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العنوان
Assessment of Nurses’ Knowledge and Practice Regarding Implanted Port-A-Catheter Care for Patients Undergoing Chemotherapy /
المؤلف
AL-Betar, Hadeer Hassan Mohamed Mahmoud.
هيئة الاعداد
باحث / هدير حسن محمد محمود البيطار
مشرف / ميرفت عبد الفتاح محمد
مشرف / ثريا محمد عبدالعزيز
مشرف / نرجس محمد صيام
مناقش / زيزي فكري محمد عبد الرسول
مناقش / آمنة يحيى سعد عيد
الموضوع
Medical Surgical Nursing.
تاريخ النشر
2023.
عدد الصفحات
90 p. :
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
التمريض الطبية والجراحية
تاريخ الإجازة
1/1/2023
مكان الإجازة
جامعة الاسكندريه - كلية التمريض - Medical Surgical Nursing
الفهرس
Only 14 pages are availabe for public view

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Abstract

Cancer chemotherapy is one of the most commonly prescribed cancer treatment modalities, which is mainly directed to the use of chemical agents or drugs that destroy cancer cells in the cell cycle, and inhibit its growth and spread.
Modern chemotherapeutic management depends upon repeated and safe access to the venous system for the delivery of drugs. Hence, Peripheral veins are rapidly destroyed by repeated venipuncture and by long term chemotherapy; the long-term venous access devices (VADs) have helped to overcome this issue.
The Port-A-Catheter system is considered one of the frequently employed types of venous access system; which can be used to deliver chemotherapy, blood products, antibiotics, and IV fluids directly into the bloodstream. This catheter needs specialized care including: flushing, dressing, change of needle and minimizing the risk of contamination by scrubbing the access port with an appropriate antisepticsolution. Therefore the oncology nurses who care for patients taking chemotherapy through Port-A- Catheter must have a satisfactory level of knowledge and practices to manage and prevent complications.
Also, they should follow updates in guidelines for preventing catheter-related infections which recommend hand hygiene, sterile personnel protection equipment, chlorhexidine for skin preparation, catheter site dressing regimens, and specific sites for catheter placement, and daily checks for signs of infection. Oncology nursing is considered a specialized area of nursing practices, focusing on the needs of oncology patients and their families across the lifespan.
Since the number of patients with a port-A-catheter in hospitals is increasing; thus, it is necessary for the nurses who work with this port device to acquire and update their technical scientific base of knowledge and improve their practices in an articulated and standardized way.
The aim of this study was
To assess nurses’ knowledge and practice regarding implanted Port¬-A-Catheter care for patients undergoing chemotherapy.
Research questions:
• What is the nurses’ knowledge regarding implanted port-A-Catheter care for patients undergoing chemotherapy?
• What are the nurses’ practices regarding implanted port-A-Catheter care for patients undergoing chemotherapy?
Research design:
A descriptive research design was utilized to accomplish this study.
Setting:
This study was conducted at In- patient Medical Unitof the Damanhur Oncology Center, affiliated to Ministry of Health and Population at El-Beheira Governorate, Egypt.

Subjects:
All available oncology nurses (A convenience sample) involved in providing direct care for implanted port-A-catheter among patients undergoing chemotherapy were included in the present study. They comprised 60 nurses who were mutually working in the Inpatient and Outpatient Units (in the form of rotating); at the previous mentioned setting.
Tool of the study:
To fulfill the aim of the study, two tools were used for data collection.
Tool I: “Oncology Nurses’ Knowledge Structured Interview Questionnaire”
Structured questionnaire was developed by the researcher in English language based on a review of relevant recent literature to assess nurses’ knowledge regarding implanted port -A-Catheter care for patients undergoing chemotherapy and translated into Arabic language. It consisted of two parts as the following:
Part I: Oncology Nurses’ Socio-demographic characteristics:
This part of the questionnaire was designed to collect socio demographic characteristics of the studied nurses including: age, gender, marital status, level of education, years of experience in oncology unit, number of daily working hours, average number of assigned patients caring per day, as well as attendance of pre- or on the job- service training program(s), related to implanted Port-A-Catheter care for patients undergoing chemotherapy.
Part II: Nurses’ knowledge regarding implanted port ¬-A-Catheter care for patients undergoing Chemotherapy “Structured Interview Questionnaire”.
This part was concerned with assessing nurses’ knowledge about implanted port -A-Catheter care for patients undergoing chemotherapy. It included thirty eight multiple choice questions. The questions covered the following outlines:
1. General knowledge about implanted Port-A-Catheter.
2. Port¬-A-Catheter connection and disconnection nursing care.
3. Port¬-A-Catheter exit site care.
4. Port-A-Catheter removal.
5. Patient documentation.
6. Port¬-A-Catheter Catheter infection and complications.
Tool II: “Oncology Nurses’ Practices regarding Implanted Port¬-A-Catheter Care for Patients undergoing Chemotherapy Observational Checklist”.
This tool was developed by the researcher based on a review of relevant recent literature. It was utilized to assess oncology nurse’s practices about implanted port -A-catheter care for patients undergoing chemotherapy. It consisted of “One hundred and seventeen” items of nursing practices on implanted port -A-catheter care whichincluded four parts as follows:
1. Nursing care for Port-A-Catheter before connections to chemotherapy.
2. Nursing care for Port-A-Catheter during connections to chemotherapy.
3. Nursing care for Port-A-Catheter disconnection/ De-accessing.
4. Nursing care for Port-A-Catheter exit site.
Method:
This study was accomplished as follow:
● Approval from the Research Ethics Committee of Faculty of Nursing, Alexandria University; has been obtained before conducting the study.
● An official permission from the Faculty of Nursing, Alexandria University has been obtained and directed to the responsible authorities of the previously mentioned setting; to take their permission to conduct the study after explaining the aim of the study.
● An official written permission for data collection was obtained from the directors of the selected setting after explanation of the aim of the study.
● The two studytools were developed by the researcher after reviewing of recent relevant literatures.
• The two study tools were submitted to a jury of five experts in the field of Medical-Surgical Nursing, Faculty of Nursing, Alexandria University, and two of the academic staff at the Oncology Department, Damanhur Oncology Center; to assure the content validity, completeness, appropriateness, clarity of items and the necessary modifications were done.
• Also, the tools were tested for their reliability using Alpha Cronbach’s statistical test. Results illustrated that both tools were reliable. where reliability was 0.721, and 0.708 regarding tool I and II; respectively
• A Pilot study was carried out on six nurses who fulfilling the inclusion criteria, and were working at the Outpatient Chemotherapy Clinics in the previously mentioned setting; to ascertain the clarity, feasibility and applicability of the developed tools. The necessary modifications were done accordingly. These nurses who were included in the pilot study were excluded from the study subjects.
• All nurses were asked to fill the questionnaire(Tool I)through face to face interviewing each nurse individually once by the researcher at the previously mentioned setting, during morning shifts for 30-45 minutes after explaining the study aim to assess their knowledge regarding implanted Port-A-Catheter care for patients undergoing chemotherapy.
• Every nurse was observed(Tool II) individually twice by the researcher during their implementation ofPort-A-Catheter carebefore connections, during connections to chemotherapy, catheter disconnection/ de-accessing as well as exit site care throughout the morning and afternoon shifts. The average mean of the two observations was calculated.
• The data were collected throughout a period of four months from the beginning of January 2022 up to the end of April 2022.
Statistical analysis of the data:
After completion of data collection, statistical tests were carried out using SPSS, version 20.0for both data presentation and statistical analysis of the result. The number and percentage were used for describing and summarizing qualitative data. Mean and the standard deviation were used to present the quantitative data.

