الفهرس 
COVID-19 DisasterOnly 14 pages are availabe for public view
 |  | from | 264 |  |  |
| | | from | 264 | | |
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been globally fatal (Safadi et al., 2022). It belongs to the Coronaviridae family. These are the viruses causing the simple common cold disease to severe illnesses like Middle East Respiratory Syndrome (MERS-CoV), Severe Acute Respiratory Syndrome (SARS-CoV) (Ali & Alharbi, 2020).
Triage is an important component of emergency department care. It is designed to help identify and prioritize undifferentiated patients based on severity and risk into categories from emergent to non-urgent. It begins upon entry to the emergency department and needs to be reevaluated as the patient waits or moves through the system, to ensure the appropriate speed and level of care is being provided reliably and safely (Bahlibi et al., 2022). Triage nurse in pandemic situations plays a crucial role in identifying high-risk populations (Mulyadi et al., 2022).
During the global COVID-19 pandemic crisis, CHNs have faced a sharp increase in their workload for infection control and dealing with complaints, screening, as well as added work for isolation, contact tracing, and self-isolation training, vaccination, and follow-up actions for adverse symptoms after vaccination (Kim et al.,2022).
Aim of the Work:
This study aims to assess triage skills in Covid-19 disaster for community nurses in primary health care centers through:
1. Assessing nurse’s triage knowledge regarding to Covid-19 disaster.
2. Assessing nurse’s triage practices regarding to Covid-19 disaster.
3. Assessing factors affecting on total skill level of triage skills in Primary Health Care centers.
Research question:
1. What is the relation between nurse’s experience of primary health care centers and total knowledge of triage skills regarding COVID-19?
2. What is the relation between total knowledge of triage and total level of triage practices?
3. What is the relation between factors affecting total skill level of triage and total level of triage practices regarding COVID-19?
1-Technical Design:
The technical design includes research design, setting, subjects and tools of data collection used in this study.
Research design
A descriptive analytic design was utilized in order to assess triage skills in Covid-19 disaster for community nurses in primary health care centers through:
Setting:
The study was conducted at Primary Health Care units (PHC), Maternal and Child Health Care Centers (MCH) and Family Health Centers (FHC) in Cairo Governorate. Cairo Governorate consisted of 34 directors which include 66 PHC, (MCH) and (FHC) by using systematic random sampling selected 50% which equal 33 unites, according to the instructions of Ministry of Health the number of nurses supposed in these units from 8:15 nurses. The health care centers provide maternal and childcare, emergency, compulsory vaccinations for children, family planning, dental services and some of these nurses working in the COVID-19 pandemic (Appendix II).
Subjects:
A purposive sample was used in this study which consisted of 112 nurses, from previously mentioned Primary Health Care units (PHC), Maternal and Child Health Care Centers (MCH) and Family Health Centers (FHC) in Cairo Governorate and according to the following criteria the sample was chosen.
Inclusion criteria:
• Nurses who participated in triage group of COVID-19 pandemic.
• Nurses must be on-job now and at last two years (through pandemic).
• Include female and male nurses.
Tools of data collection:
The data were collected using the following two tools:
It was developed by the investigator, based on reviewing related literatures, magazines and expert’s opinions, written in simple Arabic and English language to assess triage skills in Covid-19 disaster for community nurses in primary health care centers.
First tool: An interviewing questionnaire (Appendix I): This included the following four parts.
Part (I): Nurses socio-demographic characteristics:
It was used to assess socio- demographic characteristics of nurses who working in PHC. This part included 8 closed ended questions (Question 1: question 8) such as nurses genders, ages, marital status, income, education level, experience years, training courses and its type.
Part (II): Nurses Knowledge about triage and classification assessment questionnaire:
It was used to assess nurse’s knowledge about triage which consisted of 7 closed and open ended questions (Q 1: Q 7) such as triage definition, aim, process, levels, color coded and waiting time for each patient.
Part (III): Nurses Knowledge about COVID-19 pandemic questionnaire:
It was used to assess nurse’s knowledge about COVID-19 pandemic which consisted of 22 closed ended questions (Q 8: Q 29) such as definition, high risk people, quarantine period, clinical symptoms, ways of spreading COVID-19 virus, diagnostic measures, treatment, safe period after infection, management of COVID-19 patients, complication, general precautionary measures for community and medical team to prevent infection.
