الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
Abstract
Based on the findings of the current study, it could be concluded that:
In light of the current study findings, it was found that, all of studied nurses had unsatisfactory level of knowledge, all of them had unsatisfactory level of practice regarding hypothermia managementand rewarming maneuver among criticaly ill patients.While almost of them had positive attitude regarding hypothermia management and rewarming maneuver among critical ill patients. The current study findings concluded that, there was highly statistically significant differences with positive correlations between total knowledge score and total attitude regarding hypothermia managementand rewarming maneuver among criticaly ill patients.
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Recommendations
Based on the findings of the present study, the
following are recommended:
• Planning for educational guideline and training program for management of patients with hypothermia.
• Standardized nursing procedures should be available for nurses in different critical care units to guide them to ward hypothermia management and rewarming maneuver among critical ill patients.
• Training courses and workshops regarding hypothermia management and rewarming maneuver for nursing staff to increase their knowledge and practice.
• Hospital practice guidelines should be reviewed periodically to include recent, acceptable and applicable finding to be enrolled in practices.
• Periodical evaluation for nurses practices about hypothermia management, internal and external rewarming maneuver for criticall ill patients.
• Further researches are required involving larger study sample of nurses at different study settings, in order to generalize the results.
Summary
Hypothermia is a medical dangerous emergency that occurs when the patients body lose heat faster than it produces. When patients body temperature DROP it causes dangers effect to the heart nerves system and other organ can’t work normally. Untreated hypothermia can lead to complete failure of the heart, respiratory system then to death. Hypothermia is common among patients who suffer from critical illness and associated with adverse mortality outcome whereas the presence of hypothermia may be marker of severity of illness associated with mortality and it may also result in complication that increase risk consequent adverse outcome (Chiu et al., 2021).
Hypothermia is caused by number of factors such as exposure to cold weather, sever trauma, people with mental illness, some medical disease such as hypoglycaemia, under weight, hypothyroidism and post operative and some medications such as analgesic, anti emetic and anti inflammatory drugs. These factors increase risk of hypothermia depending on person’s age, body mass index and length of time exposed to cold temperature (McDonald et al., 2020).
Critical care nurses are highly specialized and trained health care personnel who provide nursing care to patients with life threatening illnesses. Nurses provide specialized experience, knowledge and skills that patients need to survive (Skok et al., 2021).
Aim of the study:
This study aimed to assess nurses’ performance regarding hypothermia and rewarming maneuver among critical ill patients Through the following:
1. Assess nurses’ knowledge regarding hypothermia management and rewarming maneuver among critical ill patients.
2. Assess nurses’ practices regarding hypothermia management and rewarming maneuver among critical ill patients.
3. Assess nurses’ attitudes regarding hypothermia management and rewarming maneuver among critical ill patients.
Research questions:
1. What are nurses’ knowledge regarding hypothermia management and rewarming maneuver among critical ill patients?
2. What are nurses’ practices regarding hypothermia management and rewarming maneuver among critical ill patients?
3. What are nurses’ attitudes regarding hypothermia management and rewarming maneuver among critical ill patients?
Operational definition:
Rewarming maneuver: It’s a procedure, used to treat hypothermia, it is ranged from the using of passive or active rewarming techniques. The decision to use active or passive rewarming techniques based on several clinical parameters and degree of hypothermia. Passive rewarm such as warm blankets, warm compresses, active external warming such as heating blanket, forced air and warm infusion.
The subjects and methods used for achieving this study was portrayed under four main designs as follows:
I. Technical design.
II. Operational design.
III. Administrative design.
IV. Statistical design.
I. Technical design:
The technical design included research design, setting, subject, tools for data collection
Research design:
A descriptive exploratory research design was used to conduct this study.
Research Setting:
This study was conducted at Fayoum University Hospital in different critical care units (Medical Intensive Care Unit – Cardiac care unit – Surgical care unit).
Research subject:
A convenient sample included (100 nurse) all available nurses working at the previously mentioned setting regardless their age, gender, qualifications or experience.
Tools of data collection:
Three tools used in this study.
1.Self administer nurses’ questionnaire:-
It was designed by the investigator after reviewing the related literatures (Abd kader & Ali, 2012; Perlman et al., 2016; Mahmoud et al., 2018). It was written in an Arabic language and used to assess nurses personal data and nurses knowledge. It consisted of two parts:
Part 1: Personal characteristics of the nurses
This part was used to assess personal characteristics of the studied nurses. It composed of seven questions, it included age, gender, marital status, level of education, years of experience, department of work and training about hypothermia.
Part 2: Nurses’ knowledge regarding hypothermia:
It was used to assess nurses’ knowledge regarding hypothermia management and rewarming maneuver among critical ill patients. It included 50 questions, multiple choice questions (MCQ) (15questions) and true or false questions (35 questions) which included three sub items:
Section (A): It was concerned with anatomy and function of thermoregulatory center. It composed of four MCQ.
Section (B): It was concerned with general knowledge of hypothermia. It composed of 11MCQ.
