Assessment of Nurse’s Knowledge and Practices Regarding Pediatric Cardiac Catheterization at Sulaimani Cardiac Hospital

Assessment of Nurse’s Knowledge and   Practices Regarding Pediatric Cardiac Catheterization at Sulaimani Cardiac Hospital

Sabah Qadir Aziz[1]       Dr. Pary M. Azize[2]

 ABSTRACT

Pediatric Cardiac catheterization is considered one of the most diagnostic and interventional procedures available to the cardiologist. Pediatric Cardiac Catheterization has decreased morbidity and mortality for cardiovascular defects, and this invasive process is not free of complications. The study's objective is to assess the nurse's knowledge and practices regarding pediatric cardiac catheterization. Descriptive -analytical designs are used in the current study. A purposive non-probability sample of ( 30 ) Nurses were recruited who worked in Sulaimani Cardiac Hospital. The present study shows that most participants were males aged between (45-49). years. The study demonstrated that nurses' knowledge in pediatric cardiac catheterization was satisfied, and more than half of them worked with "good practice." Further, the study's result indicates a significant positive statistical correlation between (nurses' knowledge and Nurses' practice at Pre-cardiac, Intra-cardiac, Post-cardiac). The study recommends specific special training courses for all the nurses working with children undergoing pediatric cardiac catheterization to reinforce their skills and promote their experience, and further studies are also recommended.

KEY WORDS: Assessment, Pediatric,  cardiac, catheterization,  Pre, intra, post , cardiac hospital

1.     INTRODUCTION 

Pediatric Cardiac catheterization is considered one of the most diagnostic and interventional procedures available to the cardiologist. It includes inserting a specialized catheter into the systemic circulation (usually through the femoral vein or artery of the puncture site), which is then guided into the heart supported by the x-ray. This procedure is safe when a knowledgeable team achieves it. The complications are usually brief and may consist of minor complications as abnormal heartbeats, reaction to dye or medications, bruising, temporary pain, minor infections, and bleeding [1].

Cardiac catheterization in the pediatric community has similarities with catheterization in adults. However, visible differences in adults, the coronary atherosclerotic disease is more common and extremely rare in pediatrics. The techniques, interventions, and indications performed in pediatrics are different. A variety of therapeutic procedures was done in the pediatric cardiac catheterization lab, including balloon angioplasty of stenotic lesions, embolization and device closure of vessels, device closure of septal defects, and valvuloplasty of stenotic valves stenting vascular stenosis, and even percutaneous pulmonary valve implantation. An entire patient assessment is required and determines the best sedation [2].

There is also a probability of more severe but uncommon complications, including hematoma, severe bleeding, blood vessel or nerve damage, irregular heart rhythms and lung or heart failure, stroke, heart attack, blood clots in the lungs or legs [3].

 Patients undergoing pediatric cardiac catheterization need a knowledgeable nurse who recognizes and spots the complications, Using an appropriate practice of nursing care that will assist the patients to cope successfully with their situation and reduce their vascular complications [4].

This invasive process is not free of complications. However, it is safe when a knowledgeable team achieves it. The complications are usually brief and may consist of minor complications as abnormal heartbeats, reaction to dye or medications, bruising, temporary pain, minor infections, and bleeding put [5]. There is also a probability of more severe but uncommon complications, including hematoma, severe bleeding, blood vessel or nerve damage, irregular heart rhythms and lung or heart failure, stroke, heart attack, blood clots in the legs or lungs, and renal failure [3]. Therefore, this study led to assess the socio-demographic data of the nurses who work in the Cardiac center and the quality of the nursing care regarding pediatric cardiac catheterization.

2.  METHODS AND MATERIALS

This Descriptive- analytical study was carried out at Sulaimani Cardiac Hospital, dealing with pediatric cardiac catheterization for about six months from 1st February 2021 to 30th October 2021. A purposeful non-probability sample of 30 nurses who deal with pediatric patients undergoing cardiac catheterization A well-structured questionnaire will use to gain information about the nurses such as socio-demographic data, which includes (Nurse’s age, gender, marital status,  level of education, number of training course and years of employment). Additional information about the knowledge in pre, intra, and post going to take, the nurses will ask about their practices following cardiac catheterization.

