1 faculty of nursing, philadelphia university, jordan

Knowledge and Practice of Blood Transfusion: A Knowledge and Practice of Blood Transfusion: A Survey of Nurses in Abu Dhabi, United Arab Survey of Nurses in Abu Dhabi, United Arab EmiratesEmirates..

Dr. Belal M. HijjiDr. Belal M. Hijji11, Proff. Kader Parahoo, Proff. Kader Parahoo22, Proff. , Proff. Mohammad M. HossainMohammad M. Hossain33, Dr. Owen Barr, Dr. Owen Barr22, ,

Shirley MurrayShirley Murray44

11Faculty of Nursing, Philadelphia University, JordanFaculty of Nursing, Philadelphia University, Jordan22Institute of Nursing Research, Faculty of Life & Health Institute of Nursing Research, Faculty of Life & Health

Sciences, University of Ulster, UKSciences, University of Ulster, UK33Institute of Medicine, Universiti Brunei DarussalamInstitute of Medicine, Universiti Brunei Darussalam

44Royal Group of Hospitals, Belfast, UKRoyal Group of Hospitals, Belfast, UK

The Second JNC The Second JNC International Nursing International Nursing Conference, April 23rd -Conference, April 23rd -24th 2008, Jordan24th 2008, Jordan 22

ContentContentss

• BackgroundBackground• AimsAims• MethodsMethods• ResultsResults• RecommendationsRecommendations


BackgroundBackground


Nurses play a crucial role in the Nurses play a crucial role in the administration of blood transfusionsadministration of blood 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 and transfusion knowledge and practice and

what influences them is lackingwhat influences them is lacking

To fill this information gap, this study was To fill this information gap, this study was undertaken in Abu Dhabi Emirate, UAEundertaken in Abu Dhabi Emirate, UAE


AimsAims


Principal aimsPrincipal aims

To observe and document nurses’ actual To observe and document nurses’ actual blood transfusion practicesblood transfusion practices

To investigate nurses’ level of knowledge of To investigate nurses’ level of knowledge of blood transfusion blood transfusion

To examine the relationship between To examine the relationship between knowledge and actual practiceknowledge and actual practice

To explore the reasons for potential To explore the reasons for potential knowledge-practice gapknowledge-practice gap


MethodsMethods


Data were collected between January and Data were collected between January and October 2005October 2005

This was a 3-phase study where a mixed This was a 3-phase study where a mixed method design incorporating quantitative method design incorporating quantitative and qualitative methods was used to meet and qualitative methods was used to meet

its aimsits aims


2 medium-sized, public, general hospitals (A, 2 medium-sized, public, general hospitals (A, B) in Abu Dhabi Emirate, UAEB) in Abu Dhabi Emirate, UAE

Observations were conducted in 3 wards in Observations were conducted in 3 wards in each hospital; the survey involved 21 each hospital; the survey involved 21

wards; and 11 departments (administrative, wards; and 11 departments (administrative, clinical, quality) provided volunteers for the clinical, quality) provided volunteers for the

focus groupsfocus groups

Study settings and accessStudy settings and access

Approvals were obtained from the Ministry Approvals were obtained from the Ministry of Health and hospital A research ethics of Health and hospital A research ethics committees, and hospital B administrationcommittees, and hospital B administration


PopulationPopulation SampleSampleObservations:Observations: 140 nur.140 nur. 50 (random)50 (random)SurveySurvey 439 nur.439 nur. 263 (random)263 (random)Focus groupsFocus groups -------- 29(convenience)29(convenience)

