الفهرس 
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Abstract
Several medical procedures are performed daily in the intensive care unit (ICU). It is evident that complications still occur frequently and are potentially life-threatening. The most common support and monitoring devices used in the ICU include, intravenous catheter, nasogastric tube, endotracheal tube, central venous catheter, hemodialysis double-lumen catheter and chest tube. Procedure complications involving critically ill patients are common and often potentially life-threatening. Decreasing the frequency of procedure-related complications is an important and direct way to improve quality of care. Understanding their incidence, causes, risk factors, diagnosis, management, and prevention are helpful in damage control, and large-volume extravasation may result in severe damage, extensive tissue necrosis, severe skin, and subcutaneous ulceration (Pronovost, 2021).
Aim of Study
This study aims to assess the nurses’ performance regarding invasive procedures at intensive care unit through the following;
• Assess the level of nurse’s knowledge regarding invasive procedures at intensive care unit.
• Assess nurse’s practice regarding invasive procedures at intensive care unit.
• Assess nurse’s regarding malpractice of invasive procedures at intensive care unit.
Research questions:
To achieve the purpose of this study the following questions will be answered:
1- What is the level of nurse’s knowledge regarding invasive procedures at intensive care unit?
2- What is the nurse’s practice regarding invasive procedures at intensive care unit?
3- What is the nurse’s malpractice regarding invasive procedures at intensive care unit?
Research Design:
• A descriptive exploratory design will be used to achieve the aim of this study.
Setting:
• This study was conducted in the intensive care units at El-Matarya Teaching Hospital, affiliated to ministry of health. The setting consists of three intensive care units, the first cardic intensive care unit(cicu) contained 9 beds the second intensive care unit (icu) contained 10 beds, the third,neuro intensive care unit (nicu) contained 11 beds. Researcher selected this setting because of the increasing flow rate of patients as indicated from the statistical records mentioned in the significance of this study.
Subjects:
• Convenience sample of all available nurses(30) nurses who working at intensive care unit at El-Matarya Teaching Hospital, of both genders.
Tools of data collection:
• Data collection was obtained by using the following three tools:
Tool I: nurses self-administered questionnaire (Appendix I)
• This tool was developed by the researcher in an Arabic language to assess nurses’ knowledge about nurses performance regarding invasive procedures in intensive care units based on review of relevant and recent literatures guided by (Linton, 2017; Pamela, 2018; Perry & Potter, 2021).
• It was consisting of the following two parts:
• Part 1: It was concerned with demographic characteristics of nurses under study including; age, gender, qualifications, years of experiences, years of experience regarding invasive procedures in intensive care unit, presence of manual guide/ book regarding invasive procedures in intensive care unit and previous attendance of training courses regarding invasive procedures in intensive care unit.
• Part 2: This part was concerned with assessment of nurses’ knowledge regarding invasive procedures in intensive care unit, it consisted of (38) questions; were multiple choice questionnaire. The items of knowledge include the following topics; general information about invasive procedures (5 items), complications of invasive procedures (4 items), and role of nurse during invasive procedures (29 items)
Tool II: nurses’ practice regarding three invasive procedure observational checklist (Appendix II)
It was concerned with assessment of nurses’ practice regarding invasive procedures in intensive care unit. It was adapted from Hartman & Wittler, (2016); Turner & Bucca, (2020); Lippincott procedures, (2020). Each procedure divided into three domains pre procedure, during procedure and post procedure. It comprised the following procedures including; patient airway suctioning (preparation) (17 steps), airway suctioning procedure (13 steps), oral suctioning (10 steps), nasotracheal suction (12 steps), tracheal/tracheostomy suctioning (2steps), endotracheal tube suctioning (28 steps), airway suctioning document (13 steps).airway suctioning evaluate (4 steps).
Central line inseration, before insertion (17 steps), during insertion (13 steps), after insertion (18 steps).
Caring of patients on endotracheal tube, Assess of respiratory Status (5steps), pre procedure (18 steps), post procedure (4). Endotracheal tube caring, pre nursing care (1 step), nursing care (23 steps), post nursing care (2 steps) and promoting optimal communication with patient (10 steps).
II-Operational design:
It included preparatory phase, content validity and reliability, pilot study and field work.
The preparatory phase:
It included reviewing of related literatures and theoretical knowledge of the various aspects of the study using books, articles, internet, periodicals and magazines to develop tools for data collection.
Content validity and reliability:
Content validity was ascertained by a group of experts (7).The (7) erperts consist of(4) professer medical –surgical nursing ,(2) assist professer of critical care nursing and (1) professer cardio-thorathic-Ainshams university. Their opinion was elicited regarding the format, layout, consistency, accuracy and relevance of the tools. While validity of tools is respectively, this indicated high total internal consistency of the used tool.
Reliability This tables show Alpha Cronbach’s test which used to measure the internal consistency (Reliability of the used tool or instrument) the reliability score of tool was 0.768 for Knowledge, 0.896 for patient airway suction ,0.854 for center line insertion and 0.874 for caring of patient on endotracheal tube. tool respectively, where the minimum reliability coefficient we need is 60%, so is the reliability coefficient for all questions.
