04.11.20091 10th annual interdisciplinary research conference, trinity college, dublin knowledge and...
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04.11.200904.11.2009 1110th Annual Interdisciplin10th Annual Interdisciplinary Research Conference, ary Research Conference, Trinity College, DublinTrinity College, Dublin
Knowledge and practice of blood transfusion: a survey Knowledge and practice of blood transfusion: a survey of nurses in the north and middle regions of Jordanof nurses in the north and middle regions of Jordan
Dr. Belal M. Hijji1, Dr. Rasha Dabbour1, Dr. Arwa Owies1
11Faculty of Nursing, Philadelphia University, Faculty of Nursing, Philadelphia University, JordanJordan
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ContentsContents
• BackgroundBackground• Aim and objectivesAim and objectives• MethodsMethods• ResultsResults• RecommendationsRecommendations
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BackgroundBackground
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Nurses play a crucial role in the administration of Nurses play a crucial role in the administration of blood transfusionsblood transfusions
Their relevant knowledge and practice are Their relevant knowledge and practice are important determinants of the safety of important determinants of the safety of
transfusionstransfusions
Published information about nurses' blood Published information about nurses' blood transfusion knowledge and practice is lackingtransfusion knowledge and practice is lacking
To fill this information gap, this study was To fill this information gap, this study was undertaken in Jordanundertaken in Jordan
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AimAim
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Principal AimPrincipal Aim
To investigate nurses’ knowledge and practice of To investigate nurses’ knowledge and practice of blood transfusionblood transfusion
Objectives
A. Investigate nurses’ knowledge and/ or reported practice of:1. Patient preparation before blood collection2. Blood pack collection3. Pre-transfusion initiation nursing activities4. Post transfusion initiation activities and issues
B. Identify statistically significant correlations between nurses’ knowledge scores and their characteristics
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MethodsMethods
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Design, Settings and Access
1. A descriptive cross-sectional survey using an interviewer-administered questionnaire
2. The study involved in-patient areas where blood transfusion events were common
3. Four teaching and public hospitals
4. Ethical approvals5. Participant information sheet6. Voluntary informed consent7. Anonymity and confidentiality
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Population and sample
Population: 906 nursesPopulation: 906 nursesSample: 320 nurses selected at random Sample: 320 nurses selected at random Inclusion criteria: Registered nurses with Inclusion criteria: Registered nurses with direct care responsibilitiesdirect care responsibilitiesExclusion criteria: Auxiliary staff, head Exclusion criteria: Auxiliary staff, head nurses, and nurses in out-patient areas and nurses, and nurses in out-patient areas and OT.OT.
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An overview of data collection
Nurses’ knowledge and reported practice of blood transfusion was measured via a questionnaire developed following consultation with nursing literature. It has 44 items in seven sections. A: nurses’ demographics and training (8 items); B: patient preparation before blood collection (4 items); C: blood bag collection (3 items); D: pre-transfusion initiation nursing responsibilities (8 items); E: post transfusion initiation nursing responsibilities (11 items); F: complications related to blood transfusion (8 items); and G: issues related to local policies (2 items).
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Validity and Reliability of the Questionnaire
1. A panel of seven international transfusion specialist nurses
2. Pilot study3.3. The Flesch Reading Ease (RE) Index is 66.15.
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An overview of data collection (continued…)
Data collection started on 5th November 2008 and was completed by 31st January 2009.
Two research assistants collected the data They attended a session on questionnaire
administration and collection They received written instructions
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Data AnalysisData Analysis
Allocation of scores
For most items, one point was awarded for the
correct answer and 0 for the incorrect one. The
maximum score was 57 (100%) points. Descriptive
and inferential statistics were used to analyse data
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ResultsResults
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305 nurses (95.3%) filled in the questionnaire
Nurses' Hospital Affiliation
120.00 / 39.3%
185.00 / 60.7%
MOH hospital
University hospital
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Nurses' demographic characteristics
1.00
189.00
115.00
5.00
36.00
249.00
13.00
143.00
162.00
missing gender
female
male
other qualifications
dip. gen. nur.
BSN
Master
Irbid
Amman
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Nurses' length of ward experience
Num
ber
of nurs
es
200
160
120
80
40
0
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Level of involvement in blood transfusion
75.00 / 24.7%
31.00 / 10.2%
70.00 / 23.0%
95.00 / 31.3%
33.00 / 10.9%> 12 times
9-12 times
5-8 time
1-4 times
None at all
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In-service training
279.00 / 92.4%
23.00 / 7.6%
Never
Yes
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Nurses' perceived needs of training
25.00 / 4.6%
146.00 / 26.7%
154.00 / 28.2%
100.00 / 18.3%
65.00 / 11.9%
56.00 / 10.3%none
serious hazards
adverse reactions
blood administration
collection of blood
sampling
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Patient preparation before blood collection
38.00 / 10.2%
100.00 / 27.0%
90.00 / 24.3%
143.00 / 38.5%
incomplete order
pre-medications
nurse is ready
patency of IV line
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Blood pack collection
26.00
100.00 154.00
knowledge of ABO
transport method right bld collection
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Pre transfusion initiation activities and issues
210.00
88.00
138.00
241.00
91.00final check omission
cause of fatality
blood warming
pt education
pt. identification
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Pre administration responsibilities (contin...)
169.0024.00
117.00
identification procblood handling
timeliness
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Pre transfusion initiation activities (contin...)
15.00
71.00
273.00
administration set
filter size
vital signs
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Post transfusion initiation responsibilities
136.00
171.00
61.00127.00
226.00
physical observation
ind. for slow bt
slow transfusionvital signs
routine activities
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Post transfusion initiation responsibilities (contin...)
151.00
172.00
144.00
compatible agents
preventive practice
risk of bact growth
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Acute transfusion reactions
193.00
134.00
138.00255.00
219.00
cardiac arrythmias
management of rash
urticariamanagement of ahtr
hemolytic reaction s
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Knowledge ScoresMean Median Mode Range Skewness Kurtosis SD
51.3 52 53 13-70 - 0.74 2.44 7.3
Inferential StatisticsOne-way ANOVA revealed no statistically significant correlations between nurses’ knowledge scores and
hospital affiliation, qualifications, gender, level of involvement in blood transfusion, ward experience, and previous training
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Key Findings• Nurses had serious knowledge deficits and practice deficiencies that are potentially threatening to patients health and safety • Patients were at risk of developing complications, in particular bacterial infection, destruction of red blood cells, and receiving incorrect transfusions
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RecommendationsRecommendations
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Action is needed, nationwide, to improve nurses’ knowledge and practice of blood transfusion
Urgent training and education
Systems must be developed to ensure that nurses are competent in performing blood
transfusion
Development of blood transfusion policies and guidelines for practice
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AcknowledgementsAcknowledgements
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We are immensely grateful to Ministry of Health, all nursing staff, and hospitals management.
We express our gratitude to Philadelphia University Deanship of Scientific Research and Postgraduate Studies for funding the study.
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Thank YouPrincipal Investigator