Nurses ’ Knowledge Regarding Patients Safety After Diagnostic Cardiac Catheterization in Azadi Teaching Hospital in Kirkuk City

The present study aims to assess Nurse’s Knowledge about Patient Safety after diagnostic Cardiac Catheterization at Azadi Teaching Hospital in Kirkuk City. A descriptive study survey approach was carried out from the period of 1 st March 2017 up to 1 st October 2017. A non-probability (purposive sampling) method was used to select the sample of the study. The study includes the (45) nurses who are working in medical ICU and cardiac medical ward at Azadi Teaching Hospital in Kirkuk City. The instrument of the study is Self structured questionnaire which is developed to assess the knowledge of nurses who are working in ICU and cardiac medical ward. The analysis of the data was used descriptive statistics (frequencies, percentages, mean, S.D), and inferential statistical (ANOVA and ttest). The results of the study showed that (48.9 %) of samples were in the age group between (23-27) year, and with a mean & SD of 2.13± 1.12.(64.4%) of study sample were female, (37.8 %) of the sample were graduate from Nursing institute, (75.6%) of them having (1-5) years of experience in the nursing profession, (95.6%) of the nurses had no training session in cardiac catheterization. The socio-demographic characteristic of the sample of the study has no significant relationship with knowledge at (P value < 0.05). The results of the questionnaire demonstrated that the nurses who are working in medical ICU and cardiac medical ward nurse’s knowledge towards Patient Safety after diagnostic Cardiac Catheterization were far from optimal. The researcher recommends the establishment educational training programs for staff working in cardiac catheterization and establishes specialized centers for cardiac catheterization.


Introduction:
Coronary Artery Disease (CAD) is the main causes of death in both men and women [1].
Cardiac catheterization is considered the effective diagnosing, evaluating, and treating method of Cardiac diseases problems.Although it has decreasing mortality and morbidity for cardiovascular disease, this procedure has many of complications [2].Cardiac catheterization is selected to evaluate valvular heart disease, coronary artery disease(CAD), congestive heart failure, and/or certain congenital (present at birth) heart conditions, such as Ventricular Septal Defect or Atrial, Septal Defect , when other less invasive types of diagnostic tests indicate the presence of one of these conditions.It is a common medical procedure that rarely causes serious problems [3].
Coronary Cardiac Disease is in general caused by atherosclerosis, when cholesterol (plaque) accumulate on the arteries walls in circulatory system, resulting in narrowing, then resulting in decreased blood flow to the heart.Coronary Cardiac Disease commonly causes angina pectoris (chest pain), heart attack (myocardial infarction), shortness of breath and other symptom [4].The common approach of cardiac catheterization is trans-femoral puncture.
Because of vascular disorders occurs as complications with (0.43-5.8%) of trans-femoral cardiac catheterization cases, immobilization of the catheterized leg of the patients and firmly bed rest have been considered critical to reduce the risk of their progression.Although cardiac catheterization can be inserted through the radial, brachial, or femoral arteries [5].After transfemoral cardiac catheterization, the recommended bed rest duration varies from 3 hours to 24 hours.Several patients find it complaint to use the urinal, or bedpan in the dorsal Creatinine, serum potassium, and blood urea nitrogen are particularly important [8].
The intensive care nurse, after cardiac catheterization plays a vital role in noting and evaluating the patient's status by general physical examination from head to toe, observing the generally temperature, color of the skin and accurate observing the level of consciousness (LOC).The patient is transferred after to the bed and attach to the monitor, the nurse listens directly to heart sound and breathing sounds.The nursing staff assesses the circulation peripherally and centrally by observing body temperature and color of skin of the dorsal pedals and posterior tibial pulses [9].Focusing on the early priorities for nursing staff care for patients after Percutaneous Coronary Intervention, that include determining physiological stability and patients comfort, by combining bed side, assessment and use of monitoring technology.Therefore, cardiac-nurses knowledge and competency regarding the effectiveness of measures used to prevent post-percutaneous Coronary Intervention, complication considered a quality indicator issues.Cardiac nurses are needs to identify that various techniques can be used to manage post Percutaneous Coronary Intervention, complications [10].
Cardiac Catheterization that inserted by radial artery access represent an alternating plan that don't need long time bed rest, and related with reductions, in puncture site complications, and hospitalization period of stay [11].Given the existing style toward radial access and the evidence supporting early ambulation of the patient following without complication femoral artery catheterization, early movement following cardiac catheterization may be the future typical of care.

Objectives of Study:
1. To assess the knowledge level of cardiac nurses related to patient safety after cardiac catheterization.
2. To find out relationship between the nurse's knowledge and their demographic characteristics.

Methodology: Design of the study: A descriptive ~study
Sample of the study: The sample was selected non~probability (purposive) of (45) nurses' who are working in medical ICU and cardiac medical ward from Azadi Teaching Hospital in Kirkuk City.
Setting of the study: Azadi Teaching Hospital in Kirkuk City, and collected data from 30 th of March to 10 th of May 2017.

