الفهرس 
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Abstract
Critical care medicine specializes in caring for the most seriously ill patients. These patients are best treated in an ICU staffed by experienced personnel. ICUs must have a high nurse: patient ratio to provide the necessary high intensity of service, including treatment and monitoring of physiologic parameters. Urinary catheter is most procedure done in ICU as treatment and monitoring access for critically patients. In urinary catheterization a latex, polyurethane, or silicone tube known as a urinary catheter is inserted into the bladder through the urethra. Catheterization allows urine to drain from the bladder for collection and also, be used for injection of liquids into the bladder for treatment or diagnosis of bladder conditions (Nahon & Waddington, 2017).
Urinary catheter should be used according to medical indications and must be removed as soon as possible to avoid catheter-associated urinary tract infection, these indications include acute or chronic urinary retention, orthopaedic procedures that may limit a patient’s movement, the need for accurate monitoring of input and output, benign prostatic hyperplasia, incontinence, and the effects of various surgical interventions involving the bladder, prostate or bowel (Lapides, 2016).
However, urinary catheter is indicated for most critically ill patient due to solve more problems, it may cause several complications for the patients. Generally long-term catheterization carries higher risk of complications. Long-term catheterization carries a significant risk of urinary tract infection. Other long-term complications may include blood infections (sepsis), urethral injury, skin breakdown, bladder stones, and blood in the urine (hematuria). After many years of catheter use, bladder cancer may also, develop (Hedlund et al., 2018).
Aim of the study
This study aimed to:
Assess nurses` performance regarding urinary catheter care among critically ill patients through the followings:
• Assessing nurses’ level of knowledge regarding urinary catheter care.
• Assessing nurses’ level of practices and attitude regarding urinary catheter care.
• Suggested educational guidelines based on assessment.
Research questions:
This study is proposed to answer the following research questions:
1- What are the nurses’ level of knowledge regarding urinary catheter care?
2- What are the nurses’ level of practices and attitude regarding urinary catheter care?
3- Is the educational guidelines affect on nurses performance level?
Subjects and Methods
Research design:
A descriptive exploratory design was utilized for the conduction of this study.
Setting:
This study was conducted in the critical care unit at Shibin EL- Qanater Hospital. The critical care unit at ground floor and composed of two rooms, each room has 3 beds with 3 monitors and one crash cars in each room and ECG monitor.
Subjects:
A convenience sample will be composed of all the available nurses working at critical care unit at Shibin ALqanatir hospital and they are (45 nurses) working in critical care unit. The nurses had different qualifications, years of experiences and from both gender.
Tools of data collected
Three tools were constructed and tested by the investigator to collect data pertinent to this study these tools are:
Tool (1). Nurses’ self-administered questionnaire (Appendix I).
The self -administered questionnaire was used to assess nurses’ level of knowledge regarding care of patients with urinary catheterization. It was developed by the researcher in simple Arabic language after reviewing the relevant and recent literatures (Fasugba & Mitchell, 2017). The questionnaire consisted of 65 questions in the form of multiple choices questions (MCQ).
It included two parts as follows:
Part one: Demographic characteristics of the studied nurses such as age, gender, qualifications, clinical experience, years of experience. 4 close-ended questions.
Part two: Nurses’ Knowledge questionnaire: it was used to assess nurses’ level of knowledge regarding urinary catheter care (65 MCQ questions).
Scoring system: the knowledge level was categorized into satisfactory and unsatisfactory as follows:
- >85% (>55 marks) was satisfactory level of knowledge.
- <85% (<55 marks) was unsatisfactory level of knowledge.
Tool (2): Nurses’ practice observational checklists (Appendix II): it was used to assess nurses’ level of practice regarding insertion of urinary catheter, care of urinary catheter, emptying of urine bag, changing of the urine bag, irrigation, and catheter removal. This tool is adapted from (Willson, 2016) and (Anderson & Herring, 2019).
Scoring system: the level of practice was categorized into satisfactory and unsatisfactory as follows:
- >85% (>118 marks) was satisfactory level of practice.
- <85% (<118 marks) was unsatisfactory level of practice.
Tool (3): Nurses’ attitude questionnaire:
This tool was used to assess nurses’ attitude regarding urinary catheter. It was consisted of 40 Arabic sentences and response is grading according to likert scale (Agree, don’t know and disagree). It was adapted from (Pradhan & Das, 2017) and (Holroyd, 2019).
Scoring system: the total score of nurses’ attitude expressed as percent for a maximum points as follows:
- >85% (>68 marks) was positive nurses’ attitude.
- <85% (<68 marks) was negative nurses’ attitude.
Results:
- Regarding nurses’ demographic characteristics 48.9% of the studied nurses age range between 20 to less than 30 years and 93.3% of them were female, 49% of them had technical nursing degree. Also, 48.9% of the studied nurses their years of experience were less than five years.
- Concerning the nurses’ knowledge it was found that, 68.9 % of the studied nurses had satisfactory level of knowledge regarding care of patients with urinary catheter. While, 31.1 % of them had unsatisfactory level of knowledge regarding care of patients with urinary catheter.
- Regarding nurses’ total practice, 88.9% of the studied nurses had satisfactory level of practice regarding care of patient with urinary catheter. While, 11.1 % of them had unsatisfactory level of practice regarding care of patients urinary catheter.
- Regarding nurses’ total attitude, 84.4% of the studied nurses had positive attitude about urinary catheterization. While, 15.6% of them had negative attitude about urinary catheterization.
- Furthermore, there were no statistical significant relation between nurses’ level of knowledge and qualification, age, years of experience, but there were significant relation between nurses’ level of knowledge and their gender, there were no statistical significant relation between nurses’ total level of practice and their demographic characteristics.
- In addition to, there was a significant positive correlation between total knowledge & practice of the studied nurses but there was negative correlation between total knowledge & attitude of the studied nurses regarding care of patients with urinary catheter.
Conclusion:
Based on findings of the current study, it can be concluded that: the majority of nurses had satisfactory level of knowledge and practice regarding care of patients with urinary catheter and minority of nurses had unsatisfactory level of knowledge and practice regarding care of patients with urinary catheter. Mean while, more than three quarters of the studied nurses had positive attitude regarding care of patients with urinary catheter.
While, there is no statistical significant relation between nurses’ level of knowledge and qualification, age, years of experiences, but there were significant relation between nurses’ level of knowledge and their gender, there were no statistical significant relation between nurses’ level of practice and their demographic characteristics. In addition to, there was a significant positive correlation between level of knowledge & level of practice of the studied nurses but there was negative correlation between level of knowledge & level of attitude of the studied nurses regarding care of patient with urinary catheter.
Recommendations:
Based on the results of the present study, the following recommendations are suggested:
Education:
- On-going and regular in-service educational programs regarding urinary catheter care.
- Nursing educators and clinical staff must incorporate strategies regarding urinary catheter care in all hospitals and use learning opportunities to raise awareness of nursing staff about the topic.
- Learning resources such as articles, journals and electronic resources such as computer and internet should be accessible in the units for nursing staff members. Continuing professional development programs should include skills updates.
Practice:
- In-service training and courses should be available in work field prior to the work in the critical care unit.
- Nurse supervisors should also verify that catheter care checklists appropriately followed by all nursing staff to prevent urinary catheter complications.
- Increase the number of nurses in ICU based on international nurse patient ratio to improve quality of care.
Research:
- The study should be replicated on large sample and in different hospitals setting in order to generalize the results.
- Further study to evaluate the reflection of educational program regarding nurses’ perception.