الفهرس 
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Abstract
Standards of care are constitute the first first step of any quality improvement program. Standards are defined as the desired achiveable level of performance related to the criteria against which actual performance is measured or compared. performance standrads should describe what should be done within reasonable condition to achive the expected quality care. Patients requiring hemodialysis should have the opportunity to have a right to be cared for by nurses who are competent in all aspects of hemodialysis treatments, and responsible for the planning, delivery and evaluation of the highest standards of individual care.
The present study was aimed at developing nursing care standards for hemodialysis patients through designing nursing care standards based on literature review, examining the proposed nursing care standards validity based on experts’ viewpoints, determining the importance of standards criteria from point of view of the staff nurses, and determining the developed nursing care standards applicability based on observation of nurses’ performance.
The study was conducted in the hemodialysis units at Al-Agouza Hospital, affiliated to Ministry of Health (MOH). Subjects of the study consisted of 40 staff nurses in hemodialysis units and 30 juries from nursing administration and medical-surgical departments of Faculties of Nursing, as well as internal experts from the selected study setting, as well as from Specialized Medical Center hospitals. Three types of data collection tools were used. The first was an opinionnaire sheet for experts’ assessment of the proposed nursing care standards validity. The second was an Arabic questionnaire sheet indented to assess the opinions of staff nurses of the hemodialysis units regarding the importance of standards. The third was an observation checklist for determining the developed nursing care standards applicability based on observation of their performance.
The findings of the study were as follows:
o The face and content validity of the developed nursing care standard were ascertained through majority agreement of experts upon all items, with the exception of three items which were omitted. There were the resource utilization criterion of evaluating factors related to safety, effectiveness, and cost when two or more practice options would result in the same expected outcome, the assessment criterion of checking indwelling lines appropriateness and anchored , and the post dialysis criterion of reassessing signs and symptoms infection.
• The majority of the nurses have agreed upon most of items of the proposed standards related to different standards; structural, process and outcome.
• Assessment of applicability through observation of the actual performance of the nurses revealed that many areas of the standards were not applied by most nurses such as assessment, diagnosis, outcome identification, planning, and evaluation. Meanwhile, implementation of nursing care in different dialysis phases were performed by most of the nurses, except that related to providing health teaching.
• Assessment of the study settings for structure standards revealed that there were no written mission statement, philosophy, job description or appraisal system for hemodialysis nurses, in addition to lack of training programs and unavailability of reporting forms.
In conclusion, nursing standards for hemodialysis patients were developed and face and content validated. There was also majority consensus upon the importance of standards elements among nurses in hemodialysis units. The developed standards is ready for application in the study setting where it is urgently needed given the absence of protocol for staff nurses/nursing care standards in hemodialysis units of the study hospital.
It is recommended to apply the developed standards in the study setting and also in similar settings in other hospitals. These standards should be revised periodically. Hospital management should be provide the setting with the missing structure elements. In-service education and training is essential for the hemodialysis nurses to ensure efficient applicability of the nursing standards. The developed nursing standards should be used for recruitment, placement, and transfer decisions, as well as in orientation program, and in performance evaluation of jobholders. Further research is proposed to assess the effect of implementation of the nursing standards on nurses’ performance and on the quality of nursing care in hemodialysis units.