Section (C): It was concerned with basic knowledge of hypothermia management and rewarming maneuver. It included four main sub-items :
1-Nurse’s knowledge about measuring temperature: It included six true or false questions
2- Rewarming maneuver: It included five true or false questions
3- Moisture rewarming maneuver
4- Dry rewarming: It included five true or false questions Scoring system:
The rating scale was graded as the correct answer was scored one mark and incorrect answer was scored zero mark. The total score for this questionnaire was 50. The total marks were summed, percentage was calculated for all participants and judged as the following:
- Satisfactory level of knowledge ≥ 75 %
- Unsatisfactory level of knowledge < 75%
II Observational Checklists:
It was adopted from Avery et al., 2015; Perry & Potter, 2015. It was used to assess nurses’ practice during care for patients with hypothermia. It was written in English language and included eight main sub-items the response of each step was done or not done, it consisted of 102 steps as the fowlloing :
1- Measuring rectal temperature: It included 31 steps of nursing practice
2- Measuring axillary temperature: It included 26 steps of nursing practice
3- Rewarming maneuver: It included 21 steps.
4- Warm compresses application: It included 24 steps of nursing practice
5- Warm sitz bath: It included 17 steps (not applied)
6- Warm intravenous fluid: It included 34 steps (not applied)
7- Warm gastric lavage: It included 28 steps (not applied)
8- Warming enema: It included 36 steps (not applied)
Scoring system:
A scoring system was followed to assess nurses’ practice; each checklist assigned a score according to sub-items. The steps were evaluated as “done” was taken one grade and “not done” was taken zero. These scores were summed and converted into a percentage score, and according total scoring was classified into two categories:
-Satisfactory level of practice ≥ 75% (> 77 marks).
-Unsatisfactory level of practice < 75% (<77 marks).
III. Attitude rating Scale (Appendix IV).
Attitude rating scale was designed by investigator in Arabic language based on related literatures (De Campos et al., 2020; Jebb et al., 2021). It was used to assess the attitude of nurses’ regarding hypothermia management and rewarming maneuver. It included 19 statement the response for each statement were three ranged from agree, uncertain and disagree.
Scoring system:
A scoring system was followed to assess nurses’ attitudes toward caring patients of hypothermia. Each statement of the attitude nurses scale used to assess nurses responses and accordingly, they were scored by three for “agree”, two for “uncertain” and one for “disagree”. Scores of the all the scale statements were summed and total scoring was classified into two categories:
- Positive attitude if score ≥ 75%.
- Negative attitude if score < 75%.
II. Operational design:
Preparatory phase:
It included reviewing of related literatures and theoretical knowledge of varies aspects of the study using books, articles, internet search and periodicals.
Ethical Considerations:
Research ethical committee approvals obtained. Consent obtained from each participated nurse and confidentiality of data and results considered. Every nurse has the right to withdraw from the study at any time and without giving any reasons.
Pilot study:
A pilot study carried out on 10% of the total sample size nurses to test the content, the effectiveness and time consumed to fill in study tools.
Results: the result of the study showed that:
Regarding personal characteristics of the studied nurses’ revealed that 98.0% of the studied nurses’ their age ranged from 20- 30 years, 60.0%, of them were females, 54% of them were single and 86.0% of them studied in technical nursing institute. Regarding the nurses’ years of experience, the current study shows that 78.0% of nurses’ had less than 5 years of experience, 39% of them working in medical intensive care unit and 80 % of them did not take training course about management of patient with hypothermia.
In relation to satisfactory level of knowledge of the studied nurses’ revealed that, 70% , 55% , 55% and 50% of the studied nurses’ had satisfactory level of uses of warm IV fluid, knowledge about measuring temperature, rewarming maneuver and use of warm gastric lavage , while 79%, 98%, 45% had unsatisfactory level related to nurses knowledge respectively.
Regarding total practice among the studied nurses’ it was found that, 100% of the studied nurses’ had unsatisfactory level of practice regarding rectal temperature, axillary temperature, rewarming maneuver.
In relation to studied nurses’ attitude of the studied nurses’ it is found that, 99% of the studied nurses’ had positive of attitude and there were a highly statistically significant relations between nurses’ total knowledge score regarding hypothermia management and their age which refer to nurses’ from 20-30 years more knowledgeable than nurses’ from 40-50 years.
It is found that, there were no statistically significant relations between nurses’ practice and attitude regarding hypothermia management and their age, gender, education, department and years of experience and training course. While found that, there was a statistically significant positive correlation between total knowledge score and total attitude score.
Conclusion
Based on the findings of the current study, it can be
concluded that:
Overall, this study concluded that, all of studied nurses had unsatisfactory level of knowledge, all of them had unsatisfactory level of practice regarding hypothermia managementand rewarming maneuver among criticaly ill patients.While almost of them had positive attitude regarding hypothermia management and rewarming maneuver among critical ill patients. The current study findings concluded that, there was highly statistically significant differences with positive correlations between total knowledge score and total attitude regarding hypothermia managementand rewarming maneuver among criticaly ill patients.
Recommendations
• Training courses and workshops regarding hypothermia management and rewarming maneuver for nursing staff to increase their knowledge and practice.
• Hospital practice guidelines should be reviewed periodically to include recent, acceptable and applicable finding to be enrolled in practices.
• Periodical evaluation for nurses practices about hypothermia management, internal and external rewarming maneuver for criticall ill patients.