الفهرس 
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Abstract
Benign prostatic hyperplasia (B.P.H) is the most common urological problem of ageing men resulting from an increase in the number of prostate cell extending up to bladder, obstructing the flow of urine and prevent exiting out of bladder opening. Transurethral resection of the prostate (TURP) is an excellent method for treatment of patients with symptomatic BPH, who actually need surgery. It remains the gold standard therapy for advanced cases with LUTS resulting from BPE and BOO. This endoscopic-guided procedure involves removal of the inner portion of the prostate by electro cautery. At the end of the procedure, a urinary catheter is inserted into the bladder and continuous irrigation performed until the effluent is clear.
Many complications can occur during and after the TURP surgery. One of the most dangerous complication is hemorrhage can lead to significant morbidity and mortality. Therefore a keenful observation is necessary during the post-operative care of TURP in BPH patient to prevent further complications and minimize the rate of infection. Adequate care post operatively is beneficial for speedy and healthy recovery.
The nursing role is considered as a cruical role for patients during pre and post-operative period, preparing for discharge and patient education for prevention of complications and to assure post-operative outcome.
The aim of the study was:
To assess nursing practices provided for patients undergoing transurethral resection of prostate and propose guideline instruction for patients undergoing transurethral resection of prostate.
Setting:
This study was conducted at Urological department (male units) at Alexandria Main University Hospital (MUH), University Student’s Hospital and Urology Department in Karmoz Workers Hospital. A convenience sample of 60 nurses who cared for patients undergoing transurethral resection of prostate.
Tool of the study:
Nurses’ practices for patients undergoing transurethral resection of prostate (TURP) observational checklist, in addition nurses’ socio demographic data tool was developed by the researcher to assess nursing practices provided for patients undergoing transurethral resection of prostate. It was divided into two parts:
Part 1: Assessment of pre-operative nursing practices :This part was divided into three sections
A) Routine admission nursing care.
B) Pre-operative physical care.
C) Pre-operative nursing instructions.
Part 2: Assessment of post-operative nursing practices : This part was divided into four sections
I) Immediate post-operative nursing care.
II) Routine post-operative nursing care.
III) Observation and reporting post-operative abnormalities.
IV) Post-operative teaching, long term nursing care and preparation for discharge.
Development of the study tool:
The study tool was developed by the researcher after extensive reviewing of relevant literatures. The content of constructed tool was revised by a jury 7 experts in the field of Medical Surgical Nursing Department of the faculty of nursing at Alexandria University to test content validity, relevance, completeness and clarity. Comments and suggestions of jury were considered and the tool was modified accordingly.
Reliability:
The reliability of the developed tool was tested using Alpha Cronbach’s statistical test. The reliability coefficient was (0.868).
A pilot study:
A pilot study was conducted on 6 nurses to test clarity, feasibility, and applicability of the study tool, and then necessary modification were done. Nurses included in the pilot study were excluded from the study.
Data collection:
After securing the administrative approval, data collection was started and continued for a period of 8 months from September 2016 to April 2017. A convenience of 60 nurses were observed individually by the researcher at least two times on two shifts (morning and afternoon) using developed nurses’ observational checklist for practices provided for patients undergoing TURP to collect the needed data.
The main results of the study showed that:
• All available nurses were female, the majority of the studied nurses (38.4%) were in the age group (25 > 30) years and the majority of them (43.4%) had equal or more than ten years of experience.
• The majority of studied nurses (45%) had secondary nursing education, and all of them didn’t attend training sessions about nursing practices that provided for patients undergoing TURP.
• More than half of the studied nurses (68.3%) and (71.7%) gained poor practice score on 1st and 2nd observations respectively, in relation to assessment of providing total preoperative nursing practices for patients undergoing TURP surgery.
• Half and nearly half of the studied nurses (50% & 48.3%) gained good practice score related to collecting the necessary data about patient history.
• All of the studied nurses (100%) gained poor practice score regarding obtaining signs and symptoms by using international prostate symptom score on 1st and 2nd observations.
