الفهرس 
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Abstract
Summary
Operating room is a very critical area, has the highest risks of medical errors due to the high degree of coordination, technical equipment, complex and vulnerable populations of patients and a hazardous environment.The quality of the nursing care provided in this ward directly affects the effectiveness of patient treatment. In-service training of nurses plays an indispensable role in improving the quality of inpatient care. Need to enhance the effectiveness of in-service training of nurses is an inevitable requirement. Nurses working in operating room unit must be well-equipped and demonstrate clinical knowledge and highly competent skills to meet the demands of their profession and provide safe and effective nursing care to the surgical patients in having a safe operation. Focusing on role performance is one of the most essential elements to ensure patient security
The present study is aiming to evaluate the impact of implementing an in-service training program to develop the operating room department nurses’ performance through; (a) Assess operating room nurses’ knowledge and practice level. (b) Design an in-service training program for operating room nurses based on the assessment. (c) Implement the designed in-service training program for operating room nurses. (d) Evaluate the effect of the implemented program on the operating room nurses’ performance. The research hypothesis focused on that; an implementation of an in-service training program will lead to significant improvement in knowledge and practices of operating room nurses’ performance.
Subjects and methods:
Research design:
A quasi experimental design was used to achieve the objectives of the study.
Setting:
This study was conducted at El-Hawamdia General Hospital. It is a governmental hospital affiliated to the Ministry of Health with bed capacity 240 beds. It located in Misr Assuit Way, Elhwamdia, Giza, Egypt. The study was conducted in all operating suites in the hospital which composed of (12) operations rooms serving different surgical specialties and (8) recovery beds
Subjects:
A Purposeful sample was used in this study which, included (40) OR nursing personnel who have at least one year of experience at selecting setting. Included (6) OR head nurses and assistant head nurses, (22) scrub/circulating nurses where is the exchange between alternating roles and (12) anesthesia nurses. The nurses’ responses are gathered before and after 2, 4, and 6 months conduction of an in-service training program.
Tools of data collection:
Tool (I): Operating Room Nurses’ knowledge Assessment Questionnaire: to assess operating room nurses’ acquired knowledge scores pre and post implementing developed OR in-service training program. It was developed by the researcher in Arabic language, after reviewing the related current and previous national and international literature. This tool consisted of two parts; the first part was intended to collect data about characteristics of OR nursing personnel under study to provide descriptive data regarding nurses’ age, work position, gender, qualification, years of clinical experience. In addition to, open-ended question to elicit information related to attending any training courses on operating room. The second part was concerned with knowledge and divided into different four tests. Pre/ post test regarding to covered the job- related roles in OR of head nurses, scrub nurses, circulating nurses, and anesthesia nurses.
Tool (II): Operating Room Nurses’ Performance Observation Checklists: to evaluate level of practice related to different specialty among operating room nurses groups’ pre and post implementing developed OR in-service training program.And covered each professional role of head nurses, scrub nurses, circulating nurses, and anesthesia nurses.
Developed OR in-service training program: to provide fundamental knowledge regarding preoperative nursing. There are different three developed OR in-service training program was designed and implemented according to different specialty among operating room nurses’ groups
Developed OR in-service training program for the head nurses consists of six parts management, leadership, communication, teamwork, decision making and problem solving and empathy.
The OR in-service training program for the scrub / circulating nurses consists of two parts, the first part for the scrub nurses consists of seven parts; perform surgical hand scrub, sterile gowning and gloving, create and maintain a sterile field, prepare equipment, draping, infection control measures; handling surgical instruments and sharps in a manner that prevents injury to personnel and surgical counts. The second part for circulating nurses consists of six parts; room set up, creating a sterile field, conducts and maintains a record of accountable items used during a procedure (surgical count), skin preparation, specimen handling and provide equipment and supplies based on patient needs.
The OR in-service training program for the anesthesia nurses consists of eight parts; preparing anesthesia set up, receiving patient, cannulation & medication administration, blood transfusion, airway management positioning the patient monitoring patient post-anesthesia and nursing documentation.
The results of the study revealed the following:
• The majority of the head nurses (83.3 %) had unsatisfactory knowledge score pre-test with a mean of (5.33). All of head nurses (100%) had a satisfactory knowledge with a mean post-test score of (26.50. While majority (83.3 %) of them had a moderate knowledge mean score of (20.67) four -month post-test. and third (33.3%) had moderate knowledge with a mean score of (12.83) six-month post implementation of the program.
• There were highly statistical significant difference in head nurses knowledge about managerial role at pre , post , four -month post, and six-month post implementation of the program (p = 0.000).
• Head nurses knowledge increased in the first posttest than pretest (MD= -21.17, p=0.00), and all post tests were higher than pretest, and the knowledge level decreased gradually in four -month post (MD= -15.33, p=0.00) and six-month post (MD= - 7.50, p=0.01).
• The majority (90.9%) of the studied scrub nurses revealed unsatisfactory knowledge preprogram compared to satisfactory knowledge for the more than two third (68.2%) of them in post program implementation. While half (50 %) of them had moderate knowledge about their scrubbing role during the four -month post, while around third (31.8%) had moderate knowledge at the six-month post implementation of the program.
