الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Diarrhea frequently complicates the course of the critically ill patient that is occurring among 40% to 50% of patients in the intensive care unit (ICU). Diarrhea is the most common non hemorrhagic gastrointestinal (GI) complication. Despite its high prevalence among the ICU patient, diarrhea is frequently overlooked by physicians and the ICU team, especially when more emergent cardiovascular, respiratory, and infectious issues are present. (3) The aim of the present study was to evaluate the effect of educational program on nurses’ performance regarding intensive care units induced diarrhea among critically ill patient. Research design: A quasi-experimental research design was utilized in the present study. Subjects consisted of all nurses (20) from CCU and (30) nurses from ICU from EL-Menshawy General Hospital. Tools of data collection:- Two tools were used in the current study as the following: Tool I: Structural Interviewing Questionnaire: It consisted of two parts: Part I: Socio-demographic data of nurses: which included; nurses code, age, sex, marital status, level of educational, Place of work, occupation, years of experience and previous training about ICU induced diarrhea management. Part (2): Structured nurses’ knowledge interview questionnaire: This part was developed by the researcher after reviewing the relevant literature to assess nurses’ Knowledge related to induced diarrhea in ICU. It consisted of two categories in the form of (close question) MCQ: a) Knowledge regarding Intensive Care Units induced diarrhea which included; anatomy and function of gastrointestinal system, definition, and characterization of diarrhea, risk factors, infectious and noninfectious causes, manifestation, classifications, complications and differential diagnosis of diarrhea. b) Knowledge regarding management of intensive care units induced diarrhea which included; bowel assessment and investigation of the patients, medications, nursing intervention for different types of diarrhea, dehydration, fluid and electrolyte disturbance, skin breakdown, hygiene care for patients, infection control measures, emotional support and prevention measures for ICU induced diarrhea. Tool (II) An observational checklist regarding nurses’ practice: This tool was developed by the researcher after reviewing of related literature review to assess the actual nurses’ practice of ICU diarrheal patient, it was included the following: bowel assessment, patients assessment, application of stool charts care pathways, and managing the effects of diarrhea. The researcher complete observational check list pre, immediate and 2 months later post implementation of educational program. Method 1. Assessment phase: - Part (A): Assessment of nurses’ knowledge related to patients about induced diarrhea in ICU was used three times pre , Immediately and two month post implementation of educational program by using tool No.(I) Part (B): Assessment of nurses’ practice: Nurses was observed three times pre, Immediately and two month post implementation of educational program by using tool No.(II) 2. Planning phase: This phase was formulated based on the previous assessment phase and strong review of the relevant literatures, Priorities and expected outcome criteria were put into consideration when planning patients care. Educational strategies and aids were used during the session and cover three domains of education. Educational strategies include: lecture, group discussion, demonstration were used as teaching method. Also, teaching aids include handout, booklet and PowerPoint were prepared by researcher based on literature review. (38-42) 3. Implementation phase: - The educational training program was presented to all nurses included in the study in five sessions and the duration of each sessions were 30 minutes per day for five consecutive days. Training included nurses in El-Manshawy General Hospital .Nurses was divided into small groups each one ranges from (10) nurses. The content of sessions was divided into two theoretical and three practical sessions as follows The theoretical part: included Session 1: Basic knowledge of induced diarrhea in ICU. Session 2: Basic knowledge of induced diarrhea in ICU. The practical part: included Session 3: It included application of bowel assessment. Session 4: It included application of patients’ assessment. Session 5: It included application of managing the effects of diarrhea, hygiene care for patients (Perineal and sacral skin care), infection control measures and decontamination of the patient environment, emotional support, nutritional practices as (assess and management of dehydration and fluid and electrolyte disturbance, enteral nutrition) and preventing skin breakdown. 4. Evaluation phase:- Nurses were evaluated as following: - Evaluation was done for both theoretical and practical part three times pre, immediately after teaching and training. This evaluation was repeated post two month under supervision of supervisor’s after implementation of training program by using tool (I and II). - Comparison was done to determine the effect of implementation nursing intervention training program on nurses’ performance (knowledge and practice) regarding induced diarrhea in ICU. The main results of the present study: 1. The finding of present study releaved that most (nearly more than one third 48%) of studied nurses were in the age group between 25- >30years old. 2. The majority 96% of studied nurses were female. 3. The majority 90% of studied nurses were married. 4. The result of current study showed that half 50% of studied nurses were Bachelor degree. 5. The finding of current study illustrated that the highest proportion 44% of studied nurses had experience 1-5years. 6. The current study revealed that most 78% of studied nurses did not attend training courses. 7. Finding of current study revealed that nurses’ knowledge improves into good knowledge level immediately into (84%) and two-month post program (82%) compared to pre- program implementation (46%). 8. Finding of current study revealed that nurses had satisfactory practice level immediately (88%) and two-month post program implementation (84%) than pre- program implementation (38%). 9. It was clarified that there was a statistically significant improvement in the level of knowledge about anatomy, function of gastrointestinal system and bowel dysfunction, among ICU& CCU nurses throughout all intervention periods of the study at p value = (<0.00). 10. There was an improvement regarding knowledge and practice from pre educational program and post immediate educational program p value = (<0.001*) while there were no significance between post immediate educational program and post two month of program. 11. It was noticed that there was a highly statistically significant improvement in the level of knowledge about ICU induced diarrhea among nurses throughout all intervention periods of the study at p value (<0.001*). 12. It was noticed that there was a statistically significant improvement in the knowledge about management of ICU induced diarrhea pre and post program among nurses throughout all intervention periods of the study at p value = (<0.001*) 13. There was a statistical significant improvement in nursing practice regarding bowel assessment for patient in ICU&CCU throughout all intervention periods of the study at p value =(<0.001*) 14. There was a statistical significant improvement in nursing practice regarding patient assessment during induced diarrhea pre and post nursing educational program throughout intervention periods of the study at p value = (<0.001*). 15. There was a highly significant improvement of nurses’ practice of perianal care from pre educational program and post immediate educational program p value = (<0.001*) while there were no significance between post immediate educational program and two month after program. 16. There was statistical significant improvement in the nurses’ practice regarding Sacral Skin Care pre and post immediate and after 2 month nursing educational program at p value = (<0.001*) while there were no significance between post immediate educational program and two month after program. 17. It was observed that there was statistical significant improvement in the nurses’ practice regarding infection control measures pre, post immediate and after 2 month nursing educational program at p value(<0.001*). 18. It was obvious that there were a statistical significant improvement in the nurses’ practice regarding psychological care for patient pre and post and Post 2 month nursing educational program at p value =(<0.001*) 19. There were a significant improvement in the nurses practice regarding food and fluid to the patient pre, post and post 2 month nursing educational program at p value=(<0.001*). 20. It was clarified that there was a significant improvement in the nurses practice regarding Prevent skin breakdown to the patient pre and post and post 2 month nursing educational program at p value =(<0.001*). 21. There was positive correlation between total level of ICU & CCU nurses knowledge and total level of practice for ICU induced diarrhea at pre, post immediate and 2month after educational program Pvalue=(< 0.001*). 22. It was found that there was statistically significant relation between sociodemographic characteristics of Studied ICU&CCU nurses and total knowledge score at P=(<0.001*). 23. It was cleared that highly statistically significant deference between total knowledge Pre-Immediate, Post and Post 2 months with age and educational level when p-value =(<0.001*). 24. It was clarified that there was Highly statistically significant deference between total knowledge Pre-Immediate and Post 2 months with Years of experience when p-value=( <0.001*). 25. The current study revealed that there was Highly statistically significant deference between total knowledge Pre-Immediate with Occupational level when p-value =(<0.001). 26. It was noticed that there was statistically significant deference between total knowledge Post 2 months with Occupational level. And total knowledge pre-Immediate Post and Post 2 months with training course when p-value=(<0.05*). The study concluded that the implementation of educational training program had an effect on improving the nurse’s knowledge level of induced diarrhea in ICU and improving their practice level. Post program nurse’s expressed a wide variety of expectations regarding to cope with induced diarrhea in ICU and give full performance for patients care which might have implications for patients satisfaction and delivery of the care. There was a highly significant improvement in the level of knowledge of the studied nurses regarding ICU induced diarrhea, assessment of ICU induced diarrhea, management of ICU induced diarrhea. There was a highly significant improvement in the level of the studied nurses according to their practice regarding intensive care units induced diarrhea among critically ill patients. There were a highly positive significant correlation between total practice level of the studied nurses and their total knowledge level throughout periods of study. The recommendations of the present study are: For critically ill patients 1. Providing clear instruction for patient and caregiver about appropriate health care, perineal care, and skin care. 2. Patient with diarrhea in the intensive care should be informed of the importance of early detection of any complications, how to prevent it and the type of diet that should be taken to avoid diarrhea and prevent dehydration. 2-Recommendation for nurses _Nurses should be encourage to attend workshop and seminars held about induced diarrhea in ICU to be acquainted with the most common complications ,recent advances and skills in the field. _ICU&CCU nurses should be encouraged to facilitate, adept, and develop their skills and knowledge to reflect modern care needs in the following ways: • Acting as a resource, teacher, educationalist, researcher and mentor. • Supporting visually impaired people and promoting their wellbeing. _Ongoing learning protocol must be designed and implemented for nurses at ICU& CCU for the importance of maintaining checkup. 4- Recommendations for further research studies:- • Assessment of problems facing critical care nurse regarding knowledge and practice and their effect on nurses’ performance and satisfaction. • Keeping all material available for all patients and nurses.