• All the studied nurses (100%) gained poor practice score on two observations regarding pre-operative nursing instruction about post-operative exercises.
• Nearly all the studied nurses gained good practice score (96.7% & 91.7%) on 1st and 2nd observations respectively concerning assessment of providing immediate postoperative nursing practices.
• More than half of the studied nurses (76.7% & 78.3%) gained fair practice score on 1st and 2nd observations respectively regarding providing of routine post-operative nursing practices.
• More than half of the studied nurses gained good practice score related to maintaining of sterile closed drainage system for post-operative catheter care in 1st and 2nd observations.
• All and nearly all of the studied nurses (100% & 98.3%) gained good practice score as regards carrying out catheter irrigation with continuous method
• More than half of the studied nurses gained good practice score (83.3% & 86.7%) on 1st and 2nd observations respectively regarding using open method of catheter care.
• More than half of the studied nurses (61.7%) gained fair score on 1st and 2nd observations, regarding removing the indwelling catheter and (85% & 83.3%) in 1st and 2nd observations respectively toward providing nursing practices after catheter removal.
• Nearly all of the studied nurses (98.3%) provided poor practice score on both 1st and 2nd observations according to assessment of providing postoperative teaching and nursing guidelines instructions for patients undergoing TURP.
• More than half of the studied nurses gained good practice score (73.3% & 80%) on 1st and 2nd observations respectively as regards assessment of providing total post-operative nursing practices.
• More than half of the studied nurses (66.7%) gained poor practice score on both 1st and 2nd observations related to overall nursing practices provided for patients undergoing TURP.
• There was statistically positive correlation between overall studied nurses practices scores and their working area (P =0.027*) (x2= 7.078*), marital status (P=0.050*) (X2=3.851*), and level of education (P =0.001*) (X2=14.215*).
• There was no statistically significance correlation between overall studied nurses practices scores and age (P=0.208) (X2=6.894), years of experience (P=0.280) (X2=5.030) and working shift (P=0.273) (X2=1.200).
Conclusion:
Based on the study findings, it can be concluded that, more than half of the studied nurses gained poor practice score related to nursing practices that provided for patients undergoing TURP.
The following are the main suggested recommendations based on the findings of the present study:
- For nurses:
• Nurses working in urological wards should update their knowledge through participating in educational programs, attending seminars, workshops, lectures about standards of nursing care for patients undergoing TURP surgery.
• Procedural manual about urinary catheter and its irrigation care for patients undergoing TURP surgery should be available for all nurses working in urological department.
• Adequate supervision from nursing supervisor for urological nurses’ practices with feedbacks is mandatory.
• Periodic evaluation of nursing practices by nursing supervisor for enhancing level of practices.
• Develop program about patients’ discharge to ensure safe life after hospitalization and establish teaching plan unit for patients undergoing TURP surgery.
• Development of manual guidelines for nurses about caring with patients undergoing TURP surgery pre and post-operative.
- For patients:-
• Develop a manual booklet with simple instructions and illustrations, which can be used as a teaching guide for patients undergoing TURP surgery.
- For health organization:-
• Educational programs and continuing educational sessions have to be organized for nurses about nursing care for patients undergoing TURP surgery. Educational manual booklets with drawing and simple explanation must be distributed for nurses to enhance and reinforce knowledge per training to catheter and irrigation care.
• Annual recent Center of Disease Control (CDC) guidelines about nursing interventions for patients undergoing TURP surgery should be available at the urological units.
• Nurses’ motivation through appreciation and reward for attending training programs.
• Providing necessary facilities and supplies needed for implementation of nurses ’practices in order to reach optimal standard of care.
Recommendations for further researches:-
• Developing standards of nursing care for patients undergoing TURP surgery.
• Specialized survey should be done to identify local barriers hindering nurses’ application of practices for patients undergoing TURP surgery including health care providers and health systems related barriers.
• Replication of study on a large probability sample is very important.