الفهرس 
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Abstract
Neonates can be harmed by receiving too little or too much O2. While there are numerous benefits of O2 therapy, there are similarly dangers and side effects that complicate the disease course or even worsen neonates’ clinical outcomes. Therefore, in O2 administration a constant monitoring of the dose, concentration and side effects to ensure its safe and effective use are highly required. This might suggest that health-care a professional especially nurses would be knowledgeable and familiar with its uses and limitations. So, O2 should be administered cautiously and according to the safety guidelines.
Aim of the study
This study aimed to assess the pitfalls in nurses’ performance regarding oxygen therapy administration at Neonatal Intensive Care Units (NICUS).
Research Questions:
1. What are the nurses’ knowledge regarding O2 therapy administration and pitfalls to neonates in the NICUs?
2. What are the nurses’ pitfalls in their practices during O2 therapy administration to neonates in NICUs?
3. What are the nurses’ attitudes regarding pitfalls of O2 therapy administration to neonates in NICUs?
I- Technical Design:
The technical design for the study includes a description of the study design, setting, subjects, and tools of data collection.
A. Study Design:
A descriptive design was used to achieve the aim of this study.
B. Study Setting:
This study was conducted at the NICU in El- Fayoum General Hospital affiliated to the Egyptian Ministry of Health for increasing flow rate of the neonates in this setting.
C. Study Subjects:
- A convenient sample composed of 70 nurses working in the previously mentioned study setting regardless their characteristics (age, gender, qualifications and their years of experience).
- All available neonates (70) receiving O2 therapy during the research period (six months) at the previously mentioned setting.
D. Tools of data Collection (Appendix IV):
Three tools for data collection were used in the current study as the following:
First Tool: Pre-designed Questionnaire Sheet:
It was designed by the researcher after reviewing the relevant literature and it was written in simple Arabic language to suit the level of understanding of the studied nurses. It was used to assess nurses’ knowledge regarding O2 therapy administration and their pitfalls in the NICU. This tool included the following parts:
Part 1: It was concerned with the characteristics of the studied subjects including:
A: Characteristics of the studied nurses; namely; age, gender, qualifications, years of experience, and attending previous courses in O2 therapy administration for neonates in the NICU.
B: Characteristics of the studied neonates; namely; gestational age, gender, birth weight, current weight, types of delivery, diagnosis and apgar score.
Part 2: It was used to assess:
A: Nurses’ level of knowledge regarding O2 therapy administration at NICUs including; definition, indications, methods of administration, advantages, disadvantages, dose, duration, concentration, flow rate, complications, side effects, precautions and weaning from O2 therapy.
B: Nurses’ knowledge regarding pitfalls in O2 therapy administration at NICU including; definition for the term of pitfalls, causes of nurses’ pitfalls in O2 therapy administration, types of nurses’ pitfalls, early detection of pitfalls and how to prevent it at NICU.
The questionnaire consists of 75 questions, in the form of multiple choice questions (MCQs). That were divided into categories to assess nurses’ knowledge regarding O2 therapy administration to neonates and their pitfalls in the NICUs.
Scoring system:
A scoring system which was followed to assess nurses’ level of knowledge about O2 therapy administration and their pitfalls. The right answer was scored ”one” and the wrong answer was scored ”zero”. The scores were summed up and converted into a percenteage score. The total score of pre-designed questionnaire was 75 marks which equal one hundred percent (100%). Then, the total score of nurses’ level of knowledge was classified into two categories.
- ”Satisfactory”: If nurses’ knowledge scores ≥ 80% (≥ 60 marks).
- ”Unsatisfactory”: If nurses’ knowledge scores < 80 % (<60 marks).
Second Tool: Observation Checklists for Oxygen Therapy Administration: It was adapted from Lynn & Lebon, (2018) and MacDonald et al., (2019). It was used to assess the actual nurses’ practices regarding O2 therapy administration and their common pitfalls pre, during and after O2 therapy administration at NICUs.
It consisted of eight observation checklists for O2 therapy administration namely; nasal cannula, face mask, incubator, head hood / head box, nasal continuous positive airway pressure, mechanical ventilator, oropharyneal nasal suctioning and pulse oximeter. The total steps were 97. Nurses were directely observed for their practices and were evaluated during their actual working shifts.
Scoring system:
Each checklist was assigned a score according to the steps. Each step was evaluated as “done” and taken” one” score and “not done” was taken ”zero” score. The total score was 97 marks. These scores were summed up and converted into a percentage score (100%) and according to the total score was classified into either;
- ”Competent”: If nurses’ score ≥ 90 % (≥87marks).
- ”Incompetent”: If nurses’ score <90% (<87marks).
Third Tool: Attitudes Likert Type Rating Scale: It was adapted from Likert (1932) in Khalaf et al., (2015). It was used to assess the nurses’ attitudes regarding the pitfalls in O2 therapy administration to neonates in the NICUs. It included 32 statements (20 positive and 12 negative) were divided into four categories. The studied nurses were asked to respond on 3- points Likert scale.
Scoring system:
Neonatal nurses’ responses were classified as “agree”, “uncertain”, “disagree” and scored 3, 2, 1 for positive statements. The score was reversed for negative statements and it was respectively scored 2 and the total scores of the statements were summed up and converted into a percentage scores. The total score was (32 x 3 = 96 marks grade equal 100%). Then all responses were classified into two categories:
- ”Positive attitude”: If nurses’ score ≥ 70 % (≥ 67 marks).
