الفهرس 
Introduction and Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
Infective Endocarditis (IE) is an infection of the endocardia surface of the heart, including the valves. Endocarditis is a life-threatening and serious illness; mortality rates are 15% to 20% during the acute phase and 40% within one year. The incidence and severity of IE remain unchanged (or even increased) despite improvements in diagnostic and therapeutic strategies. Infective endocarditis (IE) is associated with a broad array of complications. The likelihood of complication(s) depends on several factors including the infecting pathogen, duration of illness prior to therapy, and underlying comorbidities. Therefor the aim of the present study was evaluating the effect of implementing educational program on nurses’ performance and clinical outcomes of patient with acute infective endocarditis. This study was conducted at cardiology care unit of Educational Tanta University Hospital. The study sample: All nurses (50) who are working in CCU who are caring for acute infective endocarditis patients regardless of their years of experience, level of education and their ages. A convenience sample of (40) acute infective endocarditis patients that had been admitted to cardiology care unit and meeting the inclusion criteria. The sample size calculation by power analysis based on patient‘s admission in the hospital per year (100 patients/ year). It was calculated based on epidemiological information program based on the total patients per year according to review of Tanta main university hospital statistical record. Inclusion criteria: The subjects were selected according to the following criteria: - Adult patients, of both sexes. - Diagnosed with acute infective endocarditis - Newly admitted - Conscious, able to communicate and participate - Free from any other associated disorders as stroke, heart or renal failure, septic deep venous thrombosis or other systemic infection. Tools of data collection: - Four tools were used in this study: - Tool (I): Structured Interview Schedule: It consists of two parts Part (1): Socio-demographic characteristics of Nurses, to assess data related to age, sex, marital status, years of experience in CCU, years of experience in other department, level of education and previous training about care of patients with acute infective endocarditis. Part (2): Coronary Care nurses’ Knowledge Questionnaire regarding Acute Infective Endocarditis. This part was developed by researcher after reviewing of related literature to assess nurses’ knowledge related to simple anatomy of heart, acute infective endocarditis (definition, types, causes, risk factors, clinical manifestations, diagnostic and lab investigations, management and complications). Tools (II): Coronary Care nurses’ practice Observational Checklist: This tool was developed by researcher after reviewing of related literature to assess the actual nursing practice provided for acute infective endocarditis patients before and after implementation of educational program which will includes using of different nursing measures to decrease body temperature, relieve dyspnea, measures for safe medication administration, and nursing preventive measures for complications as deep venous thrombosis and systemic infection and other complications. Tool (III): Acute Infective Endocarditis Patients’ Clinical Outcomes Assessment Tool: It was developed by researcher after reviewing of related literature and it was included the following parts: - Part (1) patients’ Bio-Sociodemographic characteristics: This part used to assess patient‘s age, sex, marital status, educational level, duration of hospitalization, past and present medical history, family history, history of invasive procedures, cause of infective endocarditis, history of dental procedures, and clinical manifestations on admission. Part (2) physiological parameters Assessment Sheet: - This part was used by the researcher to assess the following items: - Vital signs (heart rate, body temperature, respiration, blood pressure and oxygen saturation), assess for presence of pain (site, onset, character and intensity), laboratory tests include (blood culture, C - reactive protein) and diagnostic procedures. Part (3) Self-Reported Pain Assessment: This tool was used to measure severity of pain. The amount of pain that a patient feels ranges across a continuum from none to an extreme amount of pain. Visual analogue scale is usually a horizontal line, 10 cm in length, the patient marks on the line the point that they feel represents their perception of their current state. The Visual analogue scale score is determined by measuring in centimeters from the left-hand end of the line to the point that the patient marks. Part (4): -Acute Infective Endocarditis Complications Assessment:-. This tool was developed by the researcher after reviewing of the related literature (23) to assess complications of acute infective endocarditis which include cardiac complications such as myocardial infarction, pericarditis, cardiac arrhythmia, Cardiac valvular insufficiency, Congestive heart failure, myocardial abscesses and arterial emboli, infarcts, neurological complications such as (ischemic or hemorrhagic stroke), renal complications such as ( renal infarction, glomerulonephritis and acute interstitial nephritis), respiratory complications such as ( pneumonia, pleurisy, pulmonary emboli), musculoskeletal complications such as (arthralgia or myalgia) systemic infection and deep vein thrombosis. The main result of the present study was as follows: - 1. Most of the total nurse were in the age group from (21-<30) years, and two-third of the studied nurses were female and married respectively. 