All statistical computation is enhanced using the statistical method (SPSS 24). The data had been tabulated, coded, and presented in a descriptive form. In this study, the data were analyzed by  using the basic statistical methods, which include:

1. alpha-Cronbach has been used for testing the reliability of the questionnaire.

2. Descriptive statistical data analysis (Frequency, percentage, Mean, and stranded deviation)

3. Inferential data analysis:

A- Parametric Test (Independent samples T-Test and One Way ANOVA –F-Test)

B- Spearman Rank Correlation

C-Chi-square: using multiple responses package.

3.  RESULTS  

Rating Scales and Scores:

Section two of the questionnaire knowledge items has been scaled by three level of Likert scales by as the following patterns; For items (33) has been positives scaled and items (15) has been negative scaled by three level of Likert scales and scored respectively as follow:

Section two of the questionnaire Nurses' practice items has been scaled by three level of Likert scales by as the following patterns and the three level of Likert scales and scored respectively as follow:

Table (2): Distribution of the sample according to Socio demographic characteristic

Table (2) shows that the Distribution of the sample according to Socio demographic characteristic. As a result represents that, the majority of the age was between 40- 44 years which was 33.3% of the total and 26.7% was between 45-49 years and only 23.3% was Less than 40 years old. Most participants, 63.3% of gender was Male and 36.7% was females. In addition, the highest rate of the Level of education was Nursing institute Graduated which was 66.7% and 23.3% has Nursing preliminary Graduated. Then, the majority of the Years’ employment was between 15 – 25 Years and 56.7% has 4 – 8 Years of Experience in care of Pediatric Cardiac Catheterization and 30% has Years of Experience in care of Pediatric Cardiac Catheterization

Table (3): Distribution of sample according to nurse’s Knowledge in the Pediatric Cardiac Catheterization

The data of Table (3) on repeat distributions (mean, stander deviation) indicate explanatory variables that focus on (nurse’s Knowledge in the Pediatric Cardiac Catheterization). This variable has a mean of 2.2. And a standard deviation of (0.7) .The percentage of people who responded with "good Knowledge were (67.3%), whose with “Average knowledge” were (7.4%) and (25.3%) with “poor knowledge” .

Table (4): Distribution of sample according to Nurses' practice regarding care of patients undergoing cardiac catheterization

The data of Table (4) on repeat distributions (mean, stander deviation) indicate explanatory variables that focus on (Nurses' practice regarding care of patients undergoing Pre-cardiac catheterization). This variable has a mean of 2.42. And a standard deviation of (0.71) .The percentage of people who worked with "good practice” were (65.56%), those with “Average practice” by (11.11%) and (23.33%) of them were in a “poor practice”.

Table (5): Distribution of sample according to Nurses' practice regarding care of patients undergoing cardiac catheterization

The data of Table (5) on repeat distributions (mean, stander deviation) indicate explanatory variables that focus on (Nurses' practice regarding care of patients undergoing Intra-pediatric cardiac catheterization). This variable has a mean of 2.61. And a standard deviation of (0.69) .The percentage of people who worked with "good practice” were (77.5%), those who worked in (Average practice) by (6.1%) and who were (poor practice) by (16.4%)

Table (6): Distribution of sample according to Nurses' practice regarding care of patients undergoing cardiac catheterization

The data of Table (6) on repeat distributions (mean, stander deviation) indicate explanatory variables that focus on (Nurses' practice regarding care of patients undergoing post-pediatric cardiac catheterization). This variable has a mean of 2.41. And a standard deviation of (0.46) The percentage of people who worked with "good practice” were (61.03%), (18.97%) who were with “Average practice” and  (20%) with “poor practice” .

Table (7): Distribution of sample according to scales of level knowledge nurse’s and Nurses’ practice regarding care of patients undergoing cardiac catheterization

Table 8 Comparison means between nurse’s knowledge and Socio demographic

Table (8) shows the Comparison means between nurse’s knowledge and Socio demographic.

The result of the study shows that, there were statistically significant differences between nurse’s knowledge in Level of education (p=0.000), Years’ employment (p=0.012) and Years of Experience in care of Pediatric Cardiac Catheterization (p=0.005) because the result of the p-value was less than the common alpha 0.05. But there were no statistically significant differences between nurse’s knowledge in age (p=0.078), gender (p=0.401), because (p-value >0.05) .

