الفهرس 
Aim of the studyOnly 14 pages are availabe for public view
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Abstract
Head trauma is a major cause of morbidity and mortality in both developed and developing countries. Deaths due to injuries account for 10% of the world’s mortality. In Egypt, head injury is a hidden epidemic and its related deaths are misclassified due to lack of accurate national data. A few minutes delay in treatment may result in death or permanent disability. Therefore the excellent nurses’ performance during care of those patients is very critical, so, our study aims to assess the factors affecting their performance.
Aim of the study:
This study aims to assess the factors affecting nurses’ performance in caring for patients with traumatic head injuries through;
1. Assess nurses’ performance in caring for patients with traumatic head injuries.
2. Assess nurses’ attitude in caring for patients with traumatic head injuries.
3. Identify the factors affecting nurses’ performance in caring for patients with traumatic head injuries.
Research questions:
This study based on answering the following questions:
• What is the nurses’ level of knowledge regarding care of patient with traumatic head injuries?
• What is the nurses’ level of attitude regarding care of patient with traumatic head injuries?
• What is the nurses’ level of practice regarding care of patient with traumatic head injuries?
• What are the factors affecting nurses’ performance regarding management of patient with traumatic head injuries?
Subjects and Methods:
• Research design:
A descriptive, exploratory design was used to achieve the aim of this study.
• Setting:
The study was conducted in “Neuro-Surgical ICU at EL Ahrar Zagazig teaching Hospital Sharqia Governorate”. The setting consists of two wards the first contained 9 beds and the second 6 beds the researcher selected this setting because of the increasing flow rate of patients with traumatic head injuries as indicated from the statistical records mentioned in the significance of this study.
• Subjects:
A Convenient sample of all available nurses (40) working in “Neuro-Surgical ICU in EL Ahrar Zagazig teaching Hospital” with at least 6 months experience in critical care were included in the study.
• Tools for data collection:
Three tools were constructed by the researcher based on review of related literature to collect data pertinent to this study, these tools are:
1- Nurses’ Self-administered questionnaire:
This tool consisted of three parts:
The first part: It was concerned with demographic characteristics of nurses under study including; age, gender, qualifications, years of experiences, years of experience regarding care of patients with traumatic head injury, presence of manual guide/ book regarding care of patients with traumatic head injury and previous attendance of training courses regarding care of patients with traumatic head injury.
The second part: This part was concerned with assessment of nurses’ knowledge regarding care of patients with traumatic head injuries it consisted of (48) questions; (26) of them were multiple choice questionnaire and (22) of them were true and false questions. The items of knowledge include the following topics; structure and function of the head and brain (9 items), traumatic head injury definition, causes/ risk factors, clinical manifestations, complications, assessment/ diagnosis and therapeutic management (17 items), nursing care for patients with traumatic head injuries (22 items).
The third part: This part was concerned with assessment of nurses’ attitude regarding care of patient with traumatic head injuries. It consisted of (12) sentences and response is grading according to likert scale (agree, neutral & disagree).
2- Nurses’ observational checklist
It was concerned with assessment of nurses’ practice regarding care of patients with traumatic head injuries. It comprised the following procedures including; oral care for the dependent patient, endo tracheal tube suctioning, endo tracheal tube care, nasopharyngeal suction, nasogastric tube insertion, nasogastric tube feeding and administering oxygen by mask.
Moreover; assistance in inserting central venous catheter, central venous pressure measurement via manometer, central venous catheter care, oxygen administration by nasal cannula, oropharyngeal suction, female indwelling urinary catheter insertion, male indwelling urinary catheter insertion, indwelling urinary catheter care, intravenous therapy infusion, neurological assessment, assess conscious level through Glasgow coma scale Procedure and wound dressing.
3- Questionnaire to assess factors affecting nurses’ performance in caring for patients with traumatic head injury:
This tool was concerned with assessment of the factors affecting nurses’ performance as their perception regarding care for patients with traumatic head injuries. It included 3 parts; patient related factors, nurses’ related factors and environmental factors.
Results:
The study finding demonstrate that 75% of the studied nurses’ age ranged between (20 – 30 years) with mean age of 28.25 ± 5.36 years and 57.5% were males. 65% of nurses under study were married, 50% of them were technical institute nurses and 47.5% of them their total years of experience ranged between (1 – 5) years with mean of 5.90 ± 3.53 year.
Regarding nurses’ years of experience with traumatic head injury patients, the results showed that 65% of them had less than 5 years with mean of 3.60 ± 2.47 years, while 80% of them didn’t attend any training courses regarding care of patient with traumatic head injury and all of them assured that there were no manual guide regarding care of patient with traumatic head injury.
Concerning total level of knowledge 70% of the studied nurses had unsatisfactory level of knowledge, while 77.5% of them had a positive attitude regarding study topic and 52.5% of them were having satisfactory level of practice.
Regarding factors affecting nurses’ performance in caring for patients with traumatic head injuries, the result of this study revealed that 50%, 47.5% 62.5%, 47.5%, 45%, 47.5% and 42.5% of studied nurses agree that factors including associated cervical fractures, nervous irritation, inadherence of physicians to correct recording, insufficient salary, exhaustion/ fatigue from daily intensive care, nuisance of equipment alarms and discrepancy between number of nurses and number of patients increase difficulty of caring for patient with traumatic head injury are factors affecting their performance.
Also, there were statistically significant positive correlation between total score of knowledge among studied nurses and there total score of practice and factors affecting their performance in caring for patients with traumatic head injury. Also, there were statistically significant positive correlation between total score of practice among studied nurses and their total score of knowledge and factors affecting their performance in caring for patients with traumatic head injury with p-value <0.05 and r-value of 0.481, 0.404, and 0.361 respectively.
Conclusion:
Based on the findings of current study, it can be concluded that more than two thirds of the studied nurses had unsatisfactory level of knowledge regarding care of patient with traumatic head injury, while more than three fourths of them had positive attitude and slightly more than half of them got satisfactory level of practice regarding the same topic. The result of the current study also revealed that most common factors affecting performance of nurses under study as reported by nearly half of them were patient related factors namely associated cervical fracture and nervous irritation, nurses related factors namely inadherence of physicians to correct recording, insufficient salary and exhaustion from daily intensive fatigue and the environmental factors namely nuisance from equipment alarms and discrepancy between number of nurses and number of patients.
Recommendations:
Based on the results of the present study, the following recommendations can be suggested:
1. In-service training program must be developed based on nurses’ needs assessment regarding care of patients with THI.
2. A simplified and comprehensive manual book including nursing guidelines for critical care nurses caring for patients with traumatic head injury should be provided.
3. Continuous supervision for critical care nurses caring for patients with THI.
4. Further research will be needed to modify factors affecting nurses’ performance regarding care of patients with THI.