Population and/ or samplesPopulation and/ or samples


Methods of data collectionMethods of data collection

A structured observation scheduleA structured observation schedule

Knowledge questionnaireKnowledge questionnaire

Focus group interviewsFocus group interviews


Data on nurses’ actual practice was collected via an Data on nurses’ actual practice was collected via an observation schedule developed by Bayraktar and observation schedule developed by Bayraktar and Erdil (2000) and new items were added based on Erdil (2000) and new items were added based on the BSCH (1999) guidelines, experts’ advice, and the BSCH (1999) guidelines, experts’ advice, and local practice. Nurses were observed 10 minutes local practice. Nurses were observed 10 minutes before blood collection until 15 minutes after the before blood collection until 15 minutes after the

initiation of transfusioninitiation of transfusion

An overview of data collectionAn overview of data collection

Nurses’ knowledge of blood transfusion was Nurses’ knowledge of blood transfusion was measured via a questionnaire developed following measured via a questionnaire developed following consultation with nursing literature on caring for consultation with nursing literature on caring for

transfusion patients. It covered nurses’ transfusion patients. It covered nurses’ demographics and training (9 items), general issues demographics and training (9 items), general issues relating to the care of transfusion patient (27 items), relating to the care of transfusion patient (27 items), complications related to transfusion (13 items), and complications related to transfusion (13 items), and

issues related to local policies (2 items). issues related to local policies (2 items).


Allocation of scores to knowledge and Allocation of scores to knowledge and practice itemspractice items

QuestionnaireQuestionnaire: For the majority of the items, one : For the majority of the items, one point was awarded for each correct response and no point was awarded for each correct response and no point for the incorrect one. The maximum score of point for the incorrect one. The maximum score of 70 points was allocated. The test item formats used 70 points was allocated. The test item formats used were multiple choice and response, true – false, and were multiple choice and response, true – false, and short answers. The Flesch Reading Ease (RE) Index short answers. The Flesch Reading Ease (RE) Index is 68.3 suggesting that the questionnaire is easily is 68.3 suggesting that the questionnaire is easily understandable.understandable.

Observation scheduleObservation schedule: For most items, one point : For most items, one point was given for the performance of an observable was given for the performance of an observable activity and no point for the non-performance or for activity and no point for the non-performance or for unnecessary practices. This resulted in a maximum unnecessary practices. This resulted in a maximum score of 21 points. The items were linked with the score of 21 points. The items were linked with the relevant ones on the questionnaire and were given relevant ones on the questionnaire and were given identical weight.identical weight.


The interview guide had 4 questions focusing on The interview guide had 4 questions focusing on the reasons for the knowledge practice gap, the reasons for the knowledge practice gap, evidence for warming blood, reasons for evidence for warming blood, reasons for knowledge deficits, and ways to improve nurses’ knowledge deficits, and ways to improve nurses’ blood transfusion practicesblood transfusion practices

Validity and reliabilityValidity and reliability

Observation schedule and questionnaire: Observation schedule and questionnaire: Transfusion experts and pilot testing. CVI 95% Transfusion experts and pilot testing. CVI 95% (questionnaire)(questionnaire)

Interview guide: Check on content validity with a Interview guide: Check on content validity with a nurse manager and 1 pilot focus groupnurse manager and 1 pilot focus group


Data analysisData analysis

For the quantitative components, descriptive and For the quantitative components, descriptive and inferential statistics as well as parametric and inferential statistics as well as parametric and nonparametric tests and correlation methods nonparametric tests and correlation methods were used, as appropriate. For the qualitative were used, as appropriate. For the qualitative component, content analysis was used to component, content analysis was used to produce themes generated from the focus produce themes generated from the focus groups datagroups data


ResultsResults


49 nurses (98%) were observed49 nurses (98%) were observed

248 nurses (95.4%) filled in the 248 nurses (95.4%) filled in the questionnaire. The knowledge questionnaire. The knowledge and observed practice of 48 and observed practice of 48 nurses is only reported herenurses is only reported here

Five focus groups (5-7 members Five focus groups (5-7 members in each), including the pilot, were in each), including the pilot, were

undertaken. undertaken.


