الفهرس 
Abstract
AnatomyOnly 14 pages are availabe for public view
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Abstract
Paracentesis is a procedure in which a needle or catheter is inserted into the peritoneal cavity to obtain ascitic fluid for diagnostic or therapeutic purposes. When used correctly, it saves lives and improves health. However, paracentesis carries a potential risk of acute or delayed complications. The present study had four aims: the first: to assess nurses’ knowledge about paracentesis, the second: to design nursing guidelines about paracentesis for nurses, the third: to evaluate effect of designed nursing guidelines on nurses’ knowledge about paracentesis, and the fourth: to evaluate patient’s complications after applying designed nursing guidelines. To fulfill the aims of the study the following research hypothesis were formulated:- 1-The post mean knowledge scores of nurses who will be exposed to a designed nursing guideline will be higher than their pre mean knowledge scores. 2-The complications will be lesser among study group patients compared to those among control group ones. The study was conducted in internal medicine and tropical medicine unit, radiology unit and intermediate care unit of Al-Rajhy Liver Hospital during the period of 6 months (20/9 /2015 to 20/3/2016). To accomplish the aims of this study, data were collected from all nurses working in internal medicine, radiology and intermediate care units and who are participated in the study. In addition to (60) adult patients undergoing paracentesis were included. Those patients were divided equally into two groups, each (30) patients for study and control group. The following three tools were utilized for data collection: Tool (I): An interview questionnaire sheet for nurses: This sheet was developed by the researcher based on literature review – this tool consisted of two parts: Part (1): Socio-demographic data about the nurses such as: name, age, sex, level of education, years of experience, marital status, number of training courses and previous training courses. 60 Part (2): Knowledge about paracentesis included: (definition, indications, contraindications, complications, and nursing role). Tool (II): Designed nursing guidelines: This tool was developed by the researcher based on nurses’ knowledge assessment after reviewing current national and international literature. It included ”definition, indications, contraindications, complications” of paracentesis and nurses’ role. Tool (III): Patient’s complications assessment sheet: This sheet was developed by the researcher based on literature review – this tool consisted of three parts: Part (1): Socio-demographic data about the patients such as: name, age, sex, level of education, residence, occupation, and marital status. Part (2): Severity of liver disease (Child Pugh grade and score), it included: bilirubin, albumin, INR, ascites and encephalopathy. The scores ranged from 5: 15 degree. (37) Part (3): Signs and symptoms of complications of paracentesis. Main findings of the present study were as the follows: Regarding to nurses: 1. The mean age of the studied nurses was (23.77± 1.14). The majority were females (86.7%), having a nursing technical Institute (66.7%). About (26.7%) of them attended training program about paracentesis. Their experiences were less than 5 years. 2. A good improvement in the mean knowledge scores after the implementation of the designed nursing guidelines (18.03±1.83, 22.57±0.77, 7.9±2.01, 13±2.08, 61.5±5.46 respectively). All of nurses (100.0 %) were in satisfactory level of knowledge post implementing of designed nursing guidelines. This means that, the designed nursing guidelines had good effect on all studied nurses regardless their socio- demographic data. 3. There was statistically significant difference in some relations between socio-demographic data and nurse’s knowledge on paracentesis before implementing of designed nursing guidelines. We found that nurse’s knowledge about paracentesis was satisfactory in most items in those had high education level and had attend training courses.
Regarding to patients: 1. The mean age of the patients was (52.5± 11.6) in control group and (53.7± 9.3) in study group. The majorities of patients were male, illiterate, live in rural area and married in both study and control group. 2. Regarding Child Pugh grade; (60.0%) of patient’s pre and post implementing of designed nursing guidelines were class (C). Regarding Child Pugh score; their mean score was (9.6±1.3) in control group and (10.3± 2.0) in study group. 3. Regarding types of paracentesis; the majority of study (66.7%) and control (76.7%) group were therapeutic paracentesis. 4. As regard paracentesis complications, it was found that, the frequency of paracentesis complications after implementation of designed nursing guidelines were lesser than pre implementation of the designed nursing guidelines. As the control group of patients developed paracentesis complications as hypotension and hypovolemia, persistent leakage of ascitic fluid, abdominal bruises or localized infection at the puncture site (within 1 week), bleeding, and hepato renal syndrome pre implementing nursing guidelines (26.7 %, 20.0 %, 16.7 %, 16.7 % and 3.3 % respectively). These complications were developed in study group as follow (6.7 %, 10.0 %, 3.3 %, 13.3 % and 0.0 % respectively).