Table 9 Comparison means between Nurses' practice at Pre-cardiac catheterization and Socio demographic

Table (9) shows the Comparison means between Nurses' practice at Pre-cardiac catheterization and Socio demographic.

The result of the study shows that, there were statistically significant differences between Nurses' practice at Pre-cardiac catheterization in age (p=0.001), Level of education (p=0.001), Years’ employment (p=0.000) and Years of Experience in care of Pediatric Cardiac Catheterization (p=0.000) because (p-value <0.05). But there were no statistically significant differences between Nurses' practice at Pre-cardiac catheterization in gender (p=0.363) because the result of the p-value was more than the common alpha 0.05.

Table (10): Comparison means between Socio demographic and Nurses' practice at Intra-pediatric cardiac catheterization

Table (10) shows the Comparison means between Nurses' practice at intra-cardiac catheterization and Socio demographic.

The result of the study shows that, there were statistically significant differences between Nurses' practice at intra-cardiac catheterization in age (p=0.033), Level of education (p=0.000), Years’ employment (p=0.017) and Years of Experience in care of Pediatric Cardiac Catheterization (p=0.001) because the result of the p-value was less than the common alpha 0.05.But there were no statistically significant differences between Nurses' practice at Intra-cardiac catheterization in gender (p=0.817) because (p-value >0.05).

Table (11): Comparison means between Socio demographic and Nurses' practice at Post-pediatrics catheterization

Table (11) shows the Comparison means between Nurses' practice at post-cardiac catheterization and Socio demographic.

The result of the study shows that, there were statistically significant differences between Nurses' practice at post-cardiac catheterization in age (p=0.009), Level of education (p=0.000), Years’ employment (p=0.031) and Years of Experience in care of Pediatric Cardiac Catheterization (p=0.002) because (p-value <0.05). But there were no statistically significant differences between Nurses' practice at post-cardiac catheterization in gender (p=0.265) because the result of the p-value was more than the common alpha 0.05.

Table 12 Correlation between nurses' knowledge and Nurses' practice

It is noted from Table (12) the Correlation between nurses' knowledge and Nurses' practice. The result of the study indicates that that there is a significant positive statistical correlation between (nurses' knowledge and Nurses' practice at Pre-cardiac, Intra-cardiac, Post-cardiac,) which was (0.683, 0.762, 0.527) and that the significance value was (0.000, 0.000, 0.003) by respectively and were less than 0.05.

1. DISCUSSION  

Nursing care is one of the most crucial factors, preventing cardiac catheterization complications experienced by patients. In Kurdistan Region, a particular hospital, which focuses on Pediatric Cardiac Catherization does not exist as there are no specialized nurses who are certified in this specific field. Thus, nurses' knowledge and practices are competent in pre,intra, and post pediatric cardiac catheterization at Sulaimani cardiac hospital. It is essential to study. The Nurse plays an essential role in providing nursing care to the patient who undergoes cardiac catheterization. According to socio-demographic factors, the distribution of the sample discovered that 33.3% of the participants were aged between 45-49 years, and 26.7% were between 40- 44 years, and only 16.7% were Less than 40 years old. The majority of participants, 63.3%, were male. This result is supported by the descriptive crosse sectional study done in Mosul Hospitals [6], as their sample were primarily male; however, they differ in sample age groups as most of them were aged between 25-29 years old.

Regarding the educational level, the current study showed that most participants hold a technical institute degree in nursing, estimated as 66.7%, and 23.3% have preliminary nursing graduates. This conclusion supported a study conducted in Eygpt by [7]. Further, [8], [3], Which were agreed, reported that more than half of nurses had a general nursing diploma according to their qualification. The experience in nursing and the duration of work for nurses in this center revealed that most of the nurses were 4 – 8 Years experienced in pediatric cardiac catheterization, and the minority had more than nine years of experience in the care of Pediatric Cardiac Catheterization. These findings confirm the study done in Baghdad [9], which indicated that the maximum percentage of job experience was ranged between (1-10) years. However, [10] the study conducted in the capital of Kurdistan Region to assess the Quality of Pre-Cardiac Catheterization Nursing Care at the Surgical Specialty Hospital -Cardiac Center in Erbil City supports the present study that no training sessions are given regarding pediatric cardiac catheterization for most of the study samples (55.5%) in Kurdistan region or abroad.

