الفهرس 
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Abstract
An infusion pump is an electronic device used to deliver measured amounts at careful and regulated rates; it is operated by a trained user who programs the rate and duration of fluid delivery through a built-in software interface. Syringe pumps are the oldest established type of powered infusion devices, highly accurate and low volume devices particularly suitable for infusing at low flow rates. Infusion pumps have contributed to improvements in patient care, allowing for greater levels of control, accuracy and precision of drug delivery.
Infusion pumps have been associated with a high rate of recalls and adverse events, resulting in patient injuries and deaths. Although some adverse events may be the result of user errors, many of the reported events are related to deficiencies in the device design and engineering. They highlight the importance of fully integrating infusion pumps into intravenous (IV) therapy training and assessment. Nurses have an important role in ensuring safety in the medication administration process; nurses have to identify the breadth of practices, education associated with administering of infusions in critical care
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units and potential patient safety issues related to IV pump infusions.
Aim of the study:
The aim of the study was to assess the nurses’ performance regarding infusion pumps’ medication administration among critically ill patients through the following:
1. Assess the nurses‘ level of knowledge regarding the infusion pumps’ medication administration among critically ill patients.
2. Measure the nurses‘ level of practice regarding the infusion pumps’ medication administration among critically ill patients.
Research questions:
1. What is the nurses‘ knowledge regarding infusion pumps’ medication administration among critically ill patients?
2. What is the nurses‘ practice regarding infusion pumps’ medication administration among critically ill patients?
3. Is there a relation between the nurses‘ knowledge and their practice regarding infusion pumps’ medication administration among critically ill patients?
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Technical design:
It includes research design, setting, subjects and tools of data collection.
Research design
A descriptive exploratory deign was used to achieve the aim of this study.
Setting
This study was conducted at the cardiac intensive care units at The Center of Cardiac and Digestive System at Sohag Governorate, affiliated to the Ministry of Health. The cardiac intensive care units in the center include two units; the post operative cardiothoracic surgery intensive care unit and the cardiac care unit.
Subjects
A convenient sample of 30 nurses working at the cardiac intensive care units affiliated to The Center of Cardiac and Digestive System in Sohag Governorate was included in the study.
Tools of data collection:
Data collection was obtained using two tools, they were developed by the investigator based on the relevant
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and most recent literatures and they consisted of the following:
A. A designed Infusion pumps’ Questionnaire tool, it was closed ended questions and filled by the studied nurses themselves. It included two parts:
Part 1: It was concerned with the assessment of the demographic characteristics of the nurses such as age, educational level, and years of experience, patient / nurse ratio, working unit, attending training programs and presence of nursing procedures‘ manuals.
Part 2: It consisted of multiple choice questions and true/ false questions concerned with the assessment of nurses’ knowledge regarding intravenous medication administration using the infusion pump among critically ill patients; it covered 8 main parts about syringe pumps‘ medication administration, which were the definition of the syringe pump, preparing and setting up an intravenous infusion, infusion calculations, managing the dead volume in intravenous lines, identifying an infusion from multiple intravenous infusions, the disadvantages of the syringe pump, labeling and infusion observation & patient monitoring.
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B. Infusion pumps’ medication administration observational checklist: It was used to assess the nurses’ level of practice, regarding infusion pumps’ medication administration among critically ill patients. It was divided into four main items; the preparing phase, the priming and setting up phase, the administration phase, and the post administration phase.
Content validity and reliability
After the construction of data collection tools, face and content validity of the tools were assessed by a jury group consisted of 9 experts in medical surgical nursing department, Ain Shams University. The tools were rephrased based on the jury opinions. Based on their recommendations and additions; correction and modifications of some items were done. Internal consistency reliability was assessed in the present study tools consistency via Cronbach‘s Alpha reliability analysis to indicate how well the items in an instrument fit together conceptually.
