الفهرس 
contentOnly 14 pages are availabe for public view
 |  | from | 139 |  |  |
| | | from | 139 | | |
Abstract
Blood transfusion is generally considered a safe process that saves lives and improves the life of patients with a large range of clinical conditions. However, there are a number of risks associated with transfusion (2). Human related errors are common and can occur in every step of the process which may lead to the administration of incompatible transfusions. Moreover incompatibility and/ or disease transmission is also a possible error (7). The nurse plays a professional role in minimizing the risks associated with transfusion (16). Thus the combination of good nurses‟ knowledge and skills in every stage of the transfusion is essential to ensure its safety.
This study aimed to assess nurses‟ knowledge and practice regarding blood transfusion.
Materials This descriptive study was conducted on a convenience sample of 80 nurses in four medical departments (nephrology and renal transplantation, hepatology, hematology and tropical medicine departments) and three surgical departments (hepatobillary, hematemesis and gastrointestinal surgical departments) at Alexandria Main University Hospital.
Two tools were used for data collection:
Tool 1: “Nurses’ knowledge related to blood transfusion questionnaire” this tool was adapted from the adapted form of the routine blood transfusion knowledge questionnaire (RBTKQ) (84) and translated into Arabic it consisted of eight parts:
Part 1.1: Nurses’ demographic characteristics to identify nurses‟ age and gender.
Part 1.2: Nurses’ professional characteristics and training to collect data about nurses‟ qualification, experience, and frequency of performing blood transfusion over the last six months, participation in in-service training programs and the nurse perception of their educational needs.
Part 1.3: Patient preparation to assess nurses‟ knowledge regarding patient preparation prior to blood transfusion.
Part 1.4: Blood bag collection which included structured questions to measure nurses‟ knowledge to ensure collecting the right blood for the right patient, safe transport of blood from blood bank to the ward.
Part 1.5: Pre-transfusion initiation nursing responsibilities which included structured questions to measure nurses‟ knowledge related to activities performed and decisions taken just before starting blood transfusion.
Part 1.6: Post transfusion initiation nursing responsibilities and issues which included structured questions to measure nurses‟ knowledge after starting transfusion till completion.
Part 1.7: Complications related to blood transfusion which included structured questions to measure nurses‟ knowledge related to blood transfusion complications including preventive measures, recognition, causes and immediate interventions.
Part 1.8: Issues related to blood transfusion policies and procedures which included structured questions to measure nurses‟ knowledge about policies and procedures of blood transfusion in hospital.
Tool 2: “Nurses’ practice regarding blood transfusion observational checklist” this was developed by the researcher after review of literature and consisted of five parts:
Part 2.1: Nurses‟ practice before blood bag collection which included items to assess nurses‟ practice in the period before blood bag collection.
Part 2.2: Nurses‟ practice before initiation of blood transfusion which included items to assess nurses‟ practice just before initiation of blood transfusion.
Part 2.3: Nurses‟ practice after initiation of blood transfusion which included items to assess nurses‟ practice during blood transfusion and their practice in relation to early detection and preventive measures of blood transfusion complications.
Part 2.4: Nurses‟ practice after completion of blood transfusion which included items to assess nurses‟ practice after blood transfusion completion.
Part 2.5: Documentation to assess nurses‟ practice in relation to documentation of blood transfusion administration.
Method
This study was conducted using the following steps:
Written approvals were obtained from the blood bank manager to review blood bank records and from Alexandria Main University Hospital responsible authorities to conduct study Both tools were tested for content validity by seven faculty members in the field of medical surgical nursing at Alexandria faculty of nursing and necessary modifications and corrections were done.
Tool 1 was tested for its reliability using Cronbach’s coefficient Alpha test, the reliability coefficient was (0.799) which was acceptable.
A pilot study was conducted on sample of eight nurses in the setting of the study to test clarity, feasibility and applicability of the tool. Necessary modifications were done.
Nurses assigned to patient scheduled for blood transfusion were observed twice for their practice in relation to blood transfusion using tool 2 “Nurses’ practice regarding blood transfusion observational checklist”.
Nurses‟ knowledge regarding blood transfusion was assessed using tool 1 “nurses‟ knowledge related to blood transfusion questionnaire” as self-administered questionnaire was distributed to nurses following their agreement to participate in the study and the tool was answered in the presence of the researcher.