The nursing activity The nursing activity

(Selective)(Selective)Nurses Nurses who who knewknew

Nurses Nurses who who performedperformed

Blood administered no later Blood administered no later than 30 minutes following than 30 minutes following removal from blood bankremoval from blood bank

4444 2727

Informing the patient (or Informing the patient (or relative)relative) about about: : Reasons/ Reasons/ benefits of blood transfusionbenefits of blood transfusion

4848 00

Risks of blood transfusionRisks of blood transfusion 2727 00

Reaction symptomsReaction symptoms 4343 1313

Blood transfusion knowledge and practice Blood transfusion knowledge and practice among nurses (n = 48)among nurses (n = 48)


The nursing activityThe nursing activity Nurses Nurses who who knewknew

Nurses Nurses who who performedperformed

Asking the patient to state his Asking the patient to state his name name

1818 33

Asking the patient to state his Asking the patient to state his date of birthdate of birth

11 00

Checking the patient ID bandChecking the patient ID band 3838 2121

Comparing together the Comparing together the information on patient's ID, information on patient's ID, blood bag, blood bank form and blood bag, blood bank form and prescription chartprescription chart

33 22

Recording BP before transfusionRecording BP before transfusion 4444 1515

Recording pulse before Recording pulse before transfusiontransfusion

4444 1818

Recording temperature before Recording temperature before transfusiontransfusion

4444 3333


The nursing ActivityThe nursing Activity Nurses Nurses who who knewknew

Nurses Nurses who who performeperformedd

Recording pulse 15 minutes Recording pulse 15 minutes after starting the transfusionafter starting the transfusion

3737 1212

Recording Recording temp.temp. 15 minutes 15 minutes afterafter

starting the transfusionstarting the transfusion

3737 1616

Blood transfusion completed Blood transfusion completed within 4 hours after collectionwithin 4 hours after collection

4141 2222Knowledge and Practice ScoresKnowledge and Practice Scores

Mean Mean Median Median Mode Mode Range Range

Knowledge Knowledge scoresscores

12.2 12.2 1313 1313 7-187-18

Practice scoresPractice scores 8.33 8.33 88 88 3-133-13


The relationship between nurses’ The relationship between nurses’ blood transfusion knowledge and blood transfusion knowledge and practice scores practice scores Spearman’s rho correlation Spearman’s rho correlation coefficient = 0.22, p. =0.14)coefficient = 0.22, p. =0.14)

Figure 6.2: Correlation between knowledge and practice scores

0

2

4

6

8

10

12

14

16

18

20

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47

Nurses' serial numbers

Sco

re o

ut o

f 21 Knowledge scores

Practice scores


Key FindingsKey Findings• Nurses’ knowledge was not sufficiently put into practiceNurses’ knowledge was not sufficiently put into practice

• Nurses’ lack of knowledge was reflected in practice Nurses’ lack of knowledge was reflected in practice

• Patients were at risk of developing complications, in Patients were at risk of developing complications, in particular bacterial infection and misidentificationparticular bacterial infection and misidentification

Barriers influencing nurses’ knowledge and Barriers influencing nurses’ knowledge and practice of blood transfusion (focus groups)practice of blood transfusion (focus groups)

Human, organisational, societal, and Human, organisational, societal, and educationaleducational


RecommendatioRecommendationsns


Action is needed, simultaneously, on Action is needed, simultaneously, on several fronts to rectify the current several fronts to rectify the current situationsituation

Urgent training and educationUrgent training and education Human and material resourcesHuman and material resources Improving image and status of Improving image and status of nursingnursing Replicate the study in JordanReplicate the study in Jordan


Thank YouThank YouPrincipal InvestigatorPrincipal Investigator

[email protected]@hotmail.com


REFERENCESREFERENCES

Bayraktar, N. and Erdil, F. (2000). Blood transfusion knowledge and practice among nurses in Turkey [Special Focus Issue: Hematology]. Journal of Intravenous Nursing, 23(5), 310-317.

British Committee for Standards of Haematology (1999). The administration ofblood and blood components and the management of transfused patients. Transfusion Medicine, 9, 227-238.

1 faculty of nursing, philadelphia university, jordan

Documents

practice of blood transfusion

nurses actual practice

nurses level of knowledge

survey of nurses

blood collection

local practice

abu dhabi emirate

hospital b administrationthe