Pilot study
A pilot study was carried out on 3 nurses (10%) to test feasibility, objectivity, and applicability of the study
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tools. Based on the results of the pilot study, needed refinements and modifications were done and pilot study subjects were excluded from the actual study subjects.
Fieldwork
Nurses who agreed to participate in the study were informed by the researcher about the nature and purpose of the study. Data were collected in three months from beginning of August 2017 to the end of October 2017. The researcher visited the two cardiac intensive care units during the actual work at the long day shift from 8 am to 8 pm or the night shift from 8 pm to 8 am two days weekly. First, each nurse was observed separately three times (for each phase) during infusion pumps‘ medication administration procedures using the observational checklist (tool II) and it took about 30 - 40 minutes, the mean of the three observations was calculated and recorded by the researcher; then, the designed infusion pumps‘ questionnaire (tool I) was filled by the nurses themselves, it took about 20 - 30 minutes. The answers were recorded by the nurses regarding demographic characteristics in 10 minutes and knowledge in 20 minutes. The researcher clarified and answered any related questions.
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Results:
The present study revealed that:
As regards the demographic characteristics of the studied nurses, the study demonstrated that all of studied subjects were females. They were less than thirty years old. Furthermore all of nurses had no manuals of nursing procedures and policies about the patient safety regarding infusion pumps‘ medication administration in their working place; 83.3% of them had less than five years of experience and 66.7% of the studied nurses had a technical institute diploma.
The study demonstrated that 70% of the studied nurses had an unsatisfactory total knowledge regarding infusion pumps’ medication administration among critically ill patients.
As regards the nurses‘ knowledge, 93.3% of the studied nurses had unsatisfactory knowledge regarding intravenous infusion calculations. They had unsatisfactory knowledge regarding managing the dead volume in intravenous lines, labeling, and infusion monitoring and patient observation (56.7%, 56.7% and 56.7%) respectively.
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The study findings revealed that 63.3% of the studied nurses had an unsatisfactory level of total practice regarding infusion pumps’ medication administration among critically ill patients. As regards the nurses‘ practice 66.7% of the studied nurses had an unsatisfactory level of practice regarding the preparing, priming and setting up phase. The study revealed the critical items mostly neglected by the majority of the studied nurses which were completing a drug additive label with name and signature of the nurse starting the infusion, applying an adhesive label to the IV tubing, placing a label on tubing with the appropriate date, completing a drug additive label with name, standardizing infusion system communication by using adhesive labels, and using an antiseptic swab to clean the access port or stopcock (96.7%, 96.7%, 93.3%, 93.3%, 93.3% & 90%) respectively.
The study revealed that there was no statistically significant relation between the total nurses‘ knowledge and their qualifications; while there was a statistically significant relation between the total nurses‘ knowledge
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and their years of experience, the patient /nurse ratio, their working place and training.
The study revealed that there was no statistically significant relation between the total nurses‘ practice level and their qualifications, working place, and the patient/nurse ratio; while there was a statistically significant relation between the total nurses‘ practice level and the years of experience, and their training.
The study findings revealed that there was statistically significant relation and correlation between the total nurses‘ knowledge and their total practice level regarding infusion pumps’ medication administration among critically ill patients.
Conclusion:
Based on the findings, the researcher concluded that the study was carried out on 30 female nurses. They were less than thirty years old. The majority of them had less than five years of experience and two thirds of them had a technical institute diploma.
The study demonstrated that less than three quarters of the studied nurses had unsatisfactory total knowledge regarding infusion pumps’ medication administration among critically ill patients. About two thirds of the
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studied nurses had an unsatisfactory level of total practice regarding infusion pumps’ medication administration among critically ill patients.
The study revealed that there was a statistically significant relation between the total nurses‘ knowledge and their years of experience, the patient /nurse ratio, working place and their training, and there was a statistically significant relation between the total nurses‘ practice level and their years of experience, and their training
There was a statistical significant relation and correlation between the total nurses‘ knowledge and their total practice level regarding infusion pumps’ medication administration among critically ill patients