الفهرس 
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Abstract
Orthopedic patient safety is an essential component of the maintenance of good patients` quality of life (QOL). The world health organization (WHO) defined patient safety as the absence of preventable harm and reduction of risk of unnecessary harm associated with health care. It involves establishing an operating system to minimize the likelihood of errors and maximizing the possibility of their interception when they occur.
Traumatic bone injury is common in the field of orthopedic trauma and requires careful and prompt treatment to avoid disability. Henceforth, a bone fracture management has received increasing interest over the last 30 years due to the wide variety of treatment modalities. External fixation (EF) is one of fracture`s modalities in which a metal frame is inserted into the bone fragments with skeletal pins or wires through skin incisions.
External fixator (EF) prevents further soft tissue damage around the fractured bone as ligaments and tendons, allows recovery of traumatized skin and subcutaneous tissue, permits wound management around the fracture, allows elective reconstruction of complex fractures and periarticular injuries, and does not negatively impact systemic complications in multiply injured patients.
Unsafe practices provided to the patients undergoing external fixation surgeries lead to complications that would burden the community with heavy financial costs. Complications of EF include: pin tract infection, neurovascular impairment, muscle or tendon impairment, muscle contractures, delayed union, refractures and deviation of the mechanical axis of the device during elongation.
Nurses have cornerstone responsibilities in providing patients undergoing external fixation surgeries with appropriate pre, intra as well as post-operative nursing interventions, in addition to conveying safety measures during all procedure processes to promote patient‟s health, enhance EF success and ensure patient‟s recovery with minimal preventable complications incidence. Thus, the applications of high quality of EF nursing care throughout the pre, intra, and postoperative periods; is closely adhering to optimistic patients‟ outcomes.
The aim of the study: was to assess nurses` safety practices provided for patients undergoing external fixation surgeries.
The study was conducted at all the Inpatient Orthopedic Male and Female Wards in addition to the Operating Theaters of EL-Hadra Orthopedic and Traumatology University Hospital Alexandria, Egypt. This hospital contains ten orthopedic sectors distributed equally as five Female and Male Sectors. The Female Sector namely is A, B, G, D, and H sectors. The Male sector namely is A,B, G, D, and H Sectors. The Operating Theatre contains 5 operating rooms, each operating room contains one operating table, an anesthesia machine and a resuscitation facility (ies).
A convenient sample of all nursing staff (a total of 95 male and female nurses) involved in providing direct care for patients undergoing external fixation surgeries were included in the study.
To fulfill the objectives of the study, one tool was developed by the researcher, based on the recent national and international guidelines related works of literature to collect the necessary study data. It was entitled ”Nurses` Safety Practices Provided for Patients Undergoing External Fixation Surgeries Observational Checklist”.
The tool was composed of three parts:
Part (I):
This part was used to assess the ideal physical set up of the orthopedic surgery ward as well as the nurses` safety practices provided for patients preoperatively. It included the following:
Part (I-a): The Ideal physical set up of the orthopedic surgery ward which included a description of the orthopedic ward, the equipment and, supplies, the system as well as the waste disposal system.
Part (I-b): Nurses` safety practices provided for patients preoperatively which include items related to physical, biological, chemical and psychological safety preparations.
Part (II): This part was used to assess the ideal physical set up of the orthopedic operating rooms and nurses` safety practices provided for patients during the intraoperative period.
It compromises two subparts as follows:
Part (II-a): Ideal physical set up of the orthopedic operating rooms, which was used to assess the ideal physical set up of the orthopedic operating rooms including pre-operative preparation area, the orthopedic operating room, and the recovery area.
Part (II-b): Nurses` safety practices provided for patients during the intraoperative period. This part was developed to assess nurses` safety practices provided for patients during the intraoperative period, which contains items related to physical, biological, chemical and psychological safety preparations.
Part (III)
This part was developed to assess nurses` safety practices provided for patients post to the external fixator surgeries, which contains items related to physical, safe patient mobility, and psychological safety practices.
Nurse`s socio-demographic datasheet: This sheet was attached to the developed tool to collect socio-demographic data of the studied nurses. It included eight items related to age (year), gender, marital status, qualifications, type of working area, type of ward, years of experience, as well as previous attendance of educational / training courses related to patient`s safety and its duration.
Scoring of the tool:
Scores for the safety measures provided to patients preoperatively, were ranging from (0-94). While, scores for the safety measures provided to patients intra-operatively, were ranging from (0 -97) and scores for the safety measures provided to patients post-operatively, were from (0 -57).
