Assessment of Nurses Practice Related to Managing Patients with Dyspnea at Emergency Units at Port Said hospitals

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1 Intenational Jounal of Caing Sciences Setembe Decembe 2016 Volume 9 Issue 3 Page 1066 Oiginal Aticle Assessment of Nuses Pactice Related to Managing Patients with Dysnea at Emegency Units at Pot Said hositals Maiam Saby Shehab Deatment of Medical Sugical Nusing, Faculty of Nusing, Pot Said Univesity, Egyt Hayat Abd-Elkade Deatment of Medical Sugical Nusing, Faculty of Nusing, Pot Said Univesity, Egyt Noha Mohamed Ibahim Deatment of Medical Sugical Nusing, Faculty of Nusing, Pot Said Univesity, Egyt Coesondence: Maiam Saby Shehab Deatment of Medical Sugical Nusing, Faculty of Nusing, Pot Said Univesity, Egyt samoha201029@yahoo.com Abstact Aim of this study : This study was aiming to Assess nuses' actice elated to managing atients with dysnea at emegency units at ot said hositals. Reseach design: descitive study design was used. Setting: The study was conducted at emegency units at Alameie and Alzoho hositals at Pot Said city. Subject: The study involved all available nuses' woked in emegency units at Alameie and Alzoho hositals about (50 nuse). Tool of data collection: Data wee collected using nuses' dysnea managing obsevation checklist. Results: Total mean actice scoe egading management of atients with dysnea wee un. Conclusion: Nuse s level of actice in assessing hysical assessment aametes was un in all items. Recommendation: The study ecommended continuous educational ogams should be lanned on egula basis to nuses' managing atients with dysnea fo enhancing nuses' actice and to achieve high quality of cae. Key Wods: dysnea, nuses, actice, management, cae, assessment. Intoduction Dysnea is a comlex symtom that involves an uncomfotable sensation elated to beathing o an awaeness of beathing, which can be highly distessing fo both atients and caegives. Dysnea, o beathlessness, has been descibed as simly difficulty beathing. Howeve, fom the esective of a atient with dysnea, it is likened to suffocating, o feeling like a fish out of wate (Nauck & Alt-Eing 2008, Jatuaaton et al, 2010). Dysnea can be acute, with a aid and sudden onset equiing emegency cae, o chonic, with a moe gadual onset that wosens ove time and causes a eson to seek cae when it intefees with nomal activity (Joyce et al, 2010), Pevalence of dysnea is linked to a numbe of evious isk factos, such as a histoy of smoking, asthma, COPD, cadiac disease (esecially HF), envionmental exosues (asbestos, dust fom coal, cotton, o gain), lung cance, lung adiation, anxiety, fatigue, and low efomance status, with highe evalence in individuals with moe isk factos (3). Patients who exeience dysnea ae at highe isk fo deession and have ooe health elated QOL (Janssen et al., 2010, Voll-Aaneud et al., 2010). Most atients who eot dysnea also eot ain and fatigue, egadless of thei undelying diagnosis, and the intensity of dysnea is significantly highe in atients close to death