Instruments:
The instrument of the study is Self structured questionnaire which is developed to assess the knowledge of nurses who are working in ICU and cardiac medical ward.Several Part II: Self-prepared structured questionnaire was developed to assess the knowledge of nurses who are working in ICU and cardiac medical ward.This questionnaire was developed and translated to Arabic language; the questionnaire was consisted 17-items (17 multiple choice questions).To score the results of questionnaire, each correctly answered item has assigned with score of (1).Incorrectly answered items have assigned with score of (0); total scores are summed and ranged from (0 to 17).
The instrument Validity and Reliability: -content validity was determine through a panel from Nursing and medical specialties of (17) experts.The questionnaire was translated from English to Arabic and opposite under language supervision.Reliability of questionnaire was determined during (test re-test) of pilot study (r = 0.79).
Statistical methods: Descriptive statistics (Frequency, Percentage, Mean, S.D), and Inferential statistical analysis (ANOVA and t-test) was used for data analysis.F critical = 2.00, df= 44

Results and Calculations:
Table 3 shows that the significant differences between Knowledge and their Age of study sample where not significant at P value > 0.05.  4 showed that there were no significant differences between Knowledge Items according to Gender at P value > 0.05 F critical = 2.00, df= 44 Table 5 shows that the significant differences between Knowledge and their Age of study sample where not significant at P value > 0.05

Discussion:
The results of the questionnaire demonstrated that the nurses who are working in medical ICU and cardiac medical ward nurse's knowledge towards Patient Safety After diagnostic Cardiac Catheterization were inadequate knowledge.The correct answer rate for the total scale, on average, was (23.41%) ranging from (15.6% to 91.1%),only (8) items from all items of correct answer questionnaire were more than 50%, this mean that the knowledge of nurses were poor knowledge.These results disagree with the study conducted by Arathy .S.R.
(2011), that show The knowledge level is higher in staff nurses who has experience more than 5 years compared to those whose years of experience is less than 5 years, and this is because in our country the system of the hospital for distribution of collegiate nurses at the hospital level is not appropriate and there is no Functional description for nurses [12].On comparing these two, a significant p value of 0.015 was attained, regarding to complications in our results in items (8, 10 and 2) agree with a study conducted by Mario C. sang et al, (2010) that show that show (odds ratio=5.65,95% confidence interval 2.58-12.3,p<0.001) [13].Also other study agree with our results conducted by Koraen-Smith et al. (2016), that show no significant differences in the frequencies related to non-bleeding complications between Centre (1)and Centre (2).Patients on the vascular ward had a higher frequency related to minor bleeding (p = .002)but there was no difference in major bleeding (p = .12)[14].Also our study shows there is no significance between Knowledge Score of Sample and their Age, level of education, and Years of experience in nursing profession this is because there is no specialized center or hospital in our city for cardiac catheterization, also there are no specialized professional nurses that work in cardiac catheterization units.This is a reason in our city and in hospital system no nursing appointment setting as appropriate that work in each specialized field of nursing.

Conclusions:
1-The knowledge of nurses regarding Patient Safety After diagnostic Cardiac Catheterization was far from optimal.
2-The association between general nurses information regarding nurse's knowledge towards Patient Safety After diagnostic Cardiac Catheterization and nurses (Age, gender, Level of

Volume 13 ,
Issue 4, December 2018 , pp. (45-56) ISSN: 1992-0849 (Print), 2616-6801 (Online) Web Site: www.uokirkuk.edu.iq/kujssE-mail:kujss@uokirkuk.edu.iq54 position at bed rest; moreover, studies indicated that the severity of back pain aggravated by longer period of time of bed rest after cardiac catheterization [6].Nursing staff instructions for the patients on the importance of maintaining the both leg straight, and the head of the bed no more than 45 degrees.The nursing staff plays vital role in observing and evaluating angina pectoris that repeated soon after a percutaneous coronary intervention procedure.Any chest pain demands immediate and careful attention because it may indicate either the start of vasospasm or impended occlusion of the arteries[7].The intensive care nurse must monitor, laboratory analysis, such as, serum electrolytes, cardiac enzymes, and coagulation tests (prothrombin time, and partial thromboplastin time PTT), journals and textbooks worldwide helped to develop the tool and experts in college of nursing and Kirkuk hospitals approved it.The Instruments Consisted three parts:-Part I: Socio-demographic data, which includes (6) items (Age, Gender, Level of Education, Years of experience, Training session included in Cardiac Catheterization).

Table 1 :
Demographic Characteristics of Nurses.
Table1demonstrates the demographic characteristics of the whole study sample.The results show that the majority (48.9 %) of nurses in the sample are within the age group (23-27 years) and with a mean of 2.13± 1.12.Most of them (64.4%) were female.Most of nurses were Nursing institute (37.8 %), and the highest of sample rang (1-5) Years of experience in the Nursing profession were (75.6%).With regard to training sessions in cardiac catheterization were (95.6%) of the nurses had no training session in cardiac catheterization.

Table 3 :
Difference between Knowledge of Nurses of Sample and their Age (ANOVA).

Table 4 :
Comparison of Knowledge Score of Sample regarding to their gender.

Table 5 :
Difference between Knowledge of Nurses of Sample and their Level of Education (ANOVA).

Table 6 :
Difference between Score of Knowledge for Sample and their Years of Experience in Nursing Profession.

Table 6 :
this table showed that there were no significant differences between Knowledge Items of Sample and their Years of Experience in Nursing Profession at P value > 0.05.

Table 7 :
Comparison of Knowledge Score of Sample regarding to their Training session in

Table 7
showed that there were no significant differences between Knowledge Items according to Training session in Cardiac Catheterization at P value > 0.05.