الفهرس 
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Abstract
SUMMARY
T
he OT is a very critical area, so the nurses must be very careful and take great care to provide quality care without risks and maintain patient safety. Patient safety in OT has been defined as reduction of risk of unnecessary harm associated with delivery of health care to a minimum as well as the prevention of errors and avoidable adverse events, to protect patients from injury (Ingvarsdottir & Halldorsdottir, 2017). Patient safety must be an essential priority of health care providers; and they should hold a higher level of knowledge regarding patient safety to better identify, interrupt and correct medical errors and safeguard patients (Safarpour et al., 2017).
Aim of the study:
This study aimed to assess the nurses’ performance regarding the patients’ safety measures in operating theater. This aim was achieved through the following:
1. Assessing nurses` knowledge level regarding the patients’ safety measures in operating theater.
2. Assessing nurses’ practice level regarding the patients’ safety measures in operating theater.
3. Assessing nurses’ attitude level regarding the patients’ safety measures in operating theater.
Research questions:
This study was conducted for answering the following questions:
1. What is the nurses’ level of knowledge regarding the patients’ safety measures in operating theater?
2. What is the nurses’ level of practice regarding the patients’ safety measures in operating theater?
3. What is the nurses’ level of attitude regarding the patients’ safety measures in operating theater?
4. Is there relation between nurses̕ knowledge, practice and attitude levels regarding the patients’ safety measures in operating theater?
Subjects and Methods
Research Design:
A descriptive exploratory design was used to achieve the aim of this study.
Research Setting:
This study was conducted at ORs at Belbeis Central Hospital – El sharkeya Governorate / Egypt.
Subjects of the study:
A convenient sample of all available nurses in the ORs, including 40 nurses after obtaining their consent to participate in the study. Their educational level was diploma, technical institute and B.Ss. nursing.
Tools of data collection:
Data collection was obtained using three tools, they were developed by the investigator based on the relevant and most recent literatures and reviewed by a panel of experts in critical care nursing; they consisted of the following:
I- Nurses’ Self-administered Questionnaire (Appendix I):
It was used to assess nurses’ level of knowledge regarding the patients’ safety measures in OT. It was developed by the investigator after reviewing the related literature: (Wæhle et al., 2012; Hinkle & Cheever., 2014; Debas et al., 2015 Kim; et al., 2015; Şahin et al., 2015; Ignatavicius et al., 2016; Jones & Bartlett, 2016; Katz, 2017; Anderson & Echavez, 2018; Joseph et al., 2018 & Rothrock, & McEwen., 2019). It was translated by the investigator into simple Arabic language. The questionnaire consisted of 47 questions in the form of multiple choice questions (MCQ).
Scoring system:
The correct answer for each question was given one mark and the incorrect answer was given zero, so the total score of knowledge was 47 marks, classified into the following:
Below 85% = < 41 marks was considered as unsatisfactory level.
85% and above = ≥ 41 marks was considered as satisfactory level.
II- Nurses practice observational checklist (Appendix II)
This tool used in English language form; developed by investigator based on relevant recent literature: (Hamlin et al., 2015; Woodman & Walker, 2016; American society of Perianesthesia Nurses, 2017; Operating Room Nurses Association of Canada (ORNAC), 2017; National Operating Room Nursing Audit, 2018; & Association of perioperative Registered Nurses, 2019). It was used to assess nurses’ level of practice regarding the patients ’ safety measures in OT. This tool was covering all phases of surgery (preoperative, intraoperative and postoperative), and total items were 187.
Scoring system:
In relation to nurse’ practice, each item was scored ”0” for not done or done incorrectly and ” 1” mark for done correctly, so the total score of checklist was 187 marks classified into the following;
Below 90% = < 168 was considered as unsatisfactory level.
90% and above = ≥ 168 was considered as satisfactory level.
III- Nurses’ Attitude rating scale (Appendix III):
It used to assess nurses’ level of attitude regarding safety measures for patients in OR. It developed by investigator based on relevant recent literature (Pinar and Intepeler, 2017, Quintana et al., 2018) & Kertesz et al., 2019). It translated into Arabic language and back translation were done. It included (19 statements).
Scoring system
This 3 point Likert scale had 3 responses options always, sometimes and rarely: Always considered positive response and took one grade while sometimes and rarely considered negative response and took zero. So, total score of this scale was 19 marks, classified into the following;
o ≥ 90% = ≥ 17marks considered positive attitude level.
o <90% = <17 marks considered negative attitude level.
b- Ethical Considerations
The ethical research considerations in this study included the following:
6- The research approval of protocol was obtained from Scientific Research Ethical Committee in Faculty of Nursing at Ain Shams University before starting the study.
7- The researcher clarified the objective and aim of the study to the nurses included in the study.
8- The researcher assured maintaining anonymity and confidentiality of the subject data.
9- Nurses were informed that they allowed choosing to participate or not in the study and they had the right to withdraw from the study at any time without giving any reasons.
10- Ethics, values, culture, and beliefs were respected.
c- Tools validity and reliability (Appendix IV):
Testing validity of the proposed tools by using face and content validity. Face validity aimed at inspecting the items to determine whether the tools measured what supposed to measure. Content validity was conducted to determine whether the content of the tools covered the aim of the study. This stage developed by a jury of 7 experts, one professor and three assistant professors and one lecturer of medical surgical nursing at faculty of nursing, Ain shams university, one anesthetic consultant and one general surgery consultant in Belbies hospital. The experts reviewed the tools for clarity, relevance, comprehensiveness, simplicity and applicability; minor modification was done.
Testing reliability of tools tested by using Cronbach alpha for self administered questionnaire (knowledge) was 0.825, observationl checklist (practice) was 0.965 and attitude rating scale was 0.925.
D- Pilot study:
A pilot study was conducted to test clarify, feasibility and applicability of the tools used in this study. It was carried out on 10% of total study subjects (4 nurses). Minor modifications was done on the used tools so that, the nurses who included in the pilot study were included in the main study group.
Results:
The present study revealed that:
The study finding demonstrated that 47.5% of the nurses under study their age ranged between 30 to 40 years with mean age of 27.25± 6.79. 95% of them were females, 70% of them were married, and 42.5% of them were holding technical institute of nursing degree. Also, 32.5% of them their general years of experience ranged between 1 to 5 years with mean of 12.13 ± 6.20 and, 82% of them were attended training courses about the patients’ safety measures in OT.
Concerning total level of knowledge, 70% of the nurses under study had satisfactory level, 75% of them had total satisfactory practice level and 72.5% of them had positive attitude regarding safety measures in OT.
There was statistically significant relation between total level of the studied nurses` knowledge among studied nurses and their demographic characteristics including qualifications, regarding the patients’ safety measures in OT (P ˂ 0.05), and there was no statistically significant relation between total level of the studied nurses’ practice and attitude regarding the patients’ safety measures in OT and their demographic characteristics (P ˃ 0.05).
Moreover, there was statistically significant positive correlation between total level of the studied nurses` practice and their total level of knowledge (r = 0.73 at p-value ˂ 0.05) and statistically significant positive correlation between total levels of nurses` attitude and their total level of knowledge (r = 0.211at p-value < 0.05) respectively, Meanwhile, there was highly statistically significant positive correlation between total level of nurses` practice and their total level of attitude (r = 0.65 at P- value < 0.001).
Conclusion
Based on findings of the current study, it can be concluded that, more than two third of the studied nurses had total satisfactory level of knowledge and positive attitude. As well as, three quarter of them had total satisfactory practice level regarding the patients’ safety measures in operating theater. Moreover, there was statistically significant positive correlation between total ’ knowledge, practice and attitude level among the studied nurses.
Recommendations:
Based on the findings of the present study, the following items are recommended:
a. Importance of implementing continuous in-service training programs to improve nurses’ performance regarding the patients’ safety measures in all operating theater.
b. Standard nursing procedures booklets regarding the patients’ safety measures in operating theater should be available in all hospital.
c. Continuous application of surgical safety checklists in all operating theater to prevent errors and complications which may occur for the patients during three phases of surgery.
d. Posters and simple illustrations about precautions of patients’ safety should be available in every operating theater.
e. Strict observation of nurses during the work and continuous evaluation of their performance regarding the patients’ safety measures in operating theater.
f. A similar study should be replicated on a large sample and other settings to generalize the findings.
g. Further study should be suggested to evaluate effect of implementing training program based on the studied nurses performance about regarding the patients safety measures in OT ( need assessment ) on patients morbidity and mortality rate.
h. Further study should be suggested to evaluate other factors affecting patients safety measures in OT