الفهرس 
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Abstract
Summary
Diabetic ketoacidosis (DKA) is common, dangerous condition accounting for a major source of mortality in patients with T1DM, patients with T2DM, can also develop DKA in the context of infection and catabolic stressors. The rate of increase in cases of DKA appears to exceed the overall increase in the underlying diagnosis of diabetes. Emergency departments (EDs) account for over 12 million visits annually for diabetes-related complaints, comprising 9.4% of all ED visits, with approximately 175, 000 annual ED visits for DKA. DKA is typically managed in an ICU. Standardized treatment pathways for DKA care in ICUs and inpatient settings are well described (Griffey, et al., 2019).
Aim of the Study
This study aimed to: Assess the factors affecting the patients safety with DKA in ICUs through the following;
1- Assess DKA associated complications among the studied patients.
2- Assess the factors which affect on the patients safety with DKA from the nurses point of view.
Research questions:
To achieve the aim of this study the following research questions formulated:
1- What are DKA associated complications among the studied patients?
2- What are the factors which affect on the patients’ safety with DKA from the nurses point of view?
Research design
A descriptive exploratory design used to conduct the study.
Setting
The study conducted in ICU at Fayoum University Medicine Hospitals which located in second floor and consisted of five rooms, each room covering 5 beds so the total number of beds was 20,
Subjects:
• A convenient sample of all available nurses (30 nurses) working in ICU.
• A convenient sample of patients with DKA admitted to ICUs (70 patients)
Tools of data collection:
The following tools were used to accomplish the purpose of the study;
Tool (I) Self-administered questionnaire: it was developed by the researcher after reviewing the related literatures (Ignatavicius & Workman, (2013); Pellico, (2013); Burke et al., (2014); Hinkle & Cheever, (2014): Urden et al., (2014) and Pazokian & Borhani, (2017). It used to assess nurses related factors and other factors from their point of view, it include three parts:
Part one: It concerned with demographic characteristics of nurses under study such as age, gender, qualification, training, experiences …..…etc).
Part two: It concerned with nurses knowledge regarding safety nursing management for caring of patients with DKA
Part three: It was covered other factors affecting patients safety with DKA from nurses’ point of view including 2 components; The first one concerned with general nursing safety measures related factors and the second component focused on organizational related factors.
Tool (II) Nurses practice observational checklist: it was developed by the researcher based on relevant literature from (Joint Commission accreditation of health organization, 2016 & Perry, et al., 2018 & Linda, and Angela, 2019 & Wilkinson, et al., 2019). It was used to assess nurses’ practice regarding safety nursing management for caring of patients with DKA.
Tool (III) Patients interviewing questionnaire: it was developed by the investigator after reviewing the related literature (Alagappan, 2015 & Creed, and Hargreaves, 2016).It used to assess patients related factors and consisted of three parts:
A- Demographic characteristics of patients; it was used to assess patients demographic data as age, gender, educational level, marital status, job, place of residence and smoking.
B- Medical history; it was used to assess medical data of patients which including; Present medical history, past history and family health history.
C- Patients knowledge; it was used to assess patients level of knowledge regarding DKA and safety management
Tool (IV) Patients complications assessment sheet: It concerned with assessment of DKA associated complications among the studied patients, this sheet included:
• Complications related to acute disease
• Complications related to therapy
• Later complications of DKA
Tools validity and reliability:
It established by a panel of five expertise who reviewed the instruments for clarity, relevance, comprehensives understanding, applicability, and easiness for administration.
Reliability:
Data collection tools tested statistically to assure that the internal consistency of the used tools.
Pilot Study
A pilot study carried out on 10% of the subjects under study to evaluate the applicability, clarity and efficiency of the tools. The necessary modifications were done according to the result of the pilot study.
Ethical consideration
The approval for data collection from the studied subjects obtained and the researcher was clarify the aims, objectives and expected outcomes from the study. They were secured that all the gathered information was confidential and used for the research purpose only.
Results:
The main study findings summarized as the following:
Results for nurses;
• All the studied nurses (100%) had age ranged from 20-30 years.
• Less than two thirds were females (60%) and (56.7%) had diploma of nursing
• Majority of studied nurses (86.7%) less than 5 years of experience in ICU
• Most of nurses (83.3%) did not attend any training courses about DKA and 100% of them about safety with DKA
• More than half of nurses (56.7%) had satisfactory knowledge and (60%) of them had satisfactory level of practice regarding safety nursing management for caring of patients with DKA.
• Around two third of the studied nurses had satisfactory level about factors affecting patients safety including general nursing safety measures (63.3%) and organizational related factors (70%).
Results for patients;
• Less than one third of patients (30%) had age ranged from 18-20 and (24.3%) within 20-25 years and (62.9%) were females.
• Less than half of them (45.7%) were married and their (35.7%) had intermediate education
• More than one quarter of them (28.6%) were housewives and (54.3%) were from rural area
• Less than two third (61.4%) of patients had unsatisfactory level of knowledge about DKA
• There was statistically significant relation between DKA associated complications total mean score and nurses qualification, years of experience in ICU and training courses about patient safety with DKA.
• There highly statistically significant relation between DKA associated complications and education level among the studied patients.
• There was relation between DKA associated complications total mean score and nurses knowledge, practice, other factors affecting and patients total knowledge level.
• There had highly statistically negative correlation between DKA associated complications total mean score with nurses knowledge and practice score & had statistically negative correlation between DKA associated complications with other factors affecting and patients knowledge.
Conclusion;
Regarding nurses related factors more than half of the nurses had satisfactory level of knowledge and practice regarding safety nursing management of patients with DKA. Also, more than two thirds of nurses had satisfactory level regarding other factors affecting patients safety namely general nursing safety measures and organizational related factors.
As regards patients related factors less than two third of them had unsatisfactory level of knowledge regarding DKA safety management and consequently little percentage of them had DKA associated complications; namely complication related to therapy (hypokalemia and hypoglycemia) followed by complication related to acute disease namely cardiovascular complication (hypovolemic shock).
Recommendations:
Based on the study results, the following recommendations could be inferred from the current study including the following;
1) Importance of in-service training courses to enhance the nurses knowledge and practice regarding patients safety with diabetic ketoacidosis in intensive care unit to decrease morbidity and mortality rate.
2) Importance of all health care providers to take into consideration all the studied factors affecting patients safety with DKA in planning and managing care for such group of patients.
3) Periodical educational program is necessary for all patients with DKA for enhance their knowledge regarding safety disease management.
4) The study should be replicated on large sample of patients with DKA in different hospitals in order to generalize the study results.
5) Further study is suggested to develop safety management protocol for patients with DKA in intensive care unit considering all the studied factors affecting their safety and evaluate its effect on the complications rate.