04.11.20091 10th Annual Interdisciplinary Research Conference, Trinity College, Dublin Knowledge and practice of blood transfusion: a survey of nurses

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

10th Annual Interdisciplin10th Annual Interdisciplinary Research Conference, ary Research Conference, Trinity College, DublinTrinity College, Dublin

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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

[email protected]

Documents

04.11.20091 10th Annual Interdisciplinary Research Conference, Trinity College, Dublin Knowledge and practice of blood transfusion: a survey of nurses