الفهرس 
Neonatal intensive care unit (NICU)Only 14 pages are availabe for public view
Abstract
Neonatal period in the period consider from birth to one month of life or the twenty eight days of life (Taha, 2011)
Pulse oximeter is a noninvasive nursing procedure for measuring oxygen saturation to guide oxygen therapy. A sensor composed of alight emitting diode and photo detector is placed in opposition around afoot, hand, finger, toe, forehead and ear lope. The value of pulse oximeter called functional saturation which compares the amount of Hemoglobin (Hb) that is saturated with the total amount of Hb present (Perry & Hockenberry, 2014).
Pulse oximeter is essential in the monitoring of neonates. It provides continuous non-invasive beat-to-beat monitoring of oxygen saturation and heart rate.It also provides information about peripheral perfusion and therefore cardiac output and volume status (Glenys Boxwell, 2010).
Oximetry can helpful in multiple settings, including the operating or emergency room, special procedures as bronchoscopy, Computed Tomography scanning (CT), postoperative neonates,sleep studies, exercise testing, in neonates with respiratory problems, weaning from supplemental oxygen, mechanical ventilation,pulmonary rehabilitation and helpful in prescribing home oxygen therapy (Aitkenhead&Moppett, 2013).
Pulse 0ximeter has been affected either by Physiological factors or technical factores. The physiological effects on the pulse oximtery values obtained are unreliable include elevated levels of abnormal (Hb) presence of vascular dyes, vasoconstriction medications shock, poor tissue perfusion,cardiac arrest, severe anemia and lidocaine therapy (Morton&Fontaine, 2013).
Technical effects on the accuracy of pulse oximetry include bright light, excessive motion, and incorrect placement of the prop. Bright light may interfere with the photo detector and cause inaccurate results. Excessive motion can mimic arterial pulsation and can lead to false readings. Incorrect placement of the probe can lead to inaccurate results, because part of the light can reach to the photo detector without having passed through blood (Urden &Stacy, 2010).
Oximetery offers several advantages such as; doesn’t require heating the skin, thus reducing risk of burn, maintains an accurate measurement regard less of the age or skin characteristics or presence of lung disease but the long use of pulse oximeter on one site and sensors attached too tightly causes a lot of complication such as injury, ischemia and second, third degree of burn reported so we should assess site of pulse oximeter at least every 2 to 4 hours and move the probe to different sites in order to reduce these complication (Davidwilson & Hochenberry, 2013).
Neonatal nurses’ performance for neonates with pulse oximeter are hand hygiene, position infant comfortably, if using the finger is monitoring site perfusion of this finger with support lower arm, secure probe to the great toe, secure cable to foot, cover foot with a snugly fitting sock, heat and light sources affect sensors and Cover sensors when used during phototherapy or with radiant warmers so that the nurse has an important role in mangment of neonatal care use puls oximeter (Perry & Potter, 2010).
When the Nurses use the pulse oximetr thy should concern with these points; don’t attach probe to finger, ear, or bride of nose if area is edematous or skin integrity is compound, don’t use ear lobe and bride of the nose sensors for neonates because of skin fragility, don’t attach sensor to finger that are hypothermic and don’t place sensor on same extremity as electronic BP cuff because blood flow to finger will be temporarily interrupted when cuff infants and cause inaccurate reading that can trigger alarms ( Perry & Hockenberry, 2014)
Significance of the Study:
Pulse oximeter is an essential monitoring and useful tool used in the intensive care unit although it has some pitfalls in it use. Therefore this study should be dealt with the factors contribute to neonatal nurses pitfalls during apply of puls oximeter in neonatal intensive care unit.
Aim of the Study:
This study aimed to assess the factors contributing to neonatal nurses pitfalls during applies of pulse oximeter in neonatal intensive care unit.
Research Question:
What are the factors contributing to neonatal nurses pitfalls during apply of pulse oximeter in neonatal intensive care unit?
Subjects & methods:
• Technical Design.
• Operational Design.
• Administrative Design.
• Statistical Design.
Technical Design includes:
¬Research Design:
A descriptive design was used to conduct this study.
Settings:
The study was conducted at neonatal intensive care units affiliated to Ain Shams University Hospitals and Zagazig Universty Hospital.
Subjects:
A purposive sample composed of (80 nurses 50 nurses work at Ain Shams University Hospital +30 nurses worke at Zagazig University Hospital who provid care to neonates with puls oximeter.
