Transcript Document 7171498

Knowledge and Practice of Blood Transfusion: A
Survey of Nurses in Abu Dhabi, United Arab Emirates.
Dr. Belal M. Hijji1, Proff. Kader Parahoo2, Proff.
Mohammad M. Hossain3, Dr. Owen Barr2, Shirley
Murray4
1Faculty
of Nursing, Philadelphia University, Jordan
2Institute of Nursing Research, Faculty of Life & Health
Sciences, University of Ulster, UK
3Institute of Medicine, Universiti Brunei Darussalam
4Royal Group of Hospitals, Belfast, UK
Contents
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The Second JNC
International Nursing
Conference, April 23rd 24th 2008, Jordan
Background
Aims
Methods
Results
Recommendations
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Background
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Nurses play a crucial role in the administration of
blood transfusions
Their relevant knowledge and practice are
important determinants of the safety of
transfusions
Published information about nurses' blood
transfusion knowledge and practice and what
influences them is lacking
To fill this information gap, this study was
undertaken in Abu Dhabi Emirate, UAE
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Aims
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Principal aims
To observe and document nurses’ actual blood
transfusion practices
To investigate nurses’ level of knowledge of blood
transfusion
To examine the relationship between knowledge
and actual practice
To explore the reasons for potential knowledgepractice gap
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Methods
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This was a 3-phase study where a mixed method
design incorporating quantitative and qualitative
methods was used to meet its aims
Data were collected between January and October
2005
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Study settings and access
2 medium-sized, public, general hospitals (A, B) in
Abu Dhabi Emirate, UAE
Approvals were obtained from the Ministry of
Health and hospital A research ethics committees,
and hospital B administration
Observations were conducted in 3 wards in each
hospital; the survey involved 21 wards; and 11
departments (administrative, clinical, quality)
provided volunteers for the focus groups
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Population and/ or samples
Observations:
Survey
Focus groups
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Population
140 nur.
439 nur.
----
Sample
50 (random)
263 (random)
29(convenience)
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Methods of data collection
A structured observation schedule
Knowledge questionnaire
Focus group interviews
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An overview of data collection
Data on nurses’ actual practice was collected via an
observation schedule developed by Bayraktar and Erdil
(2000) and new items were added based on the BSCH
(1999) guidelines, experts’ advice, and local practice.
Nurses were observed 10 minutes before blood collection
until 15 minutes after the initiation of transfusion
Nurses’ knowledge of blood transfusion was measured via a
questionnaire developed following consultation with nursing
literature on caring for transfusion patients. It covered
nurses’ demographics and training (9 items), general issues
relating to the care of transfusion patient (27 items),
complications related to transfusion (13 items), and issues
related to local policies (2 items).
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Allocation of scores to knowledge and
practice items

Questionnaire: For the majority of the items, one point
was awarded for each correct response and no point for
the incorrect one. The maximum score of 70 points was
allocated. The test item formats used were multiple
choice and response, true – false, and short answers.
The Flesch Reading Ease (RE) Index is 68.3 suggesting
that the questionnaire is easily understandable.
 Observation schedule: For most items, one point was
given for the performance of an observable activity and
no point for the non-performance or for unnecessary
practices. This resulted in a maximum score of 21 points.
The items were linked with the relevant ones on the
questionnaire and were given identical weight.
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The interview guide had 4 questions focusing on the
reasons for the knowledge practice gap, evidence for
warming blood, reasons for knowledge deficits, and ways
to improve nurses’ blood transfusion practices
Validity and reliability
Observation schedule and questionnaire: Transfusion
experts and pilot testing. CVI 95% (questionnaire)
Interview guide: Check on content validity with a nurse
manager and 1 pilot focus group
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Data analysis
For the quantitative components, descriptive and
inferential statistics as well as parametric and
nonparametric tests and correlation methods
were used, as appropriate. For the qualitative
component, content analysis was used to
produce themes generated from the focus
groups data
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Results
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49 nurses (98%) were observed
248 nurses (95.4%) filled in the
questionnaire. The knowledge and
observed practice of 48 nurses is only
reported here
Five focus groups (5-7 members in
each), including the pilot, were
undertaken.
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Blood transfusion knowledge and practice among
nurses (n = 48)
The nursing activity
(Selective)
Blood administered no later than
30 minutes following removal
from blood bank
Informing the patient (or relative)
about: Reasons/ benefits of blood
transfusion
Risks of blood transfusion
Reaction symptoms
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Nurses
Nurses who
who knew performed
44
27
48
0
27
0
43
13
18
The nursing activity
Asking the patient to state his name
Asking the patient to state his date
of birth
Checking the patient ID band
Nurses
Nurses who
who knew performed
18
1
3
0
38
3
21
2
44
15
Recording pulse before transfusion
44
18
Recording temperature before
transfusion
44
33
Comparing together the information
on patient's ID, blood bag, blood
bank form and prescription chart
Recording BP before transfusion
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The nursing Activity
Nurses
who knew
Nurses who
performed
Recording pulse 15 minutes after
starting the transfusion
37
12
Recording temp. 15 minutes after
starting the transfusion
37
16
Blood transfusion completed
within 4 hours after collection
41
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Knowledge and Practice Scores
Mean
Median
Mode
Range
Knowledge scores
12.2
13
13
7-18
Practice scores
8.33
8
8
3-13
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Figure 6.2: Correlation between knowledge and practice scores
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18
16
Score out of 21
14
12
Knowledge scores
10
Practice scores
8
6
4
2
0
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
The relationship between nurses’ blood
transfusion knowledge and practice scores
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Spearman’s rho correlation coefficient =
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Key Findings
• Nurses’ knowledge was not sufficiently put into practice
• Nurses’ lack of knowledge was reflected in practice
• Patients were at risk of developing complications, in
particular bacterial infection and misidentification
Barriers influencing nurses’ knowledge and
practice of blood transfusion (focus groups)
Human, organisational, societal, and educational
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Recommendations
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Action is needed, simultaneously, on
several fronts to rectify the current
situation
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Urgent training and education
Human and material resources
Improving image and status of nursing
Replicate the study in Jordan
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Thank You
Principal Investigator
[email protected]
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REFERENCES
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 of
blood and blood components and the management of transfused patients.
Transfusion Medicine, 9, 227-238.
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