Iran Journal of Nursing

fa تأثیر برنامه آموزشی بر عملکرد پرستاران در زمینه ساکشن لوله داخل تراشه نوزادان Effect of Training on the Performance of Nurses in the Endotracheal Suctioning of Neonates پرستاری nursing پژوهشي Research <div style="text-align: justify;">زمینه و هدف: انجام نادرست ساکشن لوله داخل تراشه می‌تواند منجر به خونریزی، ضایعات در مخاط تراشه، عفونت، آتلکتازی، هایپوکسی و در نتیجه پیامدهایی مانند افزایش مرگ و میر، طولانی شدن مدت اقامت و هزینه درمان نوزادان در بیمارستان گردد. از آنجا که پرستاران نقش مهمی در پیشگیری از این عوارض دارند، مطالعه حاضر با هدف تعیین تأثیر برنامه آموزشی برعملکرد پرستاران در زمینه ساکشن لوله داخل تراشه نوزادان صورت گرفته است. روش بررسی: این مطالعه از نوع نیمه تجربی با گروه کنترل است. بدین منظور در سال 1395 تعداد 80 پرستار به روش نمونه‌گیری مستمر از بیمارستان‌های منتخب دانشگاه‌های علوم پزشکی تهران و ایران (دو بیمارستان گروه کنترل و دو بیمارستان گروه مداخله) وارد مطالعه شدند. عملکرد پرستاران قبل از مداخله با استفاده از چک لیست پژوهشگر- ساخته نمره دهی شد. پرسشنامه شامل فرم مشخصات جمعیت شناختی و چک لیست عملکرد با 30 گویه بر اساس گایدلاین‌ها و نظرات متخصصین تدوین گردید. محتوای چک لیست و مطالب محتوای آموزشی توسط تیم متخصصین بررسی و تأیید شد. مشاهدات عملکرد همان پرستاران در طی سه مرحله توسط محقق در نوبت‌های مختلف کاری انجام گرفت و پس از گذشت یک ماه از مداخله، مجدداّ عملکرد همان پرستاران طی سه مرحله مورد ارزیابی همان پژوهشگران قرار گرفت. یافته‌ها: نمره عملکرد پرستاران درگروه مداخله قبل از آموزش (70/8 ± 38/51) و بعد از آموزش (16/4 ± 19/72) اختلاف آماری معنی‌داری را (001/0P <) نشان داد. نتیجه‌گیری کلی: با توجه به این که عملکرد پرستاران در زمینه ساکشن در حد مطلوب نبوده است، آموزش پرستاران و ارایه امکانات کافی بر مبنای گایدلاین‌ها و نظر متخصصین برای ارتقاء کیفیت مراقبت ضروری است. آموزش‌های ضمن خدمت در این زمینه می‌تواند در ارتقای کیفیت خدمات به نوزادان در زمینه ساکشن، نقش بسزایی داشته باشد.</div> <div style="text-align: justify;">Background & Aims: Improper performance of endotracheal tube suctioning can lead to bleeding, lesions in the tracheal mucosa, infection, atelectasis, hypoxia, and consequences such as increased mortality, prolonged hospital stay and neonatal treatment costs in the hospital. Given the important role of nurses in the prevention of these consequences, the present study aimed to determine the effect of educational programs of intravenous endotracheal intubation in newborn care on the performance of nurses. Materials & Methods: This quasi-experimental research was performed with a control group and included 80 nurses selected by a continuous sampling method from selected hospitals of Tehran and Iran Universities of Medical Sciences (two hospitals as a control group and two hospitals as intervention group) in 2016. The inclusion criteria were a BSc or higher degree, the experience of direct clinical work with newborns, and a minimum of three months of working in neonatal intensive care units (NICUs). On the other hand, exclusion criteria were absent from more than one educational session and unwillingness to participate in the study. Nurses’ performance was scored before the intervention using a researcher-made checklist. The questionnaire included a demographic characteristics form and a performance checklist developed based on guidelines and opinions of specialists. The content of the checklist and educational content were evaluated and confirmed by a team of specialists. The checklist included 30 items prepared and developed based on various stages of intravenous endotracheal intubation in newborns, including washing the hands, different stages of preparing the tools before the procedure, proper suction pressure, and other cares during suctions and the following steps. The reliability of the checklist was confirmed using reliability interrater (r=0.93). In addition, the content validity of the checklist was assessed and confirmed by all committee members. The results obtained from the checklist before the intervention were evaluated in the research team session and attempts were made to design an educational program proportional to the weaknesses in nurses' performance and finding a solution while considering the most problems in care during intravenous endotracheal intubation in newborns. The assessment was carried out by observing and recording the performance of each nurse regarding the items of the checklist in three stages and in the morning, evening, and night shifts. The checklists were completed with the awareness of nurses, meaning that the researcher accompanied nurses during suction. The questionnaire was completed by the researcher at the end of the suction procedure. The scale of response to the tool was yes and no. At each stage, if the correct performance is done, one point is given to the nurse and if it is not done, zero points are given to the nurse. Therefore, the