Statistical analysis
After data collection, data was coded and transferred into specially designed formats, so as to be suitable for computer feeding. The suitable statistical programs was utilized (the SPSS version 20.0, Chicago, IL) for data presentation and statistical analysis of results.
Descriptive statistics
Frequency tables and cross tabulations with percentages were used to illustrate the results of categorical data and tested by the Fisher‟s Exact Test. Quantitative data were summarized by the Minimum, Maximum, Median, Arithmetic mean and Standard deviation. Comparison of means was done by Student t-test and One-Way Analysis of Variance (A Monte Carlo probability (MCP). Pearson‟s Correlation Coefficient and t-test of significance were also used to determine the direction and degree of association between quantitative variables.
The Main Results of the Study
It was found that the majority of the nurses was females (98.8%) and had a diploma in general nursing (83.8%). More than one third of them (33.8%) had 10-15 years of experience and about half of them (48.8%) performed blood transfusion more than 12 times during the past 6 months preceding data collection. About three quarter of nurses (73.8%) had reported a need for more training regarding serious hazards and more than half of them (52.5%) about the adverse reactions of blood transfusion.
Nurses‟ overall knowledge was generally unsatisfactory with mean score percentage of (40.8%). Nurses had poor knowledge regarding all knowledge domains with the highest mean score percentage obtained in knowledge of post transfusion initiation nursing activities (53.6%) while the lowest mean score percentage was regarding pre-transfusion initiation nursing activities (29.8%).
There were no statistical significant differences between overall nurses‟ knowledge regarding blood transfusion and their demographic and professional characteristics including age, gender, qualification, experience, number of transfusion over 6 months and previous training.
Nurses had poor knowledge regarding patient preparation prior blood bag collection. The majority of nurses (82.5%), (87.5%) were lacking knowledge regarding reviewing the medical order and the time frame for measuring vital signs respectively. The minority of them (7.5%) knew the aspects of information for patient teaching.
Nurses had poor knowledge regarding blood bag collection. More than sixty percent of nurses lack the information they must possess to collect the right blood for the right patient and the majority of them lack knowledge about basic ABO, Rh principles.
Nurses had poor knowledge regarding pre transfusion initiation nursing activities. The majority of nurses (87.5%), (91.2 %) did not know that patient identification is the most important nursing action before starting the transfusion and that blood transfusion should be started immediately after arrival of blood bag to the ward respectively. All of them were unaware of the steps they must follow to properly identify a patient for transfusion.
Nurses had poor knowledge regarding post transfusion initiation nursing activities. A minority of nurses (3.8%) were aware of the three routine nursing activities that the nurse had to perform just after starting the transfusion. The majority (91.2%) and (97.5%) did not know the accepted rate to start with blood transfusion and the duration within a blood unit must be transfused completely respectively. More than two third of nurses (70%) did not know that patients with heart diseases and severe anemia should be transfused at slow rate. About half of them (47.2%) did not know that it‟s essential to observe patient during first 10-15 min after starting transfusion.
Nurses had poor knowledge regarding complication of blood transfusion. The majority of nurses (93.8%), (81.2%) and (90%) did not know the collective interventions that could minimize the risk of patient experiencing acute transfusion reactions (ATR), the collective signs and symptoms of ATR and the collective actions that should be taken immediately when signs and symptoms of acute hemolytic reaction occurs respectively. The minority of nurses (12.5%) knew the time frame for returning of unused blood. The majority of nurses (88.8%) did not know that patient identification error is the most common cause of transfusion reaction. Moreover about two thirds (67.5%) of nurses responded that it is accepted not to check patient details at bed side if the nurse clearly know patient, patient is unconscious, patient is isolated, or respond with that she / he does not know. The majority of nurses (90%) reported that there are no written policies in their ward for blood administration, 10% reported the presence of it and 62.5% reported they had read this policy.
Nurses had poor practice regarding all practice domains with the highest mean score percentage was regarding practice before blood bag collection (32.0%), while the lowest mean score percentage was regarding documentation (0.0%). Nurses‟ overall practice mean score percentage was (13.0%).
Nurses had poor practice before blood bag collection as the majority of nurses (96.25%) and (93.75%) started blood transfusion without obtaining consent, and without checking the patency of venous access respectively. About two third of nurses (63.75%) did not measure temperature before collection while all of them (100%) did not measure pulse and BP.
