الفهرس 
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Abstract
SUMMARY
Blood gas analysis is a vital diagnostic tool used in the medical field to assess a patient’s respiratory and metabolic status. It involves measuring the levels of oxygen (O2) and carbon dioxide (CO2) in the blood, as well as the acidity (pH) and the bicarbonate (HCO3-) concentration. Blood gas analysis is typically performed using a blood sample drawn from an artery, most commonly the radial artery in the wrist or the femoral artery in the groin. Arterial blood is preferred over venous blood because it more accurately reflects the oxygen and carbon dioxide levels in the body (Abd Elaziz et al., 2021).
Arterial blood gases are frequently ordered by physicians and healthcare providers to assess a patient’s respiratory and metabolic status, monitor treatment effectiveness, and guide clinical decision-making. This diagnostic test plays a vital role in various medical settings, including hospitals, emergency departments, intensive care units, and respiratory care units. Overall, blood gas analysis is an indispensable tool that aids medical professionals in making accurate diagnoses and delivering optimal care to patients with respiratory and metabolic imbalances (Ibrahem et al, 2021).
Interpreting ABG results requires an understanding of normal ranges for each parameter and their relationships to each other. Deviations from the normal ranges can indicate various respiratory and metabolic disorders, such as respiratory acidosis, respiratory alkalosis, metabolic acidosis, and metabolic alkalosis. Healthcare professionals, including doctors, nurses, and respiratory therapists, use ABG analysis to tailor treatment plans, adjust ventilator settings, and monitor the progress of patients with conditions such as chronic obstructive pulmonary disease (COPD), acute respiratory distress syndrome (ARDS), kidney disorders, and more (Neder et al., 2020).
Nurses are essential members of the healthcare team when it comes to managing arterial blood gases. Their responsibilities range from proper sample collection and handling to interpretation, decision-making, ongoing monitoring, and patient education. Effective collaboration and communication among nurses and other healthcare professionals are essential for optimal patient care (Ragab & Mohamed, 2022).
However, the accurate collection and interpretation of ABGs require specialized skills that may not be uniformly taught or consistently updated during nurses’ education and training. The significance of the current study lies in its potential to bridge the existing gaps in knowledge and skills related to ABG procedures among nurses. By providing evidence-based educational guidelines.
Aim of the Study:
The study aimed to to assess the effect of educational guidelines on nurses’ performance regarding arterial blood gases sampling and interpretation through the following objectives:-
Assess nurses’ knowledge regarding arterial blood gases interpretation.
Assess nurses’ practices regarding arterial blood gases sampling.
Design and implement educational guidelines regarding arterial blood gases sampling and interpretation.
Evaluate the effect of the educational guidelines on the nurses’ performance.
Research hypothesis:
This study was hypothesized that, an application of an educational guidelines regarding arterial blood gases sampling and interpretation would affect positively on nurses’ performance.
Research design
Quasi experimental research design was conducted in this study which included pretest questionnaire, educational program (booklet) and posttest questionnaire
Setting
The present study was conducted at the Intensive Care Units of Emergency Hospital at Mansoura University which consist of three units (surgical ICU I, surgical ICU II and surgical ICU III).
Subjects
The subjects of the present study included: A convenient sample of all available nurses (50) working at the Intensive Care Units of Emergency Hospital at Mansoura University.
Tools of Data Collection
Data was collected through the following two main tools:
I) Tool I (Self-administered questionnaire):
Tools were developed by the investigator in the Arabic and English languages based on the review of relevant recent literature. It consisted of two tools:
1. Demographic characteristics of Nurses Form: it included: age, gender, marital status, educational level, years of experience, and previous training courses.
2. Nurses’ knowledge Assessment Questionnaire It included 42 questions in the form of multiple-choice questions (MCQs).
Scoring system: The total score for the questionnaire was 42 grades. Score less than 80% was considered unsatisfactory, and the score equal to or more than 80 % was considered satisfactory.
II) Tool II (Nurses’ practice Observational checklist for ABG sampling): It composed of 26 items (procedure steps) divided into 3 subitems (before sampling which included 9 items, radial and femoral sampling which included 10 items and after sampling which included 7 items).
Scoring system: The total score for the checklist was 26 grades. Score less than 80% was considered unsatisfactory level of practice, and the score equal to or more than 80 % was considered a satisfactory level of practice.
Pilot Study:
A pilot study was carried out on five nurses (10%) who were included in the study subjects to test feasibility, applicability, and clarity of the tools, and no modifications were done.
Fieldwork
Official permission was obtained from the Emergency Hospital of Mansoura University in which the study was conducted.
The actual work of this study started and completed within one month and half from 15 February (2023) until the end of April (2023). Data were collected by the researcher three days per week, in the morning and afternoon shifts in the previously mentioned settings.
The purpose of the study was explained to the studied nurses who agreed to participate in the study before data collection.
The self-administered questionnaire tool was distributed to the studied nurses in their workplace; each questionnaire took about 30 minutes to fill it.
Nurses’ practice was assessed using an observational checklist by the researcher. Maximum three nurses were observed per day during arterial blood gases sampling.
The educational program was designed and presented to the nurses in a form of booklet that explained to nurses after pretest questionnaire done.
The studied nurses divided into 10 groups to explain the booklet, each group had 5 nurses and every session took around three hours in each time, in some times these hours were prolonged due to questions and discussion to achieve the aim of these sessions.
The educational program took around 2 weeks until finished and after that posttest done.
The studied nurses were assured that the information collected would be treated confidentially and that it would be used only for the study.
Ethical Considerations:
An approval of the study protocol was obtained from the Research Ethics Committee of Faculty of Nursing-Ain Shams University before starting the study.
The researcher clarified the objectives and the aim of the study to the nurses included in the study. The researcher assured maintaining anonymity and confidentiality of the subject data. Nurses were informed that they could choose to participate or not in the study, and they have the right to withdraw from the study at any time without giving any reasons.
Results:
More than two third, 66% of the studied nurses aged less than 35 years with mean age ranged from 19 to 41 years. Also, more than three quarters,76% of them was females.
As regard educational level of the studied nurses, less than two fifth, 38% of them had bachelor degree, less than one third, 32% of them had institutional degree and 30% had diploma degree. Also, the majority, 82% the studied nurses were married.
As regard years of experience, more than half, 56% had experience from 5 to 10 years and the minority, 12% of them had previous training.
Regarding nurses’ level of knowledge regarding arterial blood gases sampling and interpretation, more than two third, 70.0% of nurses had satisfactory level of knowledge regarding arterial blood gases sampling and interpretation post -intervention of educational guidelines program, while, less than half of them, 48.0% had satisfactory level of knowledge regarding arterial blood gases sampling and interpretation pre -intervention program. Also, there is statistically significant increase in knowledge score pre and post -intervention of educational guidelines program p<0.001*.
Concerning nurses’ level of practice regarding arterial blood gases sampling and interpretation, the majority, 96.0% of nurses had satisfactory level of practice regarding arterial blood gases sampling and interpretation post -intervention of educational guidelines program, while, less than half, 44.0% of them had satisfactory level of practice regarding arterial blood gases sampling and interpretation pre -intervention program. In addition, there is statistically significant increase in in mean practice score pre and post -intervention of educational guidelines program p<0.001*.
There was a total positive correlation between total score of knowledge and practice pre and post -intervention program p<0.001*.
Conclusion:
Based on the study results, the current study concluded, that more than two third of nurses had satisfactory level of knowledge regarding arterial blood gases sampling and interpretation post educational guidelines implementation. Also, there is statistically significant difference in knowledge mean score pre and post educational guidelines implementation regarding ABG sampling and interpretation.
Furthermore, the majority of nurses had satisfactory level of practice regarding arterial blood gases sampling and interpretation post educational guidelines implementation. In addition, there is statistically significant difference in mean practice score pre and post educational guidelines implementation regarding ABG sampling and interpretation .
Moreover, there was a total positive correlation between total score of knowledge and practice post educational guidelines implementation regarding ABG sampling and interpretation.
Recommendations:
Based on the current study finding the following recommendations were proposed:
Healthcare Organizational level:
Create online platforms where healthcare professionals can share their experiences, knowledge, and practices regarding arterial blood gases sampling and interpretation.
Encourage interdisciplinary collaboration among healthcare professionals to enriches their knowledge and practices regarding arterial blood gases sampling and interpretation.
Implement a robust system to track both knowledge and practice outcomes over time which enabling the organization to make data-driven decisions regarding arterial blood gases sampling and interpretation.
Educational level:
Adoption of updated guidelines with heath care administrators and practitioners regarding arterial blood gases sampling and interpretation.
Further Research:
Conduct further studies in different settings and populations regarding arterial blood gases sampling and interpretation.
Explore the impact of individual motivation and organizational culture on nurses’ performance regarding arterial blood gases sampling and interpretation.