الفهرس 
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Abstract
SUMMARY
Chest tubes are commonly used for patients who have undergone cardiac or thoracic surgery or who have suffered chest trauma. The principal purpose of chest tubes is to maintain cardio-respiratory function and haemodynamic stability by draining the pleural and mediastinal spaces of air, blood or other fluids. Incorrect nursing management of chest tubes may lead to a number of complications which can result in increased morbidity, extended hospitalization and, in some cases, mortality. The patency and integrity of chest drainage systems are, therefore, crucial to the preservation of cardiopulmonary performance and the health and well being of patient (Millikan, Moore, Steiner, Aragon, and Van Way, 2006).
The nurse is responsible about many aspects of the management of chest tube. Also the nurses have responsibility for the day to day monitoring and management. Complications are more likely to occur if chest tube is used without appropriate knowledge or skill (Parkin, 2002).
Nursing management of patient with chest tube is important. The nurses must have a comprehensive understanding of all aspects of care with the chest drain systems and areas requiring special attention would be important to reduce the complications arising from chest tube drainage (Sullivan, 2008).
Aim of the study:
This study aimed to assess the nurses’ performance regarding management of patient with chest tube through the following:
1. Assessing nurses’ level of knowledge regarding management of patients with chest tube.
2. Assessing nurses’ practice regarding management of patient with chest tube.
Research questions
1. What are nurses’ level of knowledge regarding management of patients with chest tube?
2. What are nurses’ practice regarding management of patients with chest tube?
3. What are the factors affecting on nurses’ performance regarding management of patients with chest tube?
Subjects and Methods:
A convenience sample of all available nurses who providing care for patients with chest tube at previously mentioned setting (no=40). The nurses had different qualification and years of experiences. Nurses with different age, and qualifications were bachelor, nurses’ technical institute, diploma nurses, diploma with specialty and master degree).
The following tools were used to accomplish the purpose of the study:
1- Self administered questionnaire sheet: It was used to assess nurse’s level of knowledge regarding management of patient with chest tube, it developed by the researcher based on scientific references (Ramont, 2004, Sim, 2006), it included three parts:
Part one: Concerned with demographic characteristics of nurses under study such as age, gender, qualification, training, experiences …etc).
Part two: Included questions related to (definition, causes, types, complications, chest tube removal and management of patients with chest tube).
Part three: Concerned with factors affecting nurses’ performance during their work as; (nurses’ related factors, work’ related factors and patient’ related factors).
1- Nurses performance observational checklist: It was adopted from Dobra et al. (2001), Perry & Potter (2004), Jacob et al. (2007), Randle, Coffey and Bradbury, (2009) and Toca (2010) and modified by researcher and it was written in English language. It was used for assessing the nurse’s performance regarding to management of patients with chest tube, it was included the following:
- Nurses’ performance regarding to management of patients with chest tube that included:-
o Patient assessment.
o Assessment the drainage system patency.
o Changing chest tube insertion site dressing
o Changing of the chest drainage bottle (i.e. if broken or filled)
o Health teaching to patients with chest tube.
o Documentation after care chest tube
- Nurses’ performance regarding management of patient with chest tube removal.
o Patient preparation for chest tube removal.
o Patient assessment for signs that reveal lung expansion.
o Assessment of patient after chest tube removal.
o Documentations after chest tube removal.
o Health teaching after chest tube removal.
The important finding obtained from the study can be summarized as following:
- The highest parentage of nurses (52.50%) their ages ranged between 20 to less than 30 years and (52.50%) were secondary diploma nurses with specialty.
o Less than three quarter of the nurses (70.0%) did not attend training course about management of patient with chest tube
o Majority of nurses (82.5%) had unsatisfactory knowledge regarding to management of patient with chest tube. While less than three quarter of nurses (70.0%) had unsatisfactory level of knowledge regarding to management of patient with chest tube removal and infection control measures.
o The majority of the nurses had unsatisfactory practice regarding to management of patient with chest tube and chest tube removal (92.50% and 95.0%) respectively.
o There were statistically insignificant differences between the nurses’ knowledge and their demographic characteristics their ages of nurses (X2 =6.7 at p>0.05).
o There were statistical significant relation between the nurses’ practice and their attends training courses (X2 = 4.9 at P< 0.05).
o There were a highly statistically significant relation between the nurses’ knowledge and their years of experience and attends training courses (X2=6.9 & 9.8 at P <0.01) respectively.
o There is statistical significant relation between nurses’ practice and their knowledge (X2 =9.9 at p>0.05).
o Majority of the nurses (97.5%) had several factors affecting their performance regarding to management of patient with chest tube. Regarding nurses’ related factors (lack of job description, inadequate number of nurses, lack of nurses’ knowledge, inadequate in nursing experience, lack of training, conflict between different nursing categories, inadequate time for nurse work, inadequate nursing supervision, lack of self confident, lack of co-operation between staff nurse). While the majority of nurses (87.5%) had several work’ related factors (unavailability of infection control measures and procedure book, inadequate supplies for dressing and inadequate bottles of drainage). However, majority of the nurses (97.5%) reported patient’ related factors affecting their performance (level of education, patient complain with pain and uncooperative patients).
Conclusion
Based on the study finding, majority of nurses caring of patients with chest tube had unsatisfactory knowledge and practice. Furthermore, there were many factors affecting nurses’ performance as; nurses’ related factors, work’ related factors and patient’ related factors.
The important recommendations inferred from the study results were:
1) The importance of orientation and periodic in-service training program for nurses in cardiothoracic surgeries ICU regarding management of patients with chest tube for continues updating their knowledge.
2) Further studies is recommended to evaluate the reflections of in-service training program regarding management of patients with chest tube on nurses’ performance and consequently on the patients’ outcome.
3) Developing a simplified and comprehensive booklet including guidelines about nursing management of patients with chest tube.
4) Close supervision is needed to ensure that quality of care is provided by nurses while management of patients with chest tube.
5) For the administrative point of view, clear job description for nurses and sufficient number of qualified nurses should be provided throughout the three shifts for improving efficient quality of care needed to patients with chest tube.
6) All hospital departments should be supplied by checklists about chest tube care and dressing supplies and equipments for changing drainage bottle.
7) Developing a nursing protocol for infection control, following aseptic techniques during management of patients with chest tube.
8) Doctors’ instructions regarding management of patients with chest tube should be written clearly in patient’ file and nurses should be document implementing nursing management for such group of patients.
9) The study should be replicated on large sample and different hospitals setting in order to generalize the results.