الفهرس 
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Abstract
Summary Cardiac arrhythmia, also known as cardiac dysrhythmia or irregular heartbeat, is a group of conditions in which the heartbeat is irregular, too fast, or too slow (Davenport, 2014).
Aim of the study:
This study aims to assess the nurse’s performance regarding the care of patients with arrhythmia through the following:
Assessment of the nurse’s knowledge regarding the care of patient with cardiac arrhythmia.
Assessment of the nurse’s practices regarding the care of patient with cardiac arrhythmia.
Assessment of the nurse’s attitude regarding the care of patient with cardiac arrhythmia.
Research Question:
This study was conducted for answering the following question:
1. What are the nurses knowledge regarding the care of patient with cardiac arrhythmia?
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2. What are the nurses practices regarding the care of patient with cardiac arrhythmia?
3. What are the nurses attitude regarding the care of patient with cardiac arrhythmia?
Research design:
A descriptive explorative study was utilized to meet the aim of this study.
Setting:
The study was conducted in the coronary care unit CCU at Ain Shams Specialized Hospital, affiliated to Ain Shams university in Cairo including 50 beds cardiac care unit, and intensive care unit ICU and coronary care unit CCU at National Heart Institute in Giza affiliated to ministry of health including 40 beds intensive care unit ICU and 50 coronary care unit CCU.
Subjects:
A convenience sample of 91 nurses who are working at two hospitals, Ain shams Specialized Hospital 31 nurses and National Heart Institute 60 nurses who were caring for patients with arrhythmia in the previously mentioned study settings, were included in this study.
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Tools for data collection:
Data was collected using the following three tools:
1-Self-administered questionnaire sheet (Appendix I):
It was developed by the investigator and was written in Arabic language based on the most recent related literature ((Prentic, M. & Goncerz, Q. 2014); (Raines et al., 2015); to assess nurse’s knowledge regarding care of patient with cardiac arrhythmias. Part I: it was concerned with assessment of demographic characteristics of the nurses under study such as age, qualifications, years of experience and previous training courses. Part II: used to assess nurse’s knowledge regarding arrhythmia it included :30 items about anatomy and physiology of heart, conduction system, causes of cardiac arrhythmias, sign and symptom, complications of arrhythmia, risk factors, diagnosis and types of arrhythmia, in addition to 24 items :about nursing intervention of arrhythmias and treatment of arrhythmia.
Scoring system:
The correct response was given a score of (1) grade and incorrect were given a score of (zero) grade. A total score for questionnaire was (54) grades. The total scores
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equal or more than 80% was considered satisfactory and score less than 80% was considered unsatisfactory.
2-An observation checklist to assess nurse practice (Appendix II)
This tool was developed by the investigator based on reviewing the related literatures (Drew & Funk, 2013, Tukley, 2014),), it was used to assess the nurse’s practice regarding care of patient with cardiac arrhythmias, based on the most recent related literatures. It included eight parts:
1- Patient assessment (12 items).
2- Obtaining an electrocardiogram (ECG) (40 items).
3- Applying cardiac monitor (29 items).
4- Nursing intervention for arrhythmia (11 items).
5-Nursing immediate intervention during life threating arrhythmia (11 items).
6-Communicate patients with arrhythmia (4 items).
7-Patient/Family education before discharge and instruct the patient (14 items).
8-Documentation of patient care (14 items).
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Scoring system:
The step done completely was given a score of (1) grade, while incorrectly done step or not done was given a score of (zero) grade. A total score for the checklist was (135) grades.
The total scores equal or more than 80% considered satisfactory and score less than 80% was considered unsatisfactory.
3-Nurses attitude scale regarding patient with arrhythmia. It was adapted from (Rocco & James, 2014), to assess the nurse’s attitude toward caring for patient with arrhythmia.
Scoring system:
It was consisted 15 items:
1. Strongly disagree (0).
2. Disagree (1).
3. Neither agrees, nor disagree (2).
4. Agree (3).
5. Strongly agree (4).
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Total score equal: 60 .These scores were summed-up and converted into a percent score. It was considered as follows:
Positive attitude: 60% and more was considered positive.
Negative attitude: less than 60% was considered negative.
5) Operational Design:
The operational design includes preparatory phase, content validity, pilot study and field work.
E. The preparatory Phase:
It included reviewing of recent related literature and theoretical knowledge of various aspects of the study using books, articles, internet, periodicals and magazines to develop data collection tools.
F. Validity and Reliability
Testing validity: Tools were tested by inspecting the items to determine whether the tools measure what supposed to measure by a jury of 7 experts from different academic categories (professors and assistant professors) of the medical –surgical nursing at the faculty of nursing. Ain
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Shams University. The expertise reviewed the face and content validity of study tools, relevance, comprehensiveness and minor modification was done.
Testing reliability: of tools was done statistically by Cronbach alpha test, for knowledge assessment tool it was 0.830 and for practice it was 0.795.
G. Pilot Study:
Pilot study was carried out on 10 nurses from the study subjects to test the clarity, applicability and feasibility of the tools used and to determine the needed time for the application of the study tools. The nurses who were included in the pilot study were included to the study subjects because no modification was done after conducting pilot study.
H. Field Work:
The purpose of the study was simply explained to the studied nurses who agree to participate in the study prior to data collection. The actual work of this study started and completed within six months from September 2016 and was completed by the end of February 2017. Data was collected by the investigator during nurse’s work three days per week in two hospitals. Tools were filled at morning and afternoon shifts in the previously mentioned study settings
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during care of patients with arrhythmia in ICU and CCU units. First, the investigator used the observational checklists to assess nurse’s practice during their actual work and then the questionnaire was filled in 20-30 minutes by the nurses in their available time during their work also the investigator used the nurse’s attitude scale was filled in 10-15 minutes in in Ain Shams Specialized hospital. Also, the investigator used the observational checklists to assess nurse’s practice during their actual work and then the questionnaire was filled in 10-20 minutes by the nurses in their available time during their work also the investigator used the nurse’s attitude scale was filled in 5-15 minutes in national heart institute . The researcher assured the nurses that the information collected would be treated confidentially and that it would be used only for the purpose of the research study.
Results:
The important findings obtained from the study can be summarized as following:
1- 97 % of the nursing qualification was bachelor degree in Ain Shams Specialized hospital, while 78% of them in National Heart Institute were nursing diploma.
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2- 19.78% of them had satisfactory total level of knowledge regarding caring patient with arrhythmia
3- 36.30% of them had satisfactory total level of practice regarding caring patient with arrhythmia.
4- 62.7% of the nurses under study had a positive attitude toward patient regarding DC shock and contraindication medication.
5- 52.8 % respond negative attitude regarding its important to inform everything for nursing care provided to the patient.
6- 37% of the studied nurses had positive attitude and 63% of them had negative attitude toward caring of patient with arrhythmia
7- There was significant relationship between demographic data (workplace and qualification), the nursing qualification were Bachelor degree had satisfactory knowledge more than nursing diploma.
8- There was no significant relationship between training course and their practice.
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Based on the results of the current research, the following:
1-Updating knowledge and practice of ICU and CCU nurses through conduction of periodic educational programs regarding care of patients with arrhythmia.
2- Guideline should be available in ICU and CCU as a reference for all nurses.
3- Continuous evaluation of nurse’s knowledge and practice needs in CCU and ICU unit head nurses.
4- Orientation program should be prepared to help the newly appointment nurse to revise, acquire and develop the knowledge and practice regarding care of patients with arrhythmia.
5-Suggestions for future research and practice are proposed.