الفهرس 
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Abstract
Trauma is the leading cause of death worldwide. Approximately 2/3 of the patients have a chest trauma with varying severity from a simple rib fracture to penetrating injury of the heart or tracheobronchial disruption. Blunt chest trauma is most common with 90% incidence, of which less than 10% require surgical intervention of any kind (AbdelBary, Branscheid & Beshay, 2018) and (Ludwig & Koryllos, 2017).
In 2015, Egypt’s road accidents recorded 14,548 condition resulting in 6,203 deaths, 19,325 injured and 19,116 damaged vehicles, according to a latest report in 2016 by the Central Agency for Public Mobilization and Statistics (Magdi, 2017).
Thoracic injury is a common cause of mortality and major disability, and the leading cause of death from physical trauma after head and spinal cord injury (Huber, Biberthaler, Delhey & Trentzsch, Winter, 2014).
The nurse must realize that the first priority in trauma care is to maintain and support the respiratory system. The nurse must be able to rapidly and effectively perform a primary survey, recognize the clinical manifestations of life-threatening thoracic injuries, and intervene in patient care to help stabilize and maintain the patient’s respiratory function. The nurse must not only be able to asses, but must also be able to intervene technically, rapidly and effectively (Ursic & Curtis , 2010) .
Educational guidelines are used as a mean for nursing continuing education. Regarding the nursing guidelines of the emergency nursing work. It includes: knowledge, skills and competencies to maintain the emergency management of unstable/undiagnosed patient, in order to accommodate the specific physical and psychosocial dynamics of each patient presentation, and to identify the professional strengths, weaknesses, knowledge/skill deficits to support the development of learning objectives and professional goals.
Aim of the Study
This study aimed to evaluate the effect of educational guidelines on nurses’ competence level in caring patients with accidental chest trauma during emergency period through:
1. Assessing of nurses’ competence level in caring of patients with accidental chest trauma during emergency period.
2. Developing and implementing educational guidelines for nurses who caring of patients with accidental chest trauma during emergency period based on need assessment.
3. Evaluating the effect of educational guidelines on nurses’ competence level in caring of patients with accidental chest trauma during emergency period.
Research hypothesis:
The study hypothesized that:
The educational guidelines would have a positive effect on nurses’ competence level in caring of patients with accidental chest trauma during emergency period.
Research design:
A one group quasi-experimental research design, with pre and post-test was utilized in this study.
Setting:
The study was conducted in the emergency department affiliated to Tanta University Emergency Hospital.
Subjects:
A convenience sample of all available nurses (60) who were working in ER department, and caring patients with accidental chest trauma affiliated to Tanta University Emergency Hospital, from both sex, with different age and educational agree to participate in the study.
Tools for data collection:
The study data were collected through using the following two tools:
Tool (1): Nurses’ self-administered questionnaire (Appendix I):
It was developed by the researcher in Arabic language and was filled by the nurses. It included the following two parts:
Part I: Demographic characteristics: This part was used to assess nurses’ demographic characteristics such as age, gender, educational Level, years of experiences, and training courses.
Part II: Nurses’ knowledge questionnaire: This part was used to assess nurses’ knowledge and attitude level in caring of patients with accidental chest trauma during the emergency period.
Tool (2): Nurses’ Observational checklist (Appendix II): It was used to assess nurses’ practice level in caring patients with accidental chest trauma during emergency period. This tool was adopted from (The National Association of Emergency Medical Technicians NAMET, 2014).
Results:
• There were statistically significant differences with satisfactory level among all measured items as; knowledge regarding nursing care of patient with chest trauma during emergency pre and post implementation of the educational guidelines especially, items that related to; the anatomy of chest (91. 7 %). In addition, the total satisfactory level of nurses’ knowledge was improved from 13.3 % to 76.7% post implementation of the educational guidelines.
• There were statistically significant differences among all items of nurses’ level of practice regarding nursing care of patient with chest trauma during the emergency period pre and post implementation of the educational level especially regarding the secondary assessment. As it increased from (0%) level pre the implementation of the educational guidelines to (76.7 %) post its implementation. In addition, the total satisfactory level of nurses’ knowledge was improved from (21.7 % to 83.3%) post the implementation of the educational guidelines.
• There were statistically significant differences in the nurses’ attitude positive regarding care of patient with chest trauma during emergency period as it was improved from (43.3%) pre implementation of the educational program to (86.7%) post its implementation
• There was significant relation between nurses level of education, practice and knowledge post implementation of the educational guidelines as (P value= 0.001 & 0.004) respectively. While there was not significant correlation between nurses’ attitude (pre & post) the implementation of the educational guidelines and their level of education as P> 0.05.
The results of this study concluded that:
• The educational guidelines had a positive effect on nurses’ competence level in caring of patients with accidental chest trauma during emergency period throughout the program phases.
• Based on the research finding, study hypothesis was fulfilled. In addition to, there weren’t significant correlation between nurses’ knowledge, practice, attitude and their gender, age, and years of experiences pre and post implementation of the educational guidelines .While there was significant correlation between nurses’ educational level and their satisfactory level of knowledge post implementation of the educational guidelines.
Recommendations:
The study recommended that:
• Nursing care protocol for patients with accidental chest trauma during emergency period should be available in the ER department.
• Upgrading nurses’ knowledge and practice about nursing care of patients with accidental chest trauma during emergency period should be done periodically through:
• Encouraging nurses to attend national and international congresses, seminars, symposium and workshops regularly about nursing care of patients with accidental chest trauma during emergency period as, it is considered helpful to provide quality care for such group of patients.
• Regular continuous nursing educational program at least every six months should be implemented for enhancing and updating nurses’ knowledge and practice about nursing care offered to patients with accidental chest trauma during emergency period, in order to achieve high quality of care.
• Encouraging nurses caring patients with accidental chest trauma during emergency period to attend regular formal in-service educational programs about chest trauma, triage system, is another option.
• Emergency and critical Nurses involved in patient care should have a valid trauma care certificate like (BLS, ACLS & PHTLS and renew it regularly at least every two years.