Document Details
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Document Type |
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Thesis |
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Document Title |
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MONITORING OF REHABILITATIVE NURSING PRACTICES IN RELATION TO FUNCTIONAL ABILITY FOR PATIENTS WITH SPINAL CORD INJURY قياس ممارسات التمريض التأهيلية وعلاقتها بالقدرة الوظيفية لمرضى إصابات الحبل الشوكي |
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Subject |
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Faculty of Nursing |
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Document Language |
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Arabic |
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Abstract |
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Background
Spinal cord injuries (SCI) can be defined as a serious medical status that influences the patients’ life as well as that of their family. It also refers to a physical injury to the spinal cord that disrupts normal functioning. SCI occurs due to damage to the spinal cord resulting in transient or permanent loss of motor, sensory, and autonomic functions. Patients with SCI need to perform daily tasks and optimize their motor and cognitive functioning that will be achieved by rehabilitation.
The nurses are considered to be an integral part of the SCI rehabilitation team and they provide significant education to the patient and their family about the intricacies of living with a SCI. They help to manage the care process. Rehabilitative nurses who are caring for patients with SCI should be knowledgeable and have experience. This includes knowledge of nursing care plans, preventing complications, and patient education concerning self-care and management. It is necessary to illustrate that the nurse’s role is significant when referring to maintaining the patients functions and outcomes.
Aim of the study :
The aim of the present study is to monitor the rehabilitative nursing practices in relation to functional ability for patients with spinal cord injury.
The specific research questions:
1- What is the level of rehabilitative nurse's practices for patients with spinal cord injury ?
2-What is the degree of functional ability of patient with spinal cord injury?
3-What is the relation between the level of rehabilitative nursing practices and functional ability of patients with spinal cord injury?
Research Methodology:
Design
The design of this study is a cross sectional descriptive and correlational design
Setting
all of the inpatient departments in the Medical Rehabilitation hospital in Madinah city in the Kingdom of Saudi Arabia. This hospital has a bed capacity of 130 beds, including 3 admission departments: a Male Rehabilitation Ward (MRW1 with 24 beds), another rehabilitation Male Rehabilitation Ward (MRW2 with 21 beds) and a Female Rehabilitation Ward (FRW with 32 beds),outpatient clinic and AKU. There are 16 nurses in MRW1, 16 nurses in MRW2 and 21 nurses in FRW.
Study Sample
The study sample of the current study consisted of two groups:
1-Nurses sample:.
The population size of nurses who are working at rehabilitation hospital in Madinah city was 52. The estimated sample size was calculated by Epi Info [margin error = 0.05, the confidence level is 95%]. A convenient sample of 46 nurses was selected from those who are caring for patients with SCI was recruited. The sample was conducted based on the following criteria: Male and female registered nurses with experience for more than 6 months, caring for patients with SCI, and nurses who are willing to participate in the current study.
2-Patients’ sample
The population size of the patients with SCI was 40 patients at rehabilitation hospital in Madinah city. The estimated sample size was calculated by Epi Info [margin of error= 0.05, confidence level = 95%]. A purposive sample of 36 patients from those who have SCIs. based on the following inclusion criteria: patient age between 20 -60, classified according to (ASIA) A, B and C, and patients welling to participate in the study.
5.3. Study tools and measurements
Tool 1: Observational checklist assessment of rehabilitative nursing practices for patient with SCI. Assessment of rehabilitative nursing practices for patient with SCI observational checklist was used for the nurses to assess their rehabilitative nursing practices for patients with SCI ,the tool consisted of two parts as following:
Part I: Nurses’ demographic questionnaire form:
This part was developed by the researcher in English language to assess demographic characteristics for nurses, it includes: nurses’ gender, age, educational level, marital status, years of experience, and the work department.
Part II: Observational checklist for rehabilitative nursing practices for patients with SCI. This checklist was adopted from the Medical Rehabilitation hospital in Madinah city, which used routinely by the department of Medical Education of the Medical Rehabilitation hospital to assess the nurses’ competency skills of the daily practices. This part consisted of 9 observed main practices with 58 observed skills.
Tool II - functional ability assessment for patient with SCI: The tool consisted of the two parts: Part I: Demographic and clinical data sheet for patients with SCI.
It was developed by the Researcher. Demographic data for patient was include: gender, age, marital status, and their level of education .Clinical data of the patients such as: diagnosis (cervical injury, thoracic injury, lumbar injury, and sacral injury), type of injury (complete, sensory incomplete, motor incomplete, and normal).
Part II: Functional Independence Measure (FIM ) instrument: This checklist was adopted from McDowell and Newell (1983) in English language, it was used to assess patients’ level of disability and any change in patients’ status in response to rehabilitative nursing practices. This part consisted of two main functional scales: motor function skills and cognitive function skills.
Ethical consideration
Written approval was obtained from the faculty of nursing, King Abdul Aziz University, Institutional Review Board (IRB) and the Ministry of Health in the Kingdom of Saudi Arabia and Medical Rehabilitation hospital, written informed consent was obtained from all participants (patients and nurses) after explained the purpose of the study Confidentiality and privacy were assured .
Validity
Regarding the observational checklist assessment of rehabilitative nursing practices for patient with SCI; This tool was reviewed by jury of 5 experts in the field of Medical Surgical Nursing at Faculty of Nursing in postgraduate studies at King Abdulaziz University and validity was done. Regarding The Functional Independence Measure (FIM) instrument , it was adopted from McDowell and Newell (1983) in English language. Validity for this tool was already done
Reliability
Reliability coefficient was measured using Cronbach’s alpha coefficient. Regarding the observational checklist assessment of rehabilitative nursing practices for patient with SCI, the total Cronbach’s alpha coefficient was 0.913. Regarding the Functional Independence Measure (FIM) instrument, Inter-Rater Reliability was already done by McDowell and Newell , it was 0.86 to 0.88 .
