Assessment of nurses knowledge and practices concerning cardiogenic shock

The nurses have an important and effective role in the evaluation of the type of nursing care , which are providing to patient with cardiogenic shock , via their contribution in the quality of nursing care, which are provided to cardiogenic shock patients. The present study aims at assessment of knowledge and practices of nurses that they working in the coronary care unit and emergency department. A Correlation study was performed in the coronary care unit and emergency department in Ibn Sena teaching hospital , Almousl general hospital and aljmhori teaching hospital in mousl city for the period from 8 january 2005 to 12 may 2005. The sample of the study included (50 subject) of nurses who work in he above units. The results of the study showed that there was significant difference between the knowledge and practice of nurses in regard to theoretical mean.. The level of education . and duration of employment had appositive impact on the knowledge and practices. While the gender and the training session had no significant impact on knowledge and practice . Based on the above results , the study recommends that the nurses in these units should haven sufficient practice and the knowledge update about critical care , especially about cardiogenic shock, nursing staff who work in the coronary care unit and emergency department units should be assessing after tanning; and larger study to elaborate the effects of different variables on the knowledge and practice of nurses.

The precise incidence is difficult to measure because some patients die before reaching the hospital . Inconstant , early and intensive monitoring can increase the apparent incidence of cardiogenic shock of 7.5% ; this incidence remained stable from 1975 to 1988. In the Global utilization of streptokinase (GUSTO-1) trial , the incidence of cardiogenic shock was 7.2% , a rate similar to that found in other multicenter thrombolytic trials. (Hollenberg,et al, 1999

Setting of the study:
The study was carried out in Ibn Sena teaching hospital-coronary care unit| (CCU)-Almousl general hospital (CCU&ED), and aljmhori teaching hospital (ED).

Design of the study:
Correlation descriptive study

Sample of the study :
The sample of the study consists of (50) were used for the purpose of evaluation and statistical measurement.
Testing the validity and reliability of the tool:

Content validity :
Prior collecting the data of the study , the tools were examined to identify their validity . the investigator submitted the tools to a panel of (12) experts in different fields of knowledge.

Reliability (pilot study):
The pilot study was carried out on (6)  The gender the majority (88%) of nurse were males. Regarding the place of work 52% of nurse were working in the CCU and 48 % in the ED. Regarding duration of employment , those with less than (5 years) constituted 70%, (6-10%) 14%, and above 10 years 16%. Concerning the level of education high percentage of nurses with nursing institute 54% were graduate of school , while 20% were nurses with nursing institute, the nurse from nursing college were (9) which represent (18%), and the remaining nurses represent (8%). Concerning the number of employers 3 nurses represent (24%) , 6 nurses which represented 16%, 7 nurse which represented 60%. Regarding the time of work the day constituted 74% , evening constituted 16% , night constituted 10%.        Discussion : *Sociodemographic characteristics of the sample : The nurse plays an effective and great role in different types of care for the patients . there is no doubt that the nurse who works in the CCU and ED must be intelligent enough and qualified for these tasks in addition to his general duties, therefore , he must have a good scientific back ground about the profession and details related to coronary artery disease and critical care in order to identify the problems from which the patients and which make the proper decision for intervention . it is clear that the mean age of nurses was (33.86) , regarding the gender reveals that distribution of nursing staff according to sex (88%) male, 12 % female , regarding the place of work , the nurses working in CCU constituted (52%) while in emergency units (48%) . the problems in emergency department overcrowding. Regarding the duration of experience , less than 5 years constituted 70% , as they are recently employed . regarding the training sessions no= 36% , yes = 64% , these results reveals most of nurses have trained and have advancement in CCU and ED, regarding the level of ducation , non degree training course 8%, school of nursing 54% , nursing institute 20%. Nursing college 18% the duration of employment in nursing practice and the level of education affect the performance of nurse, the staff should have sufficient information , high training . in dealing with such disease, *knowledge and practices of nurses about cardiogenic shock Table (2,3) show significant difference regarding the knowledge and practices of nurse about cardiogenic shock, with theoretical mean by using t-test , in area of information about car of cardiogenic shock , information about medication, general nursing information and the practices area of blood pressure measurement , oxygen administration and cannula insertion. These results indicate the nurses ability to perform efficiently , safely , and multi-disciplinary collaboration in the care of patients during the work in the critical care units(hennery, 1991) Table 4 show significant difference during care cardiogenic shock and other cases of diseases in the blood pressure measurement . this result reveals nurses who have high level of accountability for decisions that affect clinical practice , and appropriate treatments as demanded by the physician in an accurate and timely manner (hennery, 1991).
Variables of nurse with knowledge and practices: 1-Age of nurse: one of the important variables that directly effect patient care in CCU and ED is the age of nurse; using ANOVA test it appear that there no significant difference in knowledge with cardiogenic shock . information about cardiogenic shock treatment, information about medications and general nursing information. Despite the fact the older nurse has more experience and the nurses a ware of different practical measures in minimizing the problems that might happen and provide the best nursing care for patients stricken by cardiogenic shock, in addition , there were no significant difference of practices regarding blood pressure measurement and oxygen administration , these results may be explained by the fact that the nurses were exposed to limited practical tasks, while for cannula insertion , there was significant difference , as this task is gained by prolonged experience. 2-The gender: table 7, 8 show that there are no significant difference in knowledge and practices with regard to sex of nurse, the fact that information included in the study sample , sufficient , and appropriate to the cognition abilities of both the sexes.
3-place of work: regarding the impact of place of work on the knowledge and practices of nurses in table (9,10) which reveled no statistical difference in knowledge and no statistical difference in practices , due to the number of nurses in CCU more than nurse in ED. But is significant regarding general nursing information . one of the most important nursing responsibilities in The CCU is monitoring and ensuring the quality of care , with in this responsibilities are all activities associated with professional practice such as self monitoring the effect of medical intervention and supervising . the emergency nurse practitioners expanding scope of practice has moved beyond managing the care of patients with minor injuries, to include those with minor illnesses and indeed beyond that to the management and care of those with increasingly complex, acute and chronic condition (brook, 2004). 4-duration of employment :the investigator divided the sample into three group according to the yearsof employment in the CCUand ED. Where explained the studies that the tension and discomfit in nurses during the work resulted from decrease in the traning 6-level of education: in order to know standards of nurses education , the researcher divided the sample into four groups according to nurses graduation. The purpose of level of education is to provide nurses with he knowledge and skills necessary to diagnose and mange medical emergencies , to provide nurses with an understanding of the social impact of critical illness and the contribution of patient behavior to these problems and to teach the nurse basic diagnostic and interventional procedures (collines.2000). several studies show that the nurses with more education deliver more cost effective care and it is not always easy for nurse with higher education to remain in clinical and public health nurses and there are often no senior position available with in the system, so that nurses with higher education do not reach a position where they can implant change and are not reward for there additional education by appropriate remuneration or promotion (kockrow.1999).

Conclusion and Recommendations:
There was significant difference between the knowledge and practices of nurses with regard to theoretical mean. The level of education had a positive impact on the knowledge and practices of nurses who are involved of the study . the gender and the place of work have no significant on knowledge and practices

Recommendation :
The nurse in these units should have sufficient practices and updated knowledge about critical care especially about cardiogenic shock, nursing stnaff working in the care unit CCU and ED should be assessing after tanning, patients with ischemic heart disease must be educated about their illness to avoid complication of heart attacks, the nursing staff can do this , it is better to provide each patient , larger study is needed to elaborate he effects of different variables on the knowledge and practices of nurses.