الفهرس 
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Abstract
Radiofrequency Ablation (RFA) is one of the most effective of the new minimally invasive procedure -particularly for people who cannot be treated surgically. It aims to; complete eradication of tumor, controlling local tumor growth, preventing recurrence, palliating symptoms and extending survival duration for patients with certain tumors.
Nurses have an effective role in the pre, intra, and post procedural care of patients undergoing RFA. The nurse helps facilitate care, improves patient care, collaborates with medical and nursing staff, and patients and significant others. The outcomes of these activities include; fewer delays; earlier discharge; decrease readmission, effective, efficient, and consistent care; and improved communication.
Aim of the study
This present study was aiming to assess the effect of nursing instructions on patient with liver tumor undergoing radiofrequency ablation through:
1. Assessing patient’s needs pre and post procedure.
2. Assessing nurses level of (knowledge & performance) regarding radiofrequency ablation procedure.
3. Developing and implementing nursing instructions regarding radiofrequency ablation based on needs assessment.
4. Evaluating the effect of nursing instructions on the level of; A)patient’s satisfaction.
B)Nurses’ knowledge and performance.
Research hypothesis:
Nursing instructions for patients with liver tumor undergoing radiofrequency ablation will significantly increase their satisfaction as well as the nurses’ level of knowledge and performance post the implementation of nursing instructions versus pre assessment.
Subjects and Methods:
Design:
A quasi-experimental research design was used in the study.
Setting:
This study was conducted at the Radiology Department in Ain Shams University Specialized Hospital, affiliated to Ain Shams University.
B. Subject
The subjects were divided into 2 groups (patients & nurses) as follows:
1- Patients: One hundred patients with liver tumor undergoing radiofrequency ablation, who were admitted to the Radiology Department of the previously mentioned hospital were recruited for the study sample. Patients’ group were divided into 2 equal homogeneous groups randomly as study group and control group. The number of this sample was defined according to statistical analysis for admitted patients to Ain Shams University Specialized Hospital in the year, 2010-2011, they were 760 patients.
2- The nurses:
The nursesˋ group was composed of all available (15) nurses working at the Radiology Department they were included in the study, from both sexes, different age groups, and different levels of qualification.
Tools for data collection:
Tools used to accomplish the aims of this study included:
I. Patient Assessment Questionnaire Sheet:(Appendix I)
1. Patient Assessment Questionnaire Sheet.
2. Nurses Questionnaire Sheet.
I. Patient Assessment Questionnaire Sheet:(Appendix I)
This sheet was divided into four parts:
A. Demographic data, which include of age, sex, level of education, marital status, residence, working, living with others. Past medical history data include other diagnosis, duration of disease, other disease, if had undergo previous radiofrequency session and cause of radiofrequency ablation procedure.
B. Patient’s Level of Satisfaction scale; This tool was used to assess patient’s level of satisfaction in both groups (study & control) pre/ post nursing instructions through using standardized scale (patient satisfaction sheet). This tool adopted from Eng (2006), it was used to measure four dimensions of patient satisfaction with quality nursing care; technical competence, information giving, assurance and empathy. It has been translated into Arabic language and retranslated again into English. It consisted of 29 items, and a total score ranging from 29-87.
C. Patient’s Level of Anxiety scale: this was used to assess patient’s level of anxiety for both groups (study & control) pre and post nursing instructions using Hamilton Anxiety Rating Scale which developed by Hamilton (1960), it was designed to measure the severity of anxiety symptoms. The scale consists of 14 items, each defined by a series of symptoms, to measure both psychic anxiety (mental agitation and psychological distress) and somatic anxiety (physical complaints related to anxiety) and it has been translated into Arabic language and retranslated again into English.
D. Physical Assessment: it was used to assess the expected patient’s complications pre/post nursing instructions as regarding radiofrequency ablation procedure in both groups (study & control groups). It was adopted by the researcher based on Albert & Nemeck (2006), Haung (2007), Correctti (2010) and Lala (2010). These complications may be related to either imaging-guided electrode placement (e.g., bleeding, infection, tumor seeding, pneumothorax) or thermal therapy (e.g., Injury to diaphragm, Injury to gastrointestinal tract, postablation syndrome, grounding pad burns), or complications related medications used for analgesia and sedation (e.g, allergic reactions, respiratory depression) and complications related specifically to liver ablation (e.g, hepatic abscess, portal vein thrombosis). This sheet was developed by the researcher in English language.