• There were statistical significant difference between scrub nurses total knowledge about scrubbing role at pre , post , four -month post, and six-month post implementation of the program (p= 0.00).
• The majority (90.9%) of the studied circulate nurses revealed unsatisfactory knowledge preprogram compared to satisfactory knowledge for the more than half (54.5%) of them in post program implementation. While the majority (81.2%) of them had moderate knowledge about their circulating role during the four -month post, while around quarter (27.3%) had moderate level of knowledge at the six-month post implementation of the program.
• There were high statistical significant differences in circulate nurses knowledge in pre-test, post-test , four-month post-test and six-month post-test at (P = 0.000)
• Three quarter (75%) of the studied anesthesia nurses revealed unsatisfactory level of knowledge preprogram compared to moderate level of knowledge for all (100%) of them in post program implementation. While the majority (91.7%) of them had moderate level of knowledge about their anesthesia role during the four -month post, as well the majority (83.3 %) had moderate level of knowledge at the six-month post implementation of the program.
• There was statistical significant difference between anesthesia nurses total knowledge about anesthesia role at pre , post , four -month post, and six-month post implementation of the program (p= 0.00).
• Head nurses’ practice about their role. Increase mean post program practice of the total score was (47.67), four -month mean post program practice score was (39.33), and the six-month mean post program practice of the total score was (29.50). Compared with mean preprogram practice of the total score was (10.83). Moreover, there were highly statistical significant difference in head nurses practice across the four phases of the program (F= 354.54, p = 0.000).
• Scrub nurses’ practice about their role. Increase mean post program practice of the total score was (75.05), four -month mean post program practice score was (69.64), and the six-month mean post program practice of the total score was (61.18). Compared with mean preprogram practice of the total score was (39.18) . Moreover, there were highly statistical significant difference in scrub nurses practice across the four phases of the program (F= 214.75, p = 0.000).
• Circulate nurses’ practice about their role. Increase mean post program practice of the total score was (36.64), four -month mean post program practice score was (31.67), and the six-month mean post program practice of the total score was (23.27). Compared with mean preprogram practice of the total score was (11.76). Moreover, there were highly statistical significant difference in circulate nurses practice across the four phases of the program (F= 104. 38, p = 0.000).
• Anesthesia nurses’ practice about their role. Increase mean post program practice of the total score was (150.58), four -month mean post program practice score was (137.36), and the six-month mean post program practice of the total score was (106.92). Compared with mean preprogram practice of the total score was (54.42). Moreover, there were highly statistical significant difference in anesthesia nurses practice across the four phases of the program (F= 344.85, p = 0.000).
CONCLUSION:
Based on the results of the present study, it can be concluded that:
All OR nursing personnel who attended the designed in-service training program showed a relative improvement in knowledge and practices of their performance, manifested by a steady increase in the six-month post-test mean scores which supported the study hypothesis. Meanwhile there was a positive strong significant correlation between the nurses’ total scores of knowledge and their total scores of practices in the OR throughout the intervention. In sum, the present study revealed that there were statistical significant differences ( at p< 0.05) related to the operating room nurses’ total mean knowledge and practices scores between the pre, post , four-month post, and six-month post program implementation .
Recommendations:
Based on the study findings and conclusion the following recommendations are suggested:
Recommendations for health care organization:
• Continuous monitoring , strict observation of operating room nurses during work and correction of poor performance is essential.
• Conduct continuous in-service training for OR nurse managers on their managerial functions and responsibilities to develop the adminstrathve skills , and OR nurse managers should be motivated for the serious participation in this training courses.
• The infection control committee should establish, develop and update all relevant protocols and guidelines annually so the new information becomes available for the best performance.
• Safety committees should be developed in healthcare settings and should work on updating all relevant safety protocols so that new information becomes available on the best practice
• Reminders for safe practices should be placed in visible locations at OR settings in the form of flyers and posters
• Ensure that rewards , incentives and promotion obtained based on nurses performance and communicate rewards policies to OR nurses.
Recommendations for educational department within organization:
• Orientation program should be developed to prepare new nurses before working in operating room department.
• Training of OR nurses should be conducted during service about nurse’s role in the OR through regular scientific meetings, workshops and training courses.
Recommendations for Ministry of Health as the legal entity for nurses:
• Apply continuous and mandatory in-service training for OR nurses , with updating knowledge based on new evidence should be provided to ensure patient safety.
• Apply periodical recertification of nurses as prerequisite to nursing practice licensure to ensure satisfactory performance.
• Nurse educators in health training institutions in consultation with other stakeholders should revise the curricula for training OR nurses in order to develop courses that will adequately prepare the OR nurse in the health care organizations.
Recommendations For further study:
• Replication of the current study on a larger sample and on a wider geographical areas is required in order to generalize the results.
• Comparative studies on the performance among OR nurses in different health sectors in Egypt are required.
• Further study is recommended to evaluate the reflection of the developed operating room in-service training program implemented on OR nurses performance and consequently on the patients’ complications outcome.
• Further studies are to be planned to achieve satisfactory nurses’ performance in all operating room in Egypt.