الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 174 |  |  |
| | | from | 174 | | |
Abstract
lead to an irreversible decrease in renal function and that usually leads to ESRF. Considering the increase in the old age population. It is incidence with patients having diseases like hypertension, diabetes mellitus and obesity, the global a prevalence of CRF is also increasing 8% a year. (Ghodsian. et al., 2021).
Peritoneal Dialysis (PD) is a type of therapy which used for replacement of renal function that could be utilized at ESRF beside with the hemodialysis and renal transplantation. Peritoneal dialysis has a several series of advantages like decreasing mortality percent in the first year, fewer hospitalizations and better preservation for the residual renal function. The main disadvantages of PD are the higher risk of infections and a limited life time due to the failure of peritoneal membrane (Mihalache, et al., 2018).
The nurses worktogether with others members of the multidisciplinary health team to assure that patients’ renalfunction does not decline and promote the kidney function.Nurses are responsible for carrying out thorough physical,psychological, and social assessment ofthe patient’s condition, and following up the patients for any signs of complications related to peritoneal dialysis. (Roxas, 2017).
In this context, nurses play a significant role in the care of patients undergoing PD, whether by performing nursing procedures or via assessing and providing information on their health condition, drugs, and therapeutic diet (Campos, et al., 2019). Nurses’ knowledge and skills level will significantly affect on the quality of dialysis and so patients’ quality of life (Lucena, et al.,2018).
There are minimalresearches in the field of nursing management of patient undergoing PD. So it is needed to provide a more in-depth understanding of this complex nursing tasks. This could help developing future PD curricula and educational intervention about chronic renal diseases (Schaepe, & Bergjan, 2015).
This study aimed to:
Determine theeffect of an educational programon nurses’ knowledge and care practices for patients undergoing peritoneal dialysis in Baghdad City.
Materials and methods:
Research design:
A quasi experimental design one-group, pre and post test was evaluation for those nurses knowledge and care practices.
Setting:
The present study was conducted at the peritoneal dialysis units of AL-Karama Hospital, AL-Yarmook Hospital, AL-Kadhmiyia Hospital, AL-Kindy Teaching Hospital and Baghdad Teaching Hospital. The peritoneal dialysis units in these hospital has a capacity (105) beds which receive patients with chronic renal failure.
Subjects:
A stratified random sample and a proportional allocation was usedfor (55) nurses who was from the total 64 nurses who were responsible in providing direct nursing care for patients undergoing peritoneal dialysis at the above-mentioned settings.
Inclusion criteria:
The subjects were recruited for this study according to the following criteria;
1. Age from 20-60 years old
2. Currently work at the above mentioned setting and involved in direct nursing care for patients with renal failure undergoing peritoneal dialysis.
3. Minimum of one year experience in care of peritoneal dialysis patient.
Tools of the study:
In order to meetthe objectives of the study two-tools were developed by the researcher to collect the necessary data as following;
Tool I: Nurses’ Knowledge related to Patients Undergoing Peritoneal Dialysis
the researcher developed this tool after review of relevant literature that was including questionnaire consisted of two parts as the following;
Part I:Nurses’ Socio- demographic characteristics
This part was developed to collect data aboutnurses’ socio-demographic characteristics as: age, gender, marital status, level of education, years of experiences in hospital,years of experiences in peritoneal dialysis,andnumber of training session course related to peritoneal dialysis, place of training session inside or outside of Iraq.
Part II: Nurses’ Knowledge related to Nursing Intervention for Patients undergoing Peritoneal Dialysis Questionnaire
It was developed by the researcher depend on a review of the related literaturesto assess nurses’ knowledge regarding to nursing intervention for patients undergoing peritoneal dialysis. The researcher translated it into arabic language to be more understandable by nurses. It consisted of39 questions (multiple choice questions) about renal failure definition and types, causes, symptoms and stages of renal failure, peritoneal dialysis definition and anatomy of peritoneum, principles of the peritoneal dialysis, indications, contraindications, advantages and disadvantages of peritoneal dialysis, complications of peritoneal dialysis, steps of peritoneal dialysis, preparation of patient, environment and equipment for peritoneal dialysis, nursing role in peritoneal dialysis procedure, prevention of complication, and diet education.
Tool II: Nurses’ Care Practices for Patients undergoing Peritoneal Dialysis Observational Checklist
An observation checklist to assessing the actual nurses’ practiceswas developed by the researcher depend on review of the related literature. This tool comprised 122 items about equipment preparation, preparation of patient and environment, nurse’s practices before connect patient on PD, nurse’s practices during connect patient on PD, nurse’s practices to disconnect patient from PD.
Methods of the study:
1. The developed tools were tested for content validity via five experts in Medical Surgical Nursingdepartment to be surethe content validity, clarity items, comprehensiveness and necessary modificationwas done.
2. Reliability of toolswas testedby a pilot study was conducted on sevennurses (10%) in order to test the clarity, feasibility and applicability of the tools and necessary modifications were done.
3. The study was carried out through 4 phases(assessment phase, planning phase, implementation phase, and evaluation phase). Data collection extended from April 2022 to September 2022.