The study demonstrated that nurses' knowledge in pediatric cardiac catheterization was satisfied, as the percentage of nurses who responded with "good Knowledge were (67.3%), whose with "Average knowledge" were (7.4%) and (25.3%) with "poor knowledge." This finding agreed with another study done in Al-Najaf All-Ashraf City, which shows nurses' knowledge regarding cardiac patient care was good [11]. This finding has come along with a cross-sectional analysis done in Pakistan indicating that registered nurses have the proper level of knowledge regarding cardiac catheter care patients [8]. However, this finding contradicts the study results done in Mosul Hospital, which indicated that nurses working in medical and surgical ward nurses' Knowledge of Patient Safety After Cardiac Catheterization were unacceptable [6]. Thwassults showed that most nurses had good knowledge about post-cardiac catheterization complications. A similar study done in Egypt to determine the Nurse's knowledge found that nurses had good knowledge about cardiac patient care [12]. Nurses' knowledge was excellent and sufficient about cardiac catheterization procedures. Inconsistent with the present study, a study conducted in the cardiac unit in Palestine to determine the Nurse's knowledge about pacemaker implantation showed similar results [13].

Regarding the Nurse's practices, the percentage of people who worked with "good practice" was (65.56%), those with "Average practice" by (11.11%) and (23.33%) of them were in a "poor practice" the result of the study done in Erbil found that overall quality of pre cardiac catheterization nursing care,  81.8% of the nurses were at an acceptable level compared to 18.2% were at a reasonable level. At the same time, the mean score of overall quality of care was 2.18, indicating an acceptable level of patient care. This contrasts with the cross-sectional analytical study in Pakistan [14] that most nurses were observed with unsatisfactory practices. The outcome of the study indicates that there were statistically significant differences between Nurse's knowledge in Level of education (p=0.000), Years' employment (p=0.012), and Years of Experience in care of Pediatric Cardiac Catheterization (p=0.005). This conclusion is supported by the study done in Rania city, Kirkuk, and Khartoum city by [15] [16] [17].

In contrast, [8] stated that no significant correlation existed between gender, age, job experience, and marital status; negative correlations were also found between practice and years of experience.

The mean of knowledge was found suitable compared to the mean of practice, which was poor. The outcome of the study indicates that there were statistically significant differences between Nurses' practice at Pre-cardiac catheterization in age (p=0.001), Level of education (p=0.001), Years' employment (p=0.000), and Years of Experience in care of Pediatric Cardiac Catheterization (p=0.000) because (p-value <0.05). Nevertheless, no statistically significant differences have been found between Nurses' practice at Pre-cardiac catheterization in gender (p=0.363).

The outcome of the study shows that there were statistically significant differences between Nurses' practice at intra-cardiac catheterization in age (p=0.033), Level of education (p=0.000), Years' employment (p=0.017), and Years of Experience in care of Pediatric Cardiac Catheterization (p=0.001). This finding is supported by the study [1], which stated that the Level of Nurse's knowledge and practice of cardiac catheterization regarding patient safety increase with experience of the job.

The study's result shows that there were statistically significant differences between Nurses' practice at post-cardiac catheterization in age (p=0.009), level of education (p=0.000), Years' employment (p=0.031), and Years of Experience in care of Pediatric Cardiac Catheterization (p=0.002) because (p-value <0.05) This showed that nurses have good knowledge about post-cardiac catheterization complications. It was found that the significant value of P < 0.0001 by applying a correlation which showed there was a good association between practice and knowledge  (P < 0.05).

Conclusion

The present study shows that most participants were male aged between(45-49). Years.  The study demonstrated that nurse's knowledge in pediatric cardiac catheterization was satisfied, and more than half of them worked with "good practice.”  Further, the study's result indicates a significant positive statistical correlation between (nurse's knowledge and nurse's practice at Pre-cardiac, Intra-cardiac, Post-cardiac). The study recommends a specific training course for all the nurses working with children undergoing pediatric cardiac catheterization, and also further qualitative studies are also recommended.

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