Nurses had poor practice before initiation of blood transfusion as all nurses (100%) did not thaw plasma properly. All of nurses did not perform double checked labels with another nurse or physician, did not identify patients properly, did not review the purpose (s) of blood transfusion with patient or ask patient to report any changes he or she may feel during the transfusion, did not empty the urine drainage collection container, or had patient to void before initiation of transfusion and did not disinfect the IV access port with alcohol swab before connection to blood administration set More than three quarter of nurses (78.8%) and (76.2%) did not perform hand hygiene and did not wear disposable gloves before initiation of blood transfusion respectively. The majority of them (87%) did not gently invert the blood component (PRBCs) bag several times. More than half of nurses (57.5%) of nurses use blood transfusion administration set for RBCs transfusion, while 42.5% didn‟t use it and used regular intravenous set for plasma transfusion. All nurses used blood administration set didn‟t fill its chambers with blood appropriately.
Nurses had poor practice after initiation of blood transfusion as more than two third of them (70%) were delayed to start transfusion , while the majority (93.8%) and (96.2%) started transfusion rate faster than 20 drop/min and did not stay with patient for the first 15 min to monitor for signs of transfusion reaction respectively. Also the majority of nurses (93.8%) did not increase (adjust) flow rate despite that patients were not at risk for circulatory overload or occurrence of adverse effects. None of the nurses monitored vital signs (temperature, pulse and BP) at 15 minutes after stating transfusion. Less than half of the nurses (42.5%) administered medication or infusions that known to be incompatible with blood transfusion at the same IV access and all of them didn‟t insert another one for medication administration.
Nurses had poor practice after completion of blood transfusion as more than half of nurses (62.5%) did not clear the IV access after finishing transfusion. None of them (100%) checked vital signs (temperature, pulse and BP) after completion of transfusion.
Nurses had poor practice regarding blood transfusion documentation as all of them didn‟t document any data related to blood transfusion on patient file. There was statistically significant positive moderate correlation between overall nurses‟ knowledge and practice regarding blood transfusion (r=0.65; P<0.001*)
Regarding blood transfusion reaction more than half of reactions (52.9%) occurred with RBCs transfusion and 47.1% occurred with FFP. More than two third of reactions (70.6%) were non -hemolytic febrile reaction, while the minority (17.6%) and (11.8%) were mild allergic reactions and severe allergic reaction respectively. More than half of the reactions (52.9%) occurred after the first 15 min of transfusion, while 47.1% occurred after completion of transfusion.
Nurses had unsatisfactory practice related to blood transfusion reaction as more than half nurses (64.7%) did not keep the IV access open with normal saline 0.9 % solution. About three quarters (76.5%) of them measured temperature, while none of them measured pulse or BP. All of them did not document data related to blood transfusion reaction.
There was statistically significant positive high correlation between overall knowledge and practice to reaction among 17 nurses who witnessed blood transfusion reactions (r=0.84; P<0.001*). There was statistically significant positive high correlation between overall practice and practice to reaction among 17 nurses who witnessed blood transfusion reactions (r=0.82; P<0.001*).
Conclusion
The study concluded nurses‟ knowledge and practice deficits regarding blood transfusion that may compromise the quality of patient care and may result in complications. These unsatisfactory knowledge and poor practice must be corrected rapidly to prevent such complications and provide safe patient care.
Recommendations
On the basis of the finding of the study, the following recommendations are suggested:
Blood transfusion as a main nursing procedure should be emphasized in the curricula of the under graduate courses in high institute and faculty of nursing.
Equip educational settings with materials and supplies that enforce the learning process.
Improve communication between post graduate nurses and educational settings to provide them with necessary updated information.
Establishing hospital blood transfusion committee to control reports of blood transfusion and possible complications.
Written updated policies and guidelines should be available at department level and nurses need to be an active partner in the development of them.
The employment of a transfusion nurse to address transfusion quality concerns that relate to nurses and to be the primary resource for the bedside nurse regarding transfusion practice concerns should be considered.
Blood-warming devices and blood administration sets should be available in all departments where transfusions are administered.
Creation of regular planned, and efficient updated in-service training programs for nurses and periodic follow up of blood transfusion practices are vital.
Establish and implement educational programme regarding blood transfusion.
Effective documentation systems should be developed and enhanced.
Develop an education learning methods and materials on blood transfusion therapy in order to engage the patient in the blood transfusion process.
Explore factors associated with poor quality of nursing care throughout blood transfusion.