The main results of the study:
• The results revealed that two thirds (66.7%) of studied nurses were females, more than half (60%) of them were in the age group of 25 to less than 30 years, and nearly half (51.7%) of them hold technical institute of nursing.
• The minor proportion (20%) of studied nurses attended training programs related to implanted port-A-Catheter care among patients undergoing chemotherapy.
• More than half (56.7%) of the studied nurses had fair level of overall knowledge regarding implanted Port -A-Catheter care for patients undergoing chemotherapy.
• More than three quarters (78.3) of studied nurses didn’t check written physician for chemotherapy drug (name, dose, time, route, frequency, infusion rate of chemotherapy).
• All (100%) of studied nurses didn’t checked the sterility and expire date of equipment and supplies.
• Also, all (100%) of them didn’t wear clean gloves ,didn’t perform hand hygiene before and after accessing the port-A-Catheter, didn’t disinfect the skin around the area of needle insertion with antiseptic solution, and allow the antiseptic solution to dry on the skin.
• All (100%) of them inserted the non-coring needle at 90- degree into the center of the portal chamber, flushed the tubing and clamped, applied sterile transparent dressing over the needle and extension tubing to maintain sterility and secure in place, disposed of contaminated waste in red bag, and discarded needle into a safety needle box.
• All (100%) of them flushing the catheter with 5-mL of heparinized saline before de-accessing it.
• Almost (95%, 96.7%); respectively of the studied nurses had poor level of practice regarding nursing care for Port-A-Catheter before and during connections to chemotherapy.
• More than two thirds (70%) of them had poor level of practice regarding nursing care for Port-A-Catheter disconnection/ de-accessing.
• All (100%) of them had poor level ofpractice regardingPort-A-Catheter exit site care
• Almostof the studied nurses (96.7%) had poor level of practice regarding implanted Port-A-Catheter care for patients undergoing chemotherapy.
• There were statistically significant differences between nurses’ overall knowledge, gender, age, level of education,years of experience in oncology unit, number of daily working hours, and previous attendance of training programs.
• There were statistically significant differences between all items of nurses’ socio demographic characteristics and their overall practice except (marital status, and gender).
• There was a positive statistically significant correlation between nurses’ overall knowledge and overall practices regarding implanted port-A-Catheter care for patients undergoing chemotherapy.

The main recommendations based on the findings of the current study were as the following:
Recommendations for nurses:
• Newly employed nurses in oncology and chemotherapeutic units are required to successfully complete a test of basic knowledge and skills before assuming independent responsibility for patient care.
• Pre-in-service and in-service education programs for nurses to update their knowledge and practices concerning implanted Port -A-Catheter care.
• Regular staff scheduled conferences and workshops must be conducted to keep pace with the rapidly growing wealth of knowledge and practice that necessary for proper nursing service.
Recommendations for administrators:
• The hospital policy, rules and regulations should be available at each hospital unit, and every nurse should be clearly oriented with them, concerning the implanted Port -A-Catheter care, how to handle and how to avoid patient’s complications.
• Orientation program should be conducted for all newly oncology nurses.
• Adequate facilities and supplies should be available in the oncology and chemotherapy units with provision of Arabic articles, pamphlets and books about how to accessing, de-accessing and flushing of Port -A-Catheter.
Recommendations for further studies:
• Replicate the study on a large probability sampling and on different geographical settings for generalization of the result.
• Explore factors that affect nurses’ knowledge and practices regarding implanted Port-A-Catheter care.
• Study the impact of implementing a training program on oncology nurses’ knowledge and practices regarding implanted Port -A-Catheter for patients undergoing chemotherapy.