الفهرس 
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Abstract
Patient safety has been recognized as a public health concern and a top priority in healthcare, including critical care. The environment of ICU is complex and fast paced, thereby presenting several patients safety challenges. Moreover, CIPs may be more vulnerable to iatrogenic injuries because of the severity and instability of their illness, as well as frequent need of medications and other interventions (Bergman et al., 2020).
Critical care nurses are key members of the transport team and hold responsibility for keeping patients safe during transport; they aim, alongside doctors and other healthcare staff, to deliver the same standard of care available in the ICU during IHT However, inadequate training and other issues in IHT may impair patients’ safety (Song et al., 2022).
Aim of the study
This study aimed to assess the nurses’ performance towards intra-hospital safe transportation of critically ill patients: suggested guidelines, this aim achieved through:
1. Assessment of the nurses’ level of performance (knowledge, practice and attitude) towards intra hospital safe transportation of critically ill patients.
2. Developing the suggested guidelines for intra hospital safe transportation of critically ill patients.
Research questions
This study was conducted for answering the following questions:
1. What is the nurses’ level of knowledge towards intra-hospital safe transportation of critically ill patients at Beni Bueif university hospital?
2. What is the nurses’ level of practice towards intra-hospital safe transportation of critically ill patients at Beni Sueif university hospital?
3. What is the nurses’ attitude towards intra-hospital safe transportation of critically ill patients at Beni Sueif university hospital?
4. Is there a relation between nurses’ performance and the demographic variables of the nurses towards intra-hospital safe transportation of critically ill patients at Beni Sueif university hospital?
Subjects and Methods
Research design:
A descriptive exploratory design was utilized to achieve the aim of the study.
Research setting:
This study was conducted at ICU units (general ICU and CCU) at Beni-Suef University hospital.
All available staff nurses (50 nurses at ICU and 30 nurses at CCU) who were working in the previously mentioned setting accepted to participate in this study from both genders with different qualifications and years of experiences were recruited in this study.
Tools of data collection:
The study included three tools:
Tool I. Nurses’ self-administered questionnaire (appendix I):
It was developed by the ivestigator based on the related literatures (Denise, 2019 & Nasser, 2016). This questionnaire was written in Arabic language to suite the level of the subjects who mostly rely on the use of Arabic language and included two parts as the following:
• Part 1: Nurses’ demographic characteristics
It was concerned with demographic characteristics of the nurses under study. It consisted of seven questions such as age, gender, marital status, level of education, years of experience in critical care units (ICU & CCU), attendance of training courses and any AEs occurred during IHT.
• Part 2: Nurses’ knowledge
It was concerned with nurses’ level of knowledge towards safe IHT of CIPs: it included questions related to definition of safe transportation and the nurses role pre, during and post transportation procedure technique.
The questionnaire consisted of (111) questions; (50) of them were M.C.Q & (61) were true & false statements,
Scoring system:
The correct answer was scored ”1” grade, while the incorrect was scored zero, so the total score of knowledge was 111 grades, classified into the following:
• ≥ 85%= (94 grade and above) was considered high level of knowledge.
• <85%-60% = < 94-67 grades were considered moderate level of knowledge.
• <60%= >67grade was considered low level of knowledge.
II. Nurses’ practice observational checklist:
It was used to assess nurses’ practice towards safe IHT of CIPs. It was developed by the investigator based on Lynn, (2018) & Nasser, (2016) & compressed the following three main sections:
• Section 1: general safe IHT guidelines included 50 steps (pre (41), during (6) and post (3) transportation).
• Section 2: IHT guidelines related to the patients’ transfer used methods included 58 steps (Transfer the patient from bed to the stretcher (27) and Transfer the patient from bed to the wheel chair (31)).
• Section 3: included 2 parts; 7 AEs during IHT and 25 steps related to action taken.
So, total steps for tool II were 133 steps except part 1 in section 3.
Scoring system: each item in the above sections was scored by correctly done = 1 or not done= zero. Except part one in section 3 related to AEs scored by present= 1 or not present = zero.
Total score of tool II was 133 degrees classified as the following:
• ≥ 85% = ≥ 113 grade was considered high competence level.
• <85%-60% = <113-80 grades were considered moderate competence level.
• <60% = < 80 grade was considered low competence level.
Total score for section 1:
• ≥ 85% = ≥ 43 grade was considered high competence level.
• < 85%-60% = < 43-30 grades were considered moderate competence level.
• <60% = < 30 grade was considered low competence level.
