الفهرس 
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Abstract
Summary
Delirium is a neurocognitive syndrome correlated with increased risk
of hospitalization, functional and cognitive impairment, and mortality.
Critically ill patients are at higher risk of developing the syndrome. In this
context delirium is one of the most frequent complications, affecting around
85% of people at the ICU (Bulic et al., 2020). It is essential to identify
delirium with specific clinical assessment tools, to assess and to treat
reversible causes in combination with environmental, psychological and
pharmacological intervention to control the symptoms (Caleffi et al., 2018).
The ICU nurses, as the members of the healthcare team who are most
intimately involved with the patient, play a significant role in assessing and
recognizing delirium (Hickin et al., 2017). Understanding predisposing and
precipitating risk factors associated with delirium are essential to prevention,
early detection, and ultimately managing the condition (Magny et al., 2018).
Nursing surveys have highlighted a lack of knowledge and practice
with high levels of stress among ICU nurses (Trogrlić et al., 2017; Karlsson,
2017). Nurses working with patients who present with delirium require both
education and support. This can take the form of multidisciplinary team
meetings, nurse team meetings and meetings with managers (Ramabulanal,
2017; Grealish et al., 2019).
Aim of study: The current study aimed to:
Evaluate the impact of educational program on performance and stress
among nurses caring for patients with delirium at intensive care units at
Thawra Hospital – Yemen.
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Research Hypotheses:
1. Nurses may have poor knowledge, practices and high levels of stress
regarding patients with delirium at preprogram implementation.
2. Educational intervention program will have a positive effect on
intensive care unit nurse’s knowledge and practices regarding delirium.
3. Educational intervention program will reduce stress among intensive
care unit nurses regarding patients with delirium.
Subjects and methods:
Research design:
A quasi-experimental design was used in this study.
Study setting:
This study was conducted in the Intensive Care Units at Al-Thawra
Hospital, Al-Hodeidah City in Yemen.
Study subjects:
The study subjects included 60 Nurses working at ICUs at AlThawra Hospital, Al-Hodeidah City in Yemen.
Nurses were distributed as follows: 40 nurses from general ICU and
20 from CCU according to certain criteria.
Tools of data collection:
The following tools were used to collect data of the current study:
Tool I: Demographic and work related characteristics data tool:
Tool II: Nurses’ knowledge questionnaire of delirium:
This tool was constructed and developed by the researcher after
reviewing the relevant literature (Hare et al., 2008; Jang & Yeom, 2018).
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Tool III: Observational checklist for assessment of nurses’ practices
caring for delirium patients:
This tool was constructed and developed by the researcher after
reviewing the relevant literature (Oh, 2018 & National Institute for Health
and Care Excellence, 2019).
Tool IV: Delirium nursing stress scale: (DNSS)
This scale has been originally developed by Suh & Yoo, (2007),
and modified by Kim & Lee, (2016). This tool is a self-reported scale takes
about 15 minutes, was designed to assess stress levels among nurses caring
for patients with delirium.
Methods of the present study included three stages as the following:
1
st stage: Preparatory stage:
The Official permission to collect data and implement the educational
program was obtained.
Tools of the study were developed by the researcher. They were revised and
corrected by supervisors.
Validity was done for all tools and the content of the educational program by
five experts.
The pilot study was carried out on 10 nurses who were later excluded from the
main study subjects.
The reliability was carried out using the Cronbach alpha coefficient test.
2
nd stage: Implementation of the program stage:
Data of the current study were collected during the period from beginning Jun
2019 till the end of October 2019.
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The educational program was implemented through twelve sessions,
covered in twelve hours approximately, seven theoretical hours and five
practical hours. The educational program sessions were implemented during
four weeks, three days every week in the Nutritional hall at Al-Thawra
Hospital, in Yemen. The nurses were divided into four groups. Every group
consists of fifteen nurses to avoid a shortage of nurses in the work setting
and also because of the difference in shifts.
3rd stage: Post-implementation evaluation phase:
The nurses were interviewed and assessed immediately after the
implementation of sessions to evaluate the outcomes of the educational
program and three months later for the follow-up to evaluate the knowledge
and skills achievement using the same pre assessment tools.
Lastly, participants’ reaction form (opinion sheet) was distributed
immediately after program implementation to elicit participants’ opinions
and the worth points about various aspects of the training program as an
educational experience and the benefits gained from it.
After implementation of the educational program the results of the
present study revealed that:
There was a positive outcome when implemented to ICU nurses in AlThawra Hospital, Al-Hodeidah City, in Yemen. It is associated with marked
improvement of their knowledge about delirium and their practices in nursing
care for patients with delirium. Also, it was associated with the reduction of
stress-related to care for delirium patients. These changes, also maintained,
after 3 months, which is the follow-up duration. The participants had positive
opinions regarding the content of the program.
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In the light of the results of this study, the following recommendations
are suggested;
1. Periodic monitoring of nurses’ knowledge and practices to evaluate the
level of nurses’ practice about delirium and construct program
according to their needs.
2. Repetition of the study on a larger probability sample acquired from
the different geographical areas in Yemen to figure out the main
aspects of these problems.