Phase 1: Assessment phase:
- The study participants were interviewed individually; the researcher introduced himself, and explained the aims of the study.
- Initial assessment of every participant was carried out before beginning of the implementation of the educational program on nurses practices regarding nursing intervention for patients undergoing peritoneal dialysisby using tools I and II to assess existing nurses knowledge and practices
Phase II: Planning phase:
- The researcher developed the educational program based-on recent literature review and obtained data from initial assessment to enhance nurses’ knowledge and practices related to patients undergoing peritoneal dialysis.
- The program included two parts theoretical information and practical procedure regarding practical nursing management of peritoneal dialysis patients.
- The final draft for the developed educational program was translated to Arabic then revised by five academic experts in the field of Medical-Surgical Nursing and necessary modifications were done accordingly.
Phase III: Implementation phase:
- The researcher planned with the nurses the times and duration of training program each a week before conducting of the training program.
- The developed educational program was delivered to the nurses through(7) sessions.These sessions included theoretical (4 sessions) and practical (3 sessions).
- This educational program was implemented in the pre-mentioned settings. The training session was implemented within the nurse’s mandatory working morning hours.
- The implementation of educational program was designed and presented in (7) sessions on two times per week for each hospital. Every session took approximately from (60-90) minutes.
- Various teaching methods were apply in the formswhich group discussion, demonstration and re-demonstration, power point presentation, training in real situation and printable version of educational program was given to every participant.
Phase IV: Evaluation phase:
Peritoneal dialysis nurses’ knowledge and practices were compared before and after implementation of the educational program immediately and after one month to determine the effectiveness of the program on the nurses’ knowledge and practice.
The main results of the study:
1- More than one third of studied nurses were in the age group of (20≥30) years and highest percentage composed of married females.
2- The approximately half of sample of the study had nursing institute certificate and the highest percentage of nurses in study had 6-10 years of experience in hospital as general and in peritoneal dialysis field.
3- About one third of the studied nurses attended one previous training session about peritoneal dialysis and it was inside Iraq.
4- The majority of the studied participants had poor level of knowledge and practice before implementation of the program, while the majority of the studied participants had fair and good level of knowledge and practice immediately and after one month from the implementation of the program.
5- The results revealed statistically significant increase in the nurses’ knowledge about all items of care of patients undergoing peritoneal dialysis (renal failure definition and types, causes, clinical manifestations, and stages of renal failure, peritoneal dialysis definition and anatomy of peritoneum, principles of the peritoneal dialysis, indication, contraindication, advantages and disadvantages for peritoneal dialysis, complication of peritoneal dialysis, steps of peritoneal dialysis, preparation of patient, environment and equipment for peritoneal dialysis, and nursing role in peritoneal dialysis procedure, prevention of complication, and diet education) in all stages of the program.
6- There were statistically significant increase in nurses’ practices about all items of care of patients undergoing peritoneal dialysis (equipment preparation, preparation of patient and environment, nurse’s practices before connect patient on PD, nurse’s practices during connect patient on PD, nurse’s practices to disconnect patient from PD) in all stages of the program.
7- Before implementing the program there was a significant association found between nurses’ knowledge mean score and their level of education, number of previous training sessions in peritoneal dialysis, and place of training sessions in peritoneal dialysis. The same result was found post program implementation.
8- There was a significant relation found between nurses’ care practices mean score in the pre assessment and their previous training sessions in peritoneal dialysis, and place of training sessions in peritoneal dialysis. While in the post program implementation the relation was found between nurses’ care practices mean score and their level of education, and place of training sessions in peritoneal dialysis.
9- There was high a positively correlation between nurses’ knowledge and care practices.
The main recommendations based on findings of the present study;
• Recommendations for hospital policy:
- The establishment of a central in-service educational department in a hospital to renew nurses’ knowledge and practice on a regular basis.
- Improve work condition through providing an adequate supply and facilities to encourage nurses to provide patient care in peritoneal dialysis unit.
- The developed handbook about nursing intervention for patients undergoing peritoneal dialysis and standard to apply peritoneal dialysis procedure should be available in the dialysis unit.
- Orient new admitted nurses about their job description and the importance of following standard of care.
- Restricted supervision of nurses’ performance is mandatory as well as nurses reinforcement an appropriate rewards for good practice.
- Continuous nurses knowledge and practices evaluation and peritoneal dialysis procedure competency should be taken into consideration.
- Number of nurses in peritoneal dialysis units should be increased to maintain reasonable nurse / patient ratio in order to provide high quality of nursing care.
• Recommendations for nurses:
- Encouraging nurses to participate national and international congresses, workshops and seminars in regularly about caring of patients undergoing peritoneal dialysis.
- Nurses should be encourage to participate in nursing peritoneal dialysis research to assist in better understanding the issues related nursing care.
• Recommendations for educational organizations:
- Peritoneal dialysis nursing development should be integrated as a basic science in the nursing curriculum to help nurses to deal effectively with patients and risks at the work environment.
• Recommendations for future studies:
- Further studies should be performed to study the effectiveness of educational programs about nurses’ knowledge and practices in improving patient quality of life.