II- Nurse’s Questionnaire Sheet (Appendix II): This sheet was designed by the researcher to assess the following:
A. Demographic data: They include, age, sex, level of education, years of experience in radiofrequency ablation and previous training about radiofrequency ablation procedure.
B. Level of Knowledge: it was used to assess nurses’ knowledge regarding radiofrequency ablation procedure pre/post nursing instructions and it was developed by the researcher after reviewing the related literature Locklin and Wood (2005), Ball (2006), National Institute of Health Clinical Center (2010), and American Cancer Society (2012). It includes the following items definition of RFA, types, indications, contraindications, complications, and role of nurse in RFA pre, during and post, alternatives for RFA to treat liver tumor, characters of patient who can undergo RFA.
Evaluation was considered as follow:
Unsatisfactory score ≤70%
Satisfactory score >70%.
C. Observational Checklist: It was used to assess the nurses’ level of performance during three phases of radiofrequency ablation procedure pre/post nursing instructions and it was developed by researcher based on Locklin and Wood (2005), Miller (2009), Nicholson (2009), National Institute of Health Clinical Center (2010), Strangio (2010), University of Connecticut Health Center (2010).
Evaluation was considered as follows:
Competent performance ≥80%
Incompetent performance < 80%.
Nursing Instructions: It is a group of items aiming to enhance nurses’ level of knowledge and performance in caring for patients with liver tumor undergoing radiofrequency ablation. Its impact was evaluated on patient outcome as: level of patient anxiety and satisfaction post intervention comparing to prior assessment. These instructions were developed by the researcher after reviewing the related literature. The researcher illustrated these nursing instructions and given booklet of instructions to all nurses included in study and given.
The field work:
Data collection for this study was carried out in the period from beginning of September 2012 to end of March 2013, during morning and afternoon shifts at the Radiology Department in Ain Shams University Specialized Hospital, four days/weekly. The purpose of the study was explained for nurses prior data collection. The researcher assured them the data collected and information will be treated confidentially.
The results of the study showed that:
• There were no statistically significant differences between both groups of patients (study & control) regarding to age, sex, marital status, educational level, and residence.
• There were highly statistically significant differences between the level of patients’ anxiety for both groups (study & control) pre/post nursing instructions regarding to anxious mood, tension, insomnia, intellectual, depressed mood, respiratory symptoms, gastro-intestinal symptoms, autonomic symptoms and behavior at interview.
• Satisfactory level of patients’ satisfaction was detected post nursing instructions more than pre nursing instructions, where satisfactory levels of patients’ satisfaction related to technical competence, information giving, assurance, and empathy increased.
• There was no statistically significant difference between the study and control groups regarding to complications related to thermal therapy.
• There was a statistically significant difference between the study and control groups, where 78% of control group had complications from procedure while they represented 56% of study group.
• Two thirds of nurses who shared in the study were under 30 years old, the majority of nurses included in the study were female, three quarters of nurses had diploma in nursing qualification, and all of the nurses had no training program before working in the Radiology Department.
• There was a highly statistically significant difference between levels of nurses` knowledge pre/post nursing instructions.
• Results showed positive impact of nursing instructions on the level of studied nurses’ performance, where there was highly statistically significant difference between the level of studied nurses pre/post nursing instructions
• Results revealed that there was, a positive correlation between the level of nurses’ knowledge pre nursing instructions and the level of nurses’ performance pre nursing instructions.
• There was apositive correlation between level of nurses performance pre nursing instructions and level of nurses performance post nursing instructions.
Conclusion:
Nursing instruction had a positive effect on nurses’ knowledge and performance. As well, they improved patients’ satisfaction, and decreased patients’ anxiety and complications.
Recommendations :-
The main recommendation can be summarized as follows:-
An orientation program should be available for newly appointed nurses and those assigned to care for patients undergoing RFA to improve their knowledge and gain competent skills in this field.
Measurement of patient satisfaction about nursing care and service received should be done in order to improve and develop quality of care health service.
Patient guidance and answer all explanation should be given to patient about procedure to decrease anxiety of patient.
Model discharge plan for patient undergoing radiofrequency ablation for liver tumor, which including allowed activities, diet, signs and symptoms of complications, site of referral when any complication and so on.