- ”Negative attitude”: If nurses’ score < 70 % (< 67 marks).
Total studied nurses’ performance:
The total studied nurses’ performance was calculated by summation of the total knowledge scores (75), total practice scores (97) and total attitude scores (96). The total score was 268 marks. These scores were converted into percentage scores (100%). Then total nurses’ performance classified into 2 categories:
- ”Competent performance ”: If nurses’ score ≥ 90 %. (≥ 241marks).
- ”Incompetent performance”: If nurses’ score < 90%. (< 241 marks).
II. Operational Design:
The operational design for this study included preparatory phase, content validity and reliability for the study tools, pilot study and field work.
a) Preparatory phase:
It included reviewing the related literature and theoretical knowledge of various aspects of the study using articles, periodicals, text books and websites.
b) Validity and reliability(Appendix III):
Validity:
Validity of the study tools was evaluated by a panel of three experts from Pediatric Nursing Department; two professors and one assistant professor from Faculty of Nursing - Ain Shams University to ensure tools’ objectivity comprehensiveness, accuracy, clarity, applicability and its relevance.
Reliability:
Reliability of the study tools was done by using Cronbach’s Alpha coefficient test which revealed that each of the three tools consisted of relatively homogenous items as indicated by the high reliability of each tool. The internal consistency of knowledge was 0.795 and 0.605 for practices and 0.632 for attitudes.
c) Pilot study:
A pilot study was carried out on 10% of the total sample (7 nurses and 7 neonates) from the study subjects to evaluate the clarity, applicability, feasibility and relevance of study tools used and time required to fulfill the tools. The nurses who were shared in the pilot study were included in the study subjects because with minor modification was done after conducting pilot study.
d) Field work:
The purpose of the study was simply explained to the nurses who agreed to participate in the study prior to data collection. The data collection process of this study started and completed within six months from the beginning of December 2021 to the end of May 2022. The researcher was available two days (Sunday and Tuesday) weekly from 10am to 2pm in NICU at Fayoum General Hospital.
The researcher was introducing herself to each nurse through, giving a clear and brief idea about the aim of the study and its expected outcomes.
Every studied nurse took about 30 minutes to complete the questionnaire and attitudes sheet (20 minutes for knowledge &10 minutes for attitudes).
The researcher was observing the nurse directly when providing their care for neonates on O2 therapy. The observation checklists were checked by the researcher and it took 30 minutes for every nurse. The researcher was assessing 2-3 nurses every week.
III- Administrative Design (Appendix II):
A written official letter was issued from the Dean of Faculty of Nursing, Ain Shams University to the director of El-Fayoum General Hospital affiliated to the Egyptian Ministry of Health for obtaining the permission for data collection after explaining the purpose of the study and its expected outcomes.
Ethical considerations:
An ethical approval obtained from the Scientific Research Ethical Committee - Faculty of Nursing - Ain Shams University to conduct this study after explaining its aim. In addition, informed oral consent was obtained from participants of the study. The researcher explained the objective and aim of the study to nurses’ included in the study. The researcher emphasized that, the participation was voluntary, anonymity and confidentiality were assured.
The researcher emphasized that, the study subjects will not exposed to any physical or psychological harm. Participants were allowed to withdraw from the study at any time freely without giving any justification.
Results:
The findings of the current study can be summarized as the following:
• More than one third (37.1%) of the studied nurses were aged from 20 < 25 years ( ±SD 23.93±3.52 years). Moreover, it was found that, more than two fifths (42.9%) of them had experience at NICUs for less than 5 years ( ±SD 4.87±6.44 years). Also, nearly two thirds (64.3%) of them had diploma of technical nursing institute.
• All (100%) of the studied nurses were females and none of them had previously attended any training courses about O2 therapy administration.
• More than half (58.6%) of the studied neonates were males, while nearly two thirds (64.3%) of them had gestational age < 37 weeks ( ±SD 35.63±4.55 weeks) and more than half (57.1%) of them their weight at birth was < 2500 gram ( ±SD 2550.30±25.32 gram).
• Less than one quarters (22.9%) of the studied nurses had satisfactory total score level of knowledge regarding the pitfalls in O2 therapy administration , while more than three quarters (77.1%) of them had unsatisfactory of total knowledge.
• More than one third (35.7%) of the studied nurses were competent regarding total score level of their practices in O2 therapy administration at neonatal intensive care units. While, less than two thirds (64.3%) of them had incompetent total practices.
• Most (84.3%) of the studied nurses had positive attitudes regarding pitfalls of O2 therapy in NICUs, while less than one quarter (15.7 %) of them had negative attitudes.
• Less than two fifths (38.6%) of the studied nurses had competent total performance regarding pitfalls in oxygen therapy administration at NICUs, While, more than half (61.4%) of them had an incompetent total performance.
• There was positive correlation and highly statistical significance difference among all study variables (p-value < 0.001).
• There was highly statistical significant between the studied nurses’ total performance and nurses’ qualifications at p-value of 0.000).
• There was no statistically significant difference between the studied nurses’ total performance and their age and years of experience (p-value 0.193 and 0.105).