Total score for section 2:
• ≥ 85% = ≥ 49 grade was considered high competence level.
• <85%-60% = <49-35 grades were considered moderate competence level.
• <60% = < 35 grade was considered low competence level.
Total score for part 1 in section 3:
• ≥ 85% = ≥ 6 AEs was considered high AEs.
• <85%-60% =< 6-4 AEs were considered moderate AEs.
• <60% = < 4 AEs was considered low AEs.
Total score for part 2 in section 3
• ≥ 85% = ≥ 21 action was considered high competence level.
• <85%-60% = <21-15 actions were considered moderate competence level.
• <60% = < 15 action was considered low competence level.
Tool III. Nurses’ attitude likert scale
This tool adapted from Denise, (2019) and modified by the investigator to suite the study aim. It was used to assess the nurses’ attitude towards safe IHT of CIPs. It consisted of (13) sentences and participants asked to respond on 5-point likert scale. Scoring for each sentence was as the following strongly disagree =1, disagree =2, neutral=3, agree=4 and strongly agree =5 in case of positive statement while the scores were reversed in case of negative statement.
Scoring system:
For calculating the total score of this scale taking into consideration that strongly agree or agree as positive attitude while strongly disagree, disagree as negative attitude beside neutral attitude. So, the total score ranged (from 13-65) & classified into:
• ≥ 85% = ≥ 55 grade was considered positive attitude.
• <85%-60% = <55-39 grades were considered neutral attitude.
• <60% = >39 grade was considered negative attitude.
Results:
The present study was revealed that:
The study finding demonstrated that, 50% of the studied nurses were in the age group 18 - <25 years, (5%) of them were ≥45 years with mean age 27.93±7.54 and around 60% were males. Also, 57.5% of them were married, 61.3% of them were technical institute nurses and (75%) of them had 1-<5 years of nursing experience in ICU. More than three quarters of the nurses (77.5%) did not attend training courses/ workshops on the transfer of CIPs and (75%) of them did not have AEs during the transfer of CIPs.
Concerning total level of the studied nurses’ knowledge, 77.5% of them had moderate level of knowledge, 62.5% of them had moderate competence level of practice and 57.5% of them had negative attitude towards intra-hospital safe transportation of CIPs.
There was highly statistically significant relation between the nurses’ total level of knowledge, practice and attitude regarding intra-hospital safe transportation of CIPs and their demographic characteristics; level of education, years of experience in critical care and attending training courses/workshops when p-value was <0.001. Also, there was statistically significant relation between AEs and levels of knowledge, practice and attitude when p<0.05.
Moreover, highly statistically significant positive correlation between total levels of nurses’ knowledge and practice (r= 0.487 at PV<0.001), there was statistically significant positive correlation between total levels of nurses’ knowledge and attitude (r= 0.340 at PV=0.002). Meanwhile, there was statistically significant positive correlation between total levels of nurses’ attitude and practice (r = 0.282 at PV=0.011). In the other hand, there was highly statistically negative correlation between levels of nurses’ knowledge, practice, attitude and AEs occurred (r= -0.589, -0.423 and -0.409 at PV<0.001).
Conclusion:
Based on findings of the current study, it can be concluded that: More than three quarter of the studied nurses had moderate level of knowledge, more than two thirds of them had moderate level of practice and more than half of them had negative attitude towards intra-hospital safe transportation of CIPs. Additionally, there was statistically significant positive correlation between total scores of the studied nurses’ knowledge, practice and attitude among the studied nurses and highly statistically negative correlation between total scores of knowledge, practice, attitude and AEs occurred.
Recommendations:
Based on the current study’s findings the following recommendations were proposed:
• Implementing continuous in service training courses are made mandatory for ICU staff to improve nurses’ performance towards intra-hospital safe transportation of CIPs.
• Continuous application of IHT suggested guidelines, protocols and checklists in all ICUs to prevent AEs which may occur for the patients during all phases of transportation.
• Availability of posters should be hanged on the wall of ICUs to remind all nurses’ staff about safety guidelines for IHT of CIPs since things they have seen easier than they have read.
• All critical care units’ staff should be aware of patients’ safety culture and keep abreast to technology so many tests, therapies and imaging requirements can now be carried out from the patients’ bedsides for limiting their transportation and consequently avoiding AEs occurred.
• A similar study should be replicated on a large sample size and other settings to generalize the findings.
• Further study should be suggested to evaluate effect of implementing training program based on the studied nurses’ performance towards intra-hospital safe transportation on patients’ morbidity and mortality rate.