Part (IV): Factors affecting the level of classification skills during the COVID-19 pandemic:
It was used to assess factors affecting the level of classification skills during COVID-19 pandemic which consisted of 3 parts as follow:
(1) Triage clinic environment, this part includes 5 closed ended questions (Q 1: Q 5) such as separate registration office for patients with respiratory symptoms, respiratory waiting area, characters of respiratory waiting area, Patients are separated from each other and triage area supplies.
(2) Personal factors, this part consists of 6 closed ended questions (Q 6: Q 11) such as worrying about getting infected, the family and medical staff with the COVID-19 virus, fear of seeing the suffering of patients, frequent absences of the medical staff and redistribution of medical staff to new places due to the pandemic.
(3) Administrative factors this part consists of 5 closed ended questions (Q 12: Q 16) such as availability of all PPE for nurses, preparing a specialized triage staff and training for classification procedures, training on the symptoms of the emerging corona virus and an additional financial rewarding.
The second tool: An observational check list to evaluate the performance of nurses during classification:
It aimed to assess nurses’ practices regarding COVID-19 patients’ classification which divided to five parts as follow:
1. Triage process this part included 8 closed ended questions
(Q 1: Q8) such as evaluation for respiratory symptoms, usage of triage algorithm/questionnaire, patient isolation/separation and application of health and safety roles.
2. Apply comprehensive precautions for infection control measures in dealing with COVID-19 patients which consisted of 7 closed ended questions (Q 9: Q 15) such as comply with PPE, wearing and taking off PPE, availability of separate area & posters for PPE donning and doffing, hand washing.
3. Applying the physical examination for COVID-19 patients which consisted of 8 closed ended questions (Q16: Q 23) such as assessment of patients′ vital signs, complaint, signs and symptoms, categorization and determine the patient′s triage stages according to the color code.
4. Implementation of nursing care which consisted of 13 closed ended questions (Q 24: Q 36) such as nursing intervention, administer needed medical laboratory tests, transferring patient as doctor order to the hospital if the situation requires and recording of case assessment results.
5. Registration and evaluation which consisted of 12 closed ended questions (Q 37: Q 48) such as patient’s identification, availability of triage cards and registration documents, recording of doctor’s prescription and nurse’s notes, application of infection control standards, Patient safety, and transferring of patient.
Results and findings:
Findings of the current study can be summarized as:
There were 96.4% of the study sample was female while 3.6% was male and 46.4% of them, their age ranged from 40˂50 years. Also shows that 57.1% of them were married with not enough family income for 70.5% of them. As regards nurses’ education the results show that 82.1% were diploma and 68.7% had experience from 5 to 10 years.
There were 78.6% of nurses in primary health care centers had unsatisfactory knowledge about triage while 21.4% had satisfactory knowledge about it.
There were 91.1% of nurses had satisfactory knowledge about COVID-19 while only 8.9% of them had un satisfactory knowledge about it.
As regards factors affecting triage skills, administrative factors were the more effecting with 92.9%, then environment of triage clinics was unsuitable with 63.4%, then environment of respiratory clinic was unsuitable with 55.4% and then personal factors was not found with 54.5%.
The total level of practice for the study sample toward triage skills was 68.7% inadequate practice level of triage skills while 31.3% of nurses had adequate practices of it.
Conclusions:
The current study findings concluded as the following:
There was highly significant relation between nurses’ total knowledge about triage and their years of experience and practices. Also there was significant relation between nurse’s practices and factors affecting triage skills as suitability of triage clinic with P value < 0.05. While more than three quarter of the study sample of nurses had unsatisfactory knowledge about triage while most of them had satisfactory level about COVID-19 in addition to inadequate practices for more than two thirds of them.
Recommendations:
In the light of the study findings, the following recommendations were suggested:
On-job training program should be designed and prepared to training the nurses in primary care center in order to improve their performance toward triage skills.
Designing a poster and brochure about triage stages, color code and triage priority for all primary health care centers.
Improving administrative, environmental factors and infrastructure of triage clinics to allow nurses to perform their role perfectly.
Further intervention studies should be conducted to improve nurse’s knowledge and practices about triage skills for proper care of large number of patients during disaster periods.