2. Less than two third of the studied nurses had technical institute, two third had years of experience in CCU from 5-10 years and all of them had not previous training about acute infective endocarditis patient care. 3. All nurses have low level of knowledge preeducational program compared to more than two third of them had high level of knowledge after program. 4. None of nurses had good practice scores about acute infective endocarditis in the pre-test compared to majority of the nurses had good practice score after one month of program. 5. There was a positive correlation was observed between total knowledge level and total practice level, both immediately and one month after session. 6. Less than half of the control group of patients were in the age group from (30-<40) years and more than third of the study group were in the age group from (21-<30) years. 7. The majority of the control group and more than two-third of the study group had hospital stay ≥15 days. 8. Less than half of the control group and a half of the study group had a past history of addiction also more than half in control patient and less than two-third of the study group had no previous admission to the hospital. 9. More than half in both control and study group prospectively had no history of medical intervention or surgical procedure. 10. All patient in both control and study group had fever, general fatigue, weakness, chills, sweating, muscle aches and joint pain as a chief complain on admission to the hospital. 11. There was a marked increase in patients‘ blood pressure at post 2 weeks from admission in study group with statically significant difference at. As evidence, there was a marked improvement in patients‘ temperature at post 2 weeks after admission in study group with statically significant difference. 12. Less than one third of patient in control group had severe pain on admission and the majority of them had moderate pain after two weeks with, on the other hand, the majority of patient had mild pain after two weeks of implementation of educational program. 13. A quarter of the study group post 2 weeks were negative blood culture, compared to all of the control group post 2 weeks were positive with leukocytes. 14. More than two-third of study group post 2 weeks were negative in Creactive protein with statically significant. 15. Less than a half of study group post 2 weeks were normal ECG, while, small percentage of the control group post 2 weeks were normal ECG. 16. Majority of the study group post 2 weeks had normal CT brain, while, more than two-thirds of control group post 2 weeks had normal CT brain. 17. The majority of control group had pericarditis, and more than two-thirds of study group had precarditis.in addition, most of study group had cardiac arrhythmia compared to, majority of control group. 18. The majority of study group did not have neurological complications compared to, more than a half of control group. 19. All patients had arthralgia and myalgia. While, more than a half and a half of control group had systemic infection and deep vein thrombosis compared to, less than a half and minority of study group had systemic infection and deep vein thrombosis respectively with statistically significant difference. Conclusion Based on the findings of the present study, it can be concluded that, most of the studied nurses had high level of knowledge and majority of them had good practice one month after than pre implementation of educational program. It can be concluded that there were a statistical significant improvement in physiological parameter, level of pain, length of hospital stay and progression of complications of patients in the study group than the control group. Based on the finding of the current study, it can be recommended that: - 2. Recommendation for nurses: 3. Upgrading nurses’ knowledge about caring of patients with acute infective endocarditis through: Encouraging nurses to attend national and international congresses, seminars, symposia and workshops regularly about IE & care of patients with IE. Regular continuous inservice educational program plan about IE & its management should be designed to nurses working in CCU at least every six months for enhancing nurses’ knowledge and practice to achieve high quality of care. Developing a system of periodical evaluation for nurses to determine strategies of upgrading their knowledge and enhancing their practice. IE training program should be mandatory for newly employed nurses. 4. Nursing school curriculum must include all items about IE care including; anatomy of the heart, definition, causes, risk factors, signs and symptoms, lap investigations, complications of IE and role of nurses towards patients with IE. 2. Recommendation for patient: 4. Early detection of patient with IE by investigations and early treatment to prevent further complications. 5. Continuous a regular assessment should be done for patients with IE from admission to discharge to improve their prognosis. 6. Protocol of care should be done for patient with IE to limit their complications. 3. Recommendation for further studies: • Studying the impact of educational programs on IE continuously using a wide probability sample in different areas to monitor improvement in nurses’ performance and points of weakness for developing more educational program to nurses dealing with patients with IE.