Tools of data collection:
Data was collected through the following tools:
A structured Interview Questionnaire:
It was developed by the researcher after reviewing the related national and international literature. It was written in a simple Arabic language to suit the understanding level of the study subject.
It was included two parts:
Part 1:
• It was concerned with characteristic of nurses such as (name, gender, age, educational level and year of experience…etc).
• It was concerned with characteristic of neonate such as (gestational age, birth weight, duration of hospitalization, diagnosis and complication….. etc).
Part2:
• To assess knowledge of nurse about pulse oximeter as (definition, indication, advantage and complication….etc).
• Observational checklist:
It was adopted from Neonatal Intensive Care Unit (NIC) practice (2015) to assess the nurses practices used pulse oximeter.
Scoring system:
A scoring system was followed to assess nurses’ knowledge according to pulse oximeter. The Questionnaire was contained of 14 questions, the total scores of the questionnaire were 14 grades, the right answer was scored as a single point and the wrong answer was scored as a zero point. These scores were summed and were converted into a percent score.
It was classified into 3 categories:
- Good knowledge if score >85%.
- Average knowledge if score from 70 < 85%.
- Poor knowledge if score <70%.
Scoring system:
A scoring system was followed to assess nurses’ practice; each competency skill was assigned a score according to sub-items. The total score of nurses’ practices were 14 grades, each item was evaluated as “competent” was taken one score and “not competent” was taken zero score. These scores were summed up and were converted into a percentage score.
It was classified into 2 categories:
- Competent if score ≥ 95%.
- Incompetent if score < 95%.
Table (1) : shows that, 56.3% of neonatal nurses were 20-<30 years, 45% were studied at technical health institute, 34.8% had experience less than 5 years.
Table 2: shows that 58.8% of neonates were female, age of 51.3% of neonates were 1-<10days, weight at delivery of 45% of neonates were 1.5-2k.g, gestational age of 35% were 30-<33weeks, actual weight of 36.2% were 1.5-<2k.g and 57.5% were appropriate weight according to gestational age.
Table (3): shows that, 42.5% of neonates were diagnosed respiratory distress, 62.4% spent 1-<10 days at NICU, 66.3% connected with pulse oximeter within 1-<10days and 66.2% had no signs of defect in circulation.
Table (4): shows that, 76.2% of neonatal nurses selected a tool used for detecting oxygen level at tissue as a description of pulse oximeter,46.3% selected a all of the above as a site of placing the pulse oximeter on the body of neonate, 33.8% selected a tool used for detecting oxygen level at tissue and assess pulse as a using of pulse oximeter and 51.2% selected all of the above as advantages of pulse oximeter.
Table (5): shows that, 100% of neonatal nurses deal with pulse oximeter, 46.3% selected sends a steady pulse prompt as indicators for working well, 63.8% selected improper position as a cause of wrong indicator, 47.5% selected defect at circulation as cause of inability of device to evaluate oxygen saturation while 68.8% select decrease oxygen saturation as cause of alarm of pulse oximeter.
Table (6): shows that, 78.9% of neonatal nurses know the complication of using pulse oximeter, 55% of neonatal nurses select skin ulcer as complication, 51.3% of neonatal nurses refuse to thickness of skin affect accuracy of device, 45% of neonatal nurses select all of the above as ways for prevention while 58.8% of neonatal nurses providing care for neonate suffered from complication of device.
Figure (1): shows that 49% of neonatal nurses had good knowledge while 32% of had average knowledge, and 19% had poor knowledge regarding care for pulse oximeter.
Table (7): shows that 54% of studied neonatal nurses were competent, while 46% were incompetent.
Figure (2): shows that 54% of neonatal nurses were competent while 46% was incompetent at care for pulse oximeter.
Table (8) shows that, there was statistically significant difference between the age, residence, years of experiences of the neonatal nurses and their total knowledge regarding care of pulse oximeter, While there was highly significant difference between the qualification of the neonatal nurses and their total knowledge and there was no statistically significant difference between marital status, training courses and their total knowledge regarding care of pulse oximeter.
Table (9) shows that, there was statistically significant difference between the qualification of the neonatal nurses and their total practice regarding care of pulse oximeter, While there was highly significant difference between the training course of the neonatal nurses and their total knowledge and there was no statistically significant difference between marital status, age, residence, years of experiences and their total practice regarding care of pulse oximeter.
Table (10) illustrates positive correlation between total knowledge of the studied neonatal nurses and their total practice regarding care of pulse oximeter.