score range of each item was 0-3, and the total score included the mean of all three scores obtained from three times of observing the performance of each nurse during the suction procedure. In this study, to evaluate the performance score of each nurse, the scores obtained from the performance were changed from 0 to 100. Following completing the pretest, the education program of nurses, the content of which along with the checklist was previously confirmed by the specialized committee, was held for small five-six-member groups. In total, four one-hour educational sessions were held in the education room of each ward. Educational content was presented using the methods of lectures, group discussions, PowerPoint presentations, and movie screening. A summary of previous sessions was presented at the beginning of each session before teaching new content, and clinical education was provided by the researcher by presenting a full explanation of the suctioning process in the last session practically. Afterwards, educational packages, which included the educational content of the sessions, were given to participants in the form of educational booklets. The content of these booklets was prepared by the researchers based on the guidelines and instructions of the ministry of health. In the end, the booklets were provided to nurses following its confirmation by the specialized committee. In addition, a poster was installed on the wall of the part of the ward that was visible to the nurses showing various stages of intravenous endotracheal intubation in newborns. After one month, the performance of nurses in the intervention and control groups was evaluated in three stages and the morning, evening, and night shifts using the same checklists and researcher. In the end, data analysis was performed in SPSS version 16 using Kolmogorov-Smirnov test (to evaluate the normal distribution of the data), as well as descriptive statistics (frequency, frequency percentage, mean and standard deviation), to describe the demographic characteristics of the participants, and inferential statistics (Chi-square, independent t-test, Fisher’s exact test, and analysis of variance). Notably, a P-value of 0.05 was considered statistically significant. Results: In this study, the mean and standard deviation of nurses in the control and intervention groups was 32.35 ± 5.32 years and 32 ± 6.21 years, respectively. In terms of the level of education, most nurses of the two groups had a BSc, and the mean and standard deviation of the work history of nurses was reported to be 8.75±5.11 and 8.18 ± 5.12 in the intervention and control groups, respectively. Moreover, the mean NICU work experiences in the control and intervention groups were 5.38 ± 3.33 and 6.3 ± 4.85, respectively. Furthermore, a significant difference was observed in the performance score of nurses in the intervention group before (51.38 ± 8.70) and after (72.19 ± 4.16) the intervention (P<0.001). Conclusion: According to the results of the study, the performance score of nurses regarding the intravenous endotracheal intubation in newborns improved after the educational intervention. Given the unfavorable performance of nurses in this area, it is crucial to train these individuals and provide sufficient facilities based on guidelines and under the supervision of specialists to improve care quality. In addition, in-service training can help improve neonatal service quality in the suction field. </div> پرستاران, نوزادان, عملکرد, آموزش, ساکشن کردن Nurses, Neonate, Performance, Education, Suctioning 43 53 http://ijn.iums.ac.ir/browse.php?a_code=A-10-251-2&slc_lang=fa&sid=1 S Khanjari صدیقه خنجری 10800319475328460025084 10800319475328460025084 No Associate Professor, Nursing Care Research Center, Department of Pediatrics and Neonatal Intensive Care, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran دانشیار، مرکز تحقیقات مراقبت‌های پرستاری، گروه پرستاری کودکان و مراقبت‌های ویژه نوزادان دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی ایران، تهران ایران N Bayati نسرین بیاتی 10800319475328460025085 10800319475328460025085 Yes MS in Neonatal Intensive Care, Department of Pediatrics and Neonatal Intensive Care, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran (*Corresponding author) Tel: +989395574968 Email: nasrin_b60@yahoo.com.tums.ac.ir . دانشجوی کارشناس ارشد مراقبت‌های ویژه نوزادان، گروه پرستاری کودکان و مراقبت‌های ویژه نوزادان، دانشگاه علوم پزشکی ایران، تهران، ایران (*نویسنده مسئول) شماره تماس: 09395574968 E-Mail: nasrin_b60@yahoo.com H Haghani حمید حقانی 10800319475328460025086 10800319475328460025086 No Lecturer, Department of Biostatistics, School of Health, Iran University of Medical Sciences, Tehran, Iran مربی، گروه آمار زیستی، دانشکده بهداشت، دانشگاه علوم پزشکی ایران، تهران، ایران