2 Intenational Jounal of Caing Sciences Setembe Decembe 2016 Volume 9 Issue 3 Page 1067 (Solano et al., 2006, Tishelman et al., 2007). These evalence statistics and isk facto data highlight that dysnea is esent in a vaiety of disease states at vaious stages of illness and is fequently associated with othe sychological symtoms such as anxiety, ain, and deession. The athohysiology of dysnea is multifactoial and includes neuohysiological and affective comonents (O Donnell et al., 2007, Mahle 2006). The neuohysiological comonent begins with chemoeceto detection of hyoxia and/o hyecania, which stimulates the tansmission of affeent neve imulses to the cental nevous system (CNS) (Mahle 2006, Thomas 2009). In the CNS, these imulses ae ocessed and tigge effeent neve imulses to the chest wall and diahagm and signal esiations to incease (Mahle 2006, Thomas 2009). Nuses lay a vital ole in management of dysnea though nusing actice, eseach, and atient education. Howeve, many common nusing inteventions fo management of dysnea ae based on tadition o exet oinion and have not been subjected to scientific examination (Humhis, & Masteson, 2000). Nusing involves caing and suoting atients, and allows ootunities fo tust to develo between the atient and the nuse. These atient-nuse inteactions ae an imotant asect of managing atients with dysnea. A thoough nusing assessment and measuement of systemic obsevations allows the nuse to gain an undestanding of how atients ae managing thei beathlessness (Booke, 2004). This study aimed to assess nuses' actice elated to managing atients with dysnea at emegency units at Pot Said hositals. Reseach Question What is the actice of nuses' elated to managing atients with dysnea at emegency units at Pot Said hositals? Methodology A descitive design was used in this study. Study Settings and oulation The esent study was conducted in emegency units at Alameie and Alzoho hositals at Pot Said city. The study oulation included all available nuses' woked with atients with dysnea at emegency units at at Alameie and Alzoho hositals at Pot Said city. About (50) nuse. Instument of data collection Data wee collected by using a tool that consisted of two ats. Pat 1 includes question fo eliciting infomation on socio-demogahic chaacteistics of the samle and consisted of (10) items. Pat 2 includes the Nuses' dysnea management efomance (obsevational checklist)that it was develoed by Bunne & Suddath s (2003) and was adoted and modified by the eseache to assess nuses actice elated to cae of atients with dysnea. It consisted of two columns ;( done and not done). Befoe the conduction of the study, an official lette was sent fom the faculty of nusing to the selected fo the study hositals. The diecto of each hosital was contacted and infomed about the study in ode to obtain emission to include the nuses' on the esent eseach. Ethical Consideations Puose and exected outcomes of the study wee exlained to each study subject, who wee asued that all the gatheed data will be used fo the eseach uose only, they wee infomed that the study was hamless and that thei aoval to aticiate is a eequisite in ode to be included in the study. Subjects wee assued that they could quit/withdaw wheneve they wanted. The oeational design of the cuent study included the eaatoy hase, content validity, ilot study and field wok. Statistical Design The collected data oganized, tabulated and statistically analyzed using statistical ackage fo social science (SPSS) vesion 16 fo windows, unning on IBM comatible comute.

3 Intenational Jounal of Caing Sciences Setembe Decembe 2016 Volume 9 Issue 3 Page 1068 Qualitative data (categoical data) wee exessed as elative fequency (numbe) and ecent distibution, and fo comaison between gous, the Chi squae. Fo inteetation of esults, the value 0.05 was consideed significant Results Table (1) shows the socio-demogahic chaacteistics of studied nuses. Most of the studied nuses had 20 yeas and less than 30 yeas (86.0%). As egad gaduation about half of them had seconday diloma (50.0%). As egad yeas of exeience about half of them had thee to five yeas of exeience (46.0%). Moe than half of studied nuses said that they; did not have any evious taining couse about management of dysnea while two thid of them had otocol about management of dysnea. On the othe hand most of them mentioned that the numbe of died cases elated to dysnea was (86.0%). Also about (82.0%) said that they obseved by suevisos. Table (2) shows nuses level of actice in assessing hysical assessment aametes. This table illustate that nuse s level of actice in assessing hysical assessment aametes was un in all items. Table (3) shows level of actice in nusing intevention fo dysnea. This table illustate that nuse s level of actice in nusing intevention fo dysnea was as egad administe escibed oxygen theay(100%) and administe escibed oioids via oal oute(72%), while it was not fo othe studied items. Table (4) shows coelation between total actice scoes and socio-demogahic chaacteistics. This table illustate that; thee was highly, statistically significant coelation between total actice scoe and level of education, attending taining ogams and esence of died cases elated to dysnea at the (0.01) level. Also thee was statistically significant coelation between total actice and age, esence of otocol and obsevation by suevisos at the (0.05) level. On the othe hand thee was no statistically significant coelation between total actice scoe and thei yeas of exeience and maital status. Discussion In the esent study they wee included 50 nuses, most of them wee females and between 20 to 30 yeas old. The majoity of nuses had a seconday degee of nusing education (diloma) and the majoity of them had thee to five yeas of exeience. Regading the taining ogam, it was found that; moe than half of studied nuses said that they; did not have any evious taining couse about management of dysnea. These esults agee with Abbas, (2014) who mad study entitled nusing intevention fo management of atient with dysnea at emegency units in Baghdad hositals. Also agee with Booke, (2004 ) that indicates the most of nuses have not taining session fo management of dysnea fo atients at the emegency unit, while two thid of them had otocol about management of dysnea. On the othe hand the numbe of died cases elated to dysnea was (86.0%). Also about (82.0%) was obseved by suevisos. Concening actice of nuses in hysical assessment aametes; the esults eveals that all items wee un such as assessment of Symtom intensity, distess, and intefeence with activities, auscultation of lung sound, assessment of fluid balance, measuement of deendent edema (cicumfeence of lowe extemities), measuement of abdominal gith, temeatue, skin colo, sutum quantity and chaacte and cough. This esult was due to lack of taining ogams done fo nuses which focus on the imotance of assessment was done fo atient befoe management.