Pilot study:
Pilot study was carried out before the actual data collection. The study was done on 10% of the nurses who working at intensive care unit to test the applicability, clarity, and efficiency of the tools items and the time required for fill in. The results of subjects of the pilot study were excluded from the study sample and necessary modifications were done.
The ethical research consideration in this study included the following:
• The research approval was obtained from ethical committee of faculty of nursing - Ain Shams University before starting the study.
• The investigator was clarified objectives of the study to nurses included in the study.
• The investigator assure of maintaining anonymity and confidentiality of subjects’ data.
• Nurses were informed that they are allowed to choose to participate or not in the study and that they have the right to withdraw from the study at any time.
• An verbal consent was taken from the nurses who choose to participate in the study.
III- Administrative design:
An official approval was taken from director of National institute of Urology and Nephrology and director of El-Matrya Teaching Hospital after explaining the aim of the study.
Field work:
1. Data collection started and was completed within 6 months from August 2019 to January 2020.
2. The purpose of the study was simply explained to the nurses who agreed to participate in the study prior to any data collection.
3. The selected setting was visited by the investigator four days per week from Sunday to wednesday during morning and afternoon shifts.
4. Observe practice each nurse for 3times, using observation check list (tool 11) during them work with the patients.
5. The nurses’ self-administered knowledge questionnaire was filled in by the nurses included in the study, during their shifts. It took about 30min to 45min to be fulfilled by each one.
IV- Statistical design:
The obtained data was organized, tabulated, analyzed, represented in tables and graphs required means and standered deviation as well as percentage, suitable statistical testes was used to test the significance of result obtained,recorded data were analyzed using the statistical package for social sciences, version 20.0 (SPSS Inc., Chicago, Illinois, USA). Quantitative data were expressed as mean± standard deviation (SD). Qualitative data were expressed as frequency and percentage.
Results
The results of this study have shown the following:
The mean age of the studied nursing was 24.60, regarding gender 76.7% of them were from female, regarding Academic qualification 70% of them were from nursing institute, regarding years of intensive care experience 53.3% of them were from 5-10 years, as well as training course 63.3% of them were from yes.
Shows that the students response representative in correct answer regarding their level of knowledge about invasive procedures are Which of the following procedures is considered to be an invasive procedure?, When starting an invasive procedure, the nurse must note the following and The most serious complications during the invasive procedures (83.3%, 83.3% and 83.3%) respectively. While students response representative in not correct answer are on the whole, The invasive procedure is defined as, The invasive procedure is used in and Which of these procedures is necessary to save the patient’s life (43.3%, 46.7% and 43.3%) respectively.
There were highly statistically significant relation between level of knowledge of the nursing and their Years of intensive care experience at (p-value <0.001). Also, there were statistically significant relation with their academic qualification and training course (P<0.05). While, there were no significant relation with age and gender at (P>0.05).
There were highly statistically significant relation between level of practice of the nursing and their Years of intensive care experience and training courses at (p-value <0.001). Also, there were statistically significant relation with their academic qualification (P<0.05). While, there were no significant relation with age and gender at (P>0.05).
There were statistically significant relation between level of knowledge about invasive procedure in intensive care unit and their Level of observational checklists regarding invasive procedures (P<0.05).
Conclusion
Based on the study findings, it was concluded that around two third of the studied nurses at intensive care unit had satisfactory total level of knowledge and around half of studied nurses had satisfactory total level of practice regarding invasive procedures.
It was concluded also that, there was statistical significant relation between the studied nurses level of knowledge and their educational level, years of experience and training courses in emergency units, while there were no statistically significant relation between total knowledge level and both age and gender of the studied nurses and marital status. Also the current study found that there was statistical significant relation between the studied nurses’ level of practice and their educational level, years of experience and training courses in emergency units.
Recommendations
The results of this study projected the following recommendations can consist of three parts knowledge recommendation, practice recommendation and research recommendations.
Education recommendations:
• Orientation and periodic in-service training program for nurses in intensive care units department regarding performance of invasive procedures for continuous updating their knowledge.
• Developing a simplified and comprehensive booklet including guidelines about nurses performance regarding invasive procedures in intensive care unit.
Practice recommendations:
• Application the guidelines related to performance of invasive procedures in the emergency department and critical department as policy in the hospitals.
• Continuous evaluation of nurses’ practice is essential to identify their needs about skills regarding invasive procedures in intensive care unit
• On-going and regular in-service educational and training programs to improve practices regarding invasive procedures in intensive care unit.
Research recommendations:
• Further studied is recommended to evaluate the reflection of in-service training program about nurses performance regarding invasive procedures in intensive care unit in emergency department on nurses’ performance and consequently on the patients’ outcome.
• The study should be replicated on large sample and different hospitals setting in order to generalize the result.