Pilot study
Pilot study was conducted on 10% (5 participants(patients and nurses) of actual number of the study is before the start of actual data collection, no modification. Patients and nurses included in the pilot study were excluded from the study.
Data Collection
From the patients: the researcher recruited the patients who meet the inclusion criteria in the selected hospital. The questionnaire was filled by the researcher . Every patient has been interviewed individually once to fill the FIM sheet by researcher, each interview lasted about 30-45 minutes ,twice per week according to patient rehabilitation session. Moreover, patients’ ethical considerations and anonymity were assured.
From the nurses: The researcher recruited the nurses who meet the inclusion criteria in the selected hospital. The Observational checklist was done by the researcher. The researcher conducted an observation for the nurses while they are providing care to the patients with SCI during the duty in the morning and evening working shift, weekly based on Sunday ,Tuesday and Thursday . This process took 1-2 hours every shift per day for one nurse to complete observational checklist . Data collection was conducted on a one year's basis (from September 2018 till September 2019). Nurses’ ethical considerations and anonymity were assured.
Data analysis:
To achieve the goal of the study, the researcher used the statistical package for Social Science (SPSS version 22) for analysing the data. Statistical procedures that have been used included descriptive statistics such as frequencies, mean, and percentages. Also, One-way ANOVA and Pearson correlation test were used.
Results
• The most of nurses (97.8%) had adequate practices in implementing of infection control practices. The majority of nurses (82.4%) had adequate practices in maintaining posture, mobility, and ambulation adequately. Nearly three quarters (73.9%) of nurses measured vital signs adequately. Meanwhile, none of nurses adequately maintained of bowel and urinary function and prevented pressure ulcers.
• Nearly three quarters (71.7%) of nurses had inadequate practices regarding total rehabilitative nursing practices for patients with SCI, while only around one quarter 28.3% of nurses had adequate of practice
• Motor functional nearly three quarters of patients (72.2%) ,(69.4%) needed helper with complete dependence in bowel and bladder management ,respectively . More than half of patients (55.6%) needed helper in toileting . Concerning total motor functional independence measure (FIM) , it was found that more than half of patients (55.6%) needed helper with modified dependence, near one quarter (27.8%) of patients needed no helper, while only (16.7%) of patient needed helper with complete dependence .
• Regarding cognitive functional independence. It was noticed that majority of patients (94.4%),(86.1%) were no needed to helper in problem solving, memory and social interaction ,respectively . Additionally, the highest majority of patients (94.4%) needed no helper regarding cognitive functional, while only (2.8%) of patients needed helper .
• The mean score of total functional independent measure were (85.58±20.92).
• Regarding the correlation between demographics/clinical characteristics and Functional Independence Measure (FIM) of patients with SCI, there was a positive correlation between type of injury with motor functional independence measure with p=(0.003)
• There were no significant correlation between total rehabilitative nurses’ practices for patients with spinal cord injury , motor, cognitive and total FIM of the patients.
Conclusion :
The results of the present study revealed that nearly three quarter of nurses had inadequate practices regarding total rehabilitative nursing practices for patients with SCI, while only about quarter of nurses had adequate of practice. Concerning total motor functional independence measure, it was found that more than half of patients needed helper with modified dependence, near one quarter of patients did not needed helper. Additionally, the highest majority of patients did not needed helper regarding cognitive functional, The correlation between demographics and clinical characteristics and FIM of patients with SCI, there was a positive correlation between type of injury with motor functional independence measure. Regarding cognitive functional , there was a positive correlation between level of education and cognitive functional independence measure. Finally, there were no significant correlation between total rehabilitative nurses’ practices for patients with spinal cord injury, motor, cognitive and total FIM of the patients.
Recommendations:
Recommendations for nursing administration
• Hospital directors and chief nurses should consider improving nurses' practices about caring of patients with SCI by giving nurses opportunities to attend regional or national conferences and workshops on rehabilitative nursing practices.
• Nurses administration should ensure nurses awareness about rehabilitative practices guideline and policy ,also continuous patients care .
• Nurses practice should examined the factors that affected nurses' performance such as shortage of staff and workload.
Recommendations for nursing practice
• Based on the results of current study there were many rehabilitative nursing practices that had performed inadequately and need practical training such as maintaining bowel, urinary function and preventing pressure ulcers.
• Head nurse and nurse educator, should assess nurses’ competence rehabilitative caring for patients with spinal cord injury.
• correlation between rehabilitative nurses’ practices; motor and cognitive should be done with FIM for the patients with spinal cord injury.
Recommendations for nursing education and training
• Provide effective and updated rehabilitative nursing practices education and training program for nurses caring of spinal cord injury that are designed based on their learning needs to achieve the optimal level of rehabilitative nursing practices, to improve the knowledge and functional ability for patients
• Increase nurses’ opportunity to attend conference and workshop regarding rehabilitative nursing practices for patients with spinal cord injury.
Recommendations for future research
• Future research is required in replicating the study at different settings with large sample size in Saudi Arabia with the aim of generalizing the results.
• Future research is required in identifying the factors influencing the rehabilitative nursing practices for patients with spinal cord injury. |
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Supervisor |
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Dr. Nahed Mersal |
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Thesis Type |
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Master Thesis |
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Publishing Year |
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1441 AH
2020 AD |
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Co-Supervisor |
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Dr. Samah sofar |
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Added Date |
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Friday, June 26, 2020 |
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Researchers
| أحلام راشد البويني | Al bowiny, Ahlam Rashed | Researcher | Master | |
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