4 Intenational Jounal of Caing Sciences Setembe Decembe 2016 Volume 9 Issue 3 Page 1069 Table (1)Distibution the nuses by thei chaacteistics. (N=50) Items N. % Age sex Hosital Social state < 20 yeas to 30 yeas > female male Alzoho Alamiee maied single divoced dilom Gaduation Technical institution bachelo >3yeas Exeience 3-5yeas <5yeas Taining Potocol yes no yes no Died cases yes no Obseved by sueviso yes no

5 Intenational Jounal of Caing Sciences Setembe Decembe 2016 Volume 9 Issue 3 Page 1070 Table (2) Distibution of the nuses accoding to thei level of actice in hysical assessment aametes (N=50) Items N. % Symtom intensity, distess, and intefeence with activities Satisfactoy auscultation of lung sounds assessment of fluid balance measuement of deendent edema (cicumfeence of lowe extemities) measuement of abdominal gith temeatue skin colo sutum quantity and chaacte Satisfactoy Satisfactoy Satisfactoy Satisfactoy Satisfactoy Satisfactoy Satisfactoy cough Satisfactoy

6 Intenational Jounal of Caing Sciences Setembe Decembe 2016 Volume 9 Issue 3 Page 1071 Table (3) Distibution of the nuses accoding to thei level of actice in nusing intevention fo dysnea (N=50) Administe escibed anxiolytic medications as indicated fo anxiety o anic associated with dysnea. Assist with elaxation techniques, guided imagey. Administe escibed bonchodilatos and coticosteoids (obstuctive athology) Administe escibed diuetics and monito fluid balance Administe escibed oxygen theay via nasal cannula, if toleated; masks may not be well toleated. Administe escibed oioids via oal oute (mohine sulfate is used most commonly) Povide ai movement in the atient's envionment with a otable fan. Teach atient and family to imlement enegy consevation measues. Place needed equiment, sulies, and nouishment within each. atient and family instuctions should include anticiation and management of cisis situations. Patients and families should be instucted about medication administation fo dysnea. condition changes that should be eoted to the healthcae ovide and nuse, and stategies fo coing with inceased symtoms as the disease ogesses. The atient and family eassued that the symtom can be effectively managed at home with the need fo activation of the emegency medical sevices o hositalization and that a nuse will be available at all times via telehone o to conduct a visit. Items N. % Satisfactoy Satisfactoy Satisfactoy Satisfactoy Satisfactoy Satisfactoy Satisfactoy Satisfactoy Satisfactoy Satisfactoy Satisfactoy Satisfactoy Satisfactoy

7 Intenational Jounal of Caing Sciences Setembe Decembe 2016 Volume 9 Issue 3 Page 1072 Table (4) coelation between total actice and socio-demogahic chaacteistics (N=50) Total Pactice.293(*) (**) (**) (*) (**) (*).015 Coelation Items Age Sex Hosital Exeience Education maital state taining ogam Potocol died cases Obseved by sueviso Also it was obseved fom the esults of this study that; thee was level in only two items of nuse s actice in nusing intevention fo dysnea, administe escibed oxygen theay and administe escibed oioid via oal oute. But thee was un level in the othe items. This esult id agee with Abbas, (2014) who mentioned that; the esults of his study eveals that evaluation of elative sufficiency was low on most items of nusing intevention fo dysnea. On the othe hand disagee with Shibe and Santana, (2006) which indicated that the most of the items elated to management of dysnea fo atient at the

8 Intenational Jounal of Caing Sciences Setembe Decembe 2016 Volume 9 Issue 3 Page 1073 emegency units was modeate level mean of scoe. The esults indicated that; thee was highly, statistically significant coelation between total actice scoe and level of education, attending taining ogams and esence of died cases elated to dysnea at the ( 0.01) level. These esults agee with Loeb, (2004) which indicated that thee is significant association between taining session of samle and thei level of education and nuses' actice. Also thee was statistically significant coelation between total actice and age, esence of otocol and obsevation by suevisos at the (0.05) level. These esults agee with Shahin et al. (2012), Mohamed & Wafa, (2011) and Penland, (2010). All of them found that thee was a statistical significance elation between nuses' actice and educational level of aticiant. These esults disagee with Abbas, (2014) who indicated that thee is no significant association between ages and nuses actice scoe. On the othe hand thee was no statistically significant coelation between total actice scoe and thei yeas of exeience and maital status. These esults agee with Abbas, (2014) who indicated that thee is significant association between nuses yeas of exeience and nuses actice scoe. Conclusion The study concluded that the most of the nuses who woked in emegency units have inadequate nusing actice skills in managing atient with dysnea. Recommendations In the light of the findings of the cuent study the following ecommendations ae suggested: