considered valid. The duration was two month.
Standard dissemination
The researcher disseminated the developed valid standards through scheduled dissemination sessions that was aimed to raise the awareness of nurses with the standards related to trauma assessment, triaging, primary survey and secondary survey. The period of training started at August 2016 and ended at March 2017. The scheduled dissemination sessions consists of 100 hours for theoretical and practical sessions in theoretical part, the staff nurses were divided into two groups each attend the 100 hrs of awareness.
The study findings were as following:
- All jury group members agreed upon the face validity of the proposed standards, except two items, which were 76.7%each by nursing experts.
- For content validity, there was unanimous agreement of jury groups upon all areas, except for non-human resources, work environment and safety and infection control which agreed upon by 50% of the medical experts.
- Observation of staff nurses’ performance demonstrated generally low percentages of adequate performance before dissemination of the standards ranged between 2.5% in area of planning to 37.5% in area of assessment.
- After dissemination of the standards, statistically significant improvements were demonstrated in all areas (p<0.001).
- The total adequate performance increased from 5.0% to 80.0%.
- Inspectionof the study settings revealed that most of structural standards are present but mission and vision need to be available to all staff, also performance appraisal need to be more clear for them.
In conclusion, it is concluded that the majority of the staff nurses had inadequate performance of most of the criteria related to process standard, with improvement in their performance after dissemination, which points to its applicability. The proposed standard has been face and content validated through majority agreement of nursing and medical experts.
Based on the finding of the study, it is recommended the developed standards of nursing care for trauma patients are recommended to be applied in the trauma center. Mission and vision should be available for all staff members, infection control guidelines should be known to all staff and used in each unit in the trauma center, and performance appraisal should be clear to all staff. Quality improvement programs should be initiated in the trauma center to improve the quality of care provided.