Scores for the ideal physical setup of the orthopedic surgery ward was ranged between (0-26). Score for the ideal physical setup of the orthopedic preoperative preparation area was ranged between (0-22). While, score for the ideal physical setup of the orthopedic operating room was ranged between (0-34). Finally, score for the ideal physical setup of the orthopedic recovery area was ranged between (0-22).
The tool was revised by 5 experts in the field of the study for content validity and necessary modifications were introduced. A pilot study was done for the developed tool. The reliability of the tool was identified and the reliability coefficient was 0.835%. Data were collected throughout a period of 3 months starting from 5th March to 10th June 2019.
The following are the most important results of the present study:
Concerning to the nurses’ socio-demographic data, it can be noted that:
About half of the studied orthopedic nurses were in the age group from 35-45 years.
Most of the studied orthopedic nurses (83.8%) were diploma holders, while only (1.3%) had a bachelor degree.
About two-thirds of the studied orthopedic nurses (61, 25%) had attended educational courses\ training programs, about patient safety practices.
Concerning to the ideal physical set up of the studied orthopedic settings and facilities, the results illustrated that:
The total set up levels of the studied setting; the orthopedic operating rooms, wards, and the recovery area i.e. 100% were found to be ”Fair”.
The total physical setup level of the pre-operative area i.e. 100% was found to be ”Poor”.
Regarding the safety measures provided pre-operatively for the patients undergoing external fixation surgeries, the results revealed that;
All the studied nurses (100%) applied the measures related to the psychological safety preparations unsafely followed by the chemical, biological and physical safety preparations (76.3%, 66.3%, and 66.3%); of nurses, respectively.
The highest mean score for physical safety preparations was (64.59±12.21). Those of the chemical, biological and psychological safety preparations were, (24.96±2.23, 20.86±3.51, 6.39±1.93); respectively.
Regarding the safety measures provided intra-operatively: it was found that;
It was found that mechanical and instrumental safety practices were carried out unsafely by (100%) of the nurses. Physical, psychological, and biological safety practices were done unsafely by; (91.3%, 56.3%, and 48.7%) of the nurses respectively .
The mean score for the physical safety preparations was; (25.13±5.24) and for the mechanical and instrumental, biological and psychological safety preparations were (15.00±5.47, 11.36±2.91 and 8.44±1.59); respectively.
Regarding the safety measures provided post-operatively, it can be noted that;
Safe mobility practices was provided unsafely by (100%) of nurses .Total physical and psychological safety practices were carried out unsafely by; (98.7% and 53.8%) of nurses, respectively.
The mean score for the physical safety practices was; (184.92±36.62) and for the safe mobility and psychological safety practices were(10.5±2.58, 4.23±7.36); respectively.
Statistical significant correlations were declared between:
The studied nurses` ”Preoperative safety preparations mean scores” and the studied ”Orthopedic ward physical set up mean scores where ;( r=0.593 at p=0.042*).
The studied nurses` ”Postoperative safety preparation practices mean scores” and the studied ”Recovery area physical set up mean scores” where, (r=0.611 at p=0.018*).
The studied nurses` total ”Pre-operative safety preparations scores” and their total ”Intra and post-operative safety practices scores since; (r=0.860 at p=0.000* and r=0.719 at p=0.000*); respectively.
The studied nurses` ”Intra-operative practices scores” and their ”Post-operative safety practices scores” where (r=0.719 at p=0.000).
Based on the findings of the present study, the following recommendations are suggested:
C. recommendations for administrators and nurses:
Overcoming obstacles to safety practices in terms of hospital department structure, physical set up equipment, supplies and devices
updated pre- and in-service training programs for orthopedic nurses are highly advocated with emphasis on the newly assigned staff.
Developing procedural manuals and standard safety measures specific to the orthopedic nursing staff in Arabic is highly required.
Regular annual self and mental-appraisals for the orthopedic nursing staff regarding safety measures provided for patients are advocated.
D. Recommendations for further research:
Developing standards regarding nursing care for safe external fixation surgeries.
Developing manuals for safety measures provided for patients undergoing external fixation surgeries at varied Egyptian orthopedic units.
Identifying the encountered obstacles that face the orthopedic nursing staff from applying the safety measures properly in the orthopedic units.
Replication of the study on large probability samples is very important.