الفهرس 
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Abstract
Paracentesis is a procedure in which a needle or catheter is inserted into the peritoneal cavity under sterile conditions in order to; drainage fluid from abdominal cavity in ascites condition, relieve pressure on the abdominal and chest organs, and to study chemical, bacteriological and cellular composition of the peritoneal fluid for the diagnosis of disease (Gil, 2022).
The successful Paracentesis procedure mainly depends on skillful practitioner, highly strict aseptic technique, good preparation and carefully monitoring for the patients throughout the procedure, nurses have a major responsibilities toward patients undergoing Paracentesis because in order to minimize of intraperitoneal fluid without intravascular volume depletion, preventing injury, and inhibit infection of peritoneal cavity (Fahmy et al., 2020).
The patient should be instructed to monitor the bleeding of the area and return if any abnormal bleeding is noted. The patient should also be educated to call with questions or concerns regarding pain, numbness, or discomfort in the area. Prescribe or recommend pain medicines as doctor instruct the patient If stopped taking other medicines before the procedure start them again, take it easy for 24 hours after the procedure, Don’t do any physical activity until recommended. A small bandage over the puncture site, stitches, surgical staples, adhesive tapes, adhesive strips, or surgical glue may be used to close the incision. They also help stop bleeding and speed healing. Take the bandage off in 24 hours. Check the puncture site for the signs of infection (Cynthia, 2021).
Significance of the study:
One of these studies is that conducted in Mansura university hospital by (El-Sayed et al., 2018) and found that 32% of patients had signs and symptoms of hypovolemia after paracentesis because of lack of monitoring, rapid and increased drainage of ascetic fluid, as well as 11% suffering from peritonitis due to breaking down of aseptic technique. Furthermore in our geographical area at Qena hospitals nurses considered that the physician is the only responsible one for performing paracentesis procedure, and there is a lack of awareness that they have a major role in assessing, preparing and monitoring patient from the beginning until finishing, as well as after the procedure. There for this study was conducted to investigate nursing performance regarding abdominal paracentesis in critical ill patients.
Subjects and Methods
Aim of the Study:
This study aimed to assess nurses’ performance regarding abdominal paracentasis procedure for critical ill patients. This aims was achieved through the following:
1. Assessing the nurses’ level of knowledge regarding abdominal paracentesis procedure for critical ill patients.
2. Assessing the nurses’ level of practice regarding abdominal paracentesis procedure for critical ill patients.
3. Assessing the nurses’ attitude regarding abdominal paracentesis procedure for critical ill patients.
Research Questions:
1. What is the nurses’ level of knowledge toward abdominal paracentesis procedure for critical ill patients?
2. What is the nurses’ level of practice toward abdominal paracentesis procedure for critical ill patients?
3. What is the nurses’ attitude toward abdominal paracentesis procedure for critical ill patients?
-Research design:
A descriptive exploratory research design was used in this study.
-Setting:
This study was conducted at medical intensive care unit at the Eldemerdash hospital Affiliated to Ain Shams University.
-Subjects:
All available nurses (51 nurses) working at the previously mentioned setting was included in the study.
Tools for data collection:
Three tools were developed by the investigator to collect data pertinent to this study, these tools are:
Tool (I): Self administrated questionnaire:
It was developed by researcher in simple Arabic language after reviewing the relevant and most recent literatures. It was divided into two parts:
Part I: was concerned with demographic characteristics of nurses under study such as age, gender, educational level, marital status, years of experiences and Attended previous training courses
Part II: was concerned with assessment nurses’ level of knowledge: regarding abdominal paracentesis procedure include (definition, indications, contraindications, complications, role of nurse pre, during, and post abdominal paracentesis procedure
Tool (II): An observational checklist (Appendix 1):
It was used to evaluate nurses’ level of practices toward abdominal paracentesis procedure for critical ill patients.
Tool (III): Nurses’ attitude Likert scale (Appendix 2):
It was used to assess nurses’ attitude toward abdominal paracentesis procedure for critical ill patients. It was developed by the researcher after reviewing the related literatures.
Results:
76.5% of the nurses under study their age ranged between 20 to < 30 with mean and standard deviation of value age were 26.25±4.61. Regarding their gender, 60.8% of the nurses under study were males. Regarding their marital status, 56.9% of studied nurses were not married. Regarding their educational level, 54.9% were graduated from technical institute of nursing.. Regarding their years of experience, 51.0% of them had general years of experience were < 5 years with mean and standard deviation value of age were 4.38±2.52. Concerning attendance of training course regarding abdominal paracentesis procedure, 82.4% of nurses under study attended training course regarding abdominal paracentesis procedure
86.3% of the studied nurses had got unsatisfactory level of total knowledge regarding their Total knowledge about the Abdominal Paracentesis Procedure.
74.5% of the studied nurses had got incompetent in Total Practice Regarding Paracentesis Procedure for Critical Ill Patients.
76.5% of the studied nurses had negative attitude regarding paracentesis procedure for critical ill patients, and about 23.5% of them has a positive attitude.
92.2% of the studied nurses had incompetent performance regarding paracentesis procedure for Critical ill patients, and only 7.8% of them had competent performance.
There are highly correlation between knowledge and total practice and total attitude regarding paracentesis procedure for critical ill patients p-value <0.01 for both.
There are correlation between total practice and total attitude regarding paracentesis procedure for critical ill patients
Conclusion:
In the light of the current study findings, it can be concluded that:
Most of the studied nurses had unsatisfactory level of total knowledge regarding abdominal paracentesis procedure; about three quarters of the studied nurses had unsatisfactory level of total practice. Additionally, less than one quarter of them has a positive attitude and more than three quarters of the studied nurses had negative attitude, regarding paracentesis procedure for critical ill patients.
Recommendations:
Based on the current study finding the following recommendations were proposed:
Recommendations for Nurses:
Providing continuous education based on evidence base for improve nurses’ knowledge regarding abdominal paracentesis procedures.
Planning and establish training programs to improve nurses’ performance regarding abdominal paracentesis procedures.
Hepatology department should be supplied by checklists about all paracentesis procedures.
Replication of the study on a larger probability sample at different geographical locations for data generalizability.
Future studies should target diverse populations in order to test whether similar factor are similarly important for nurses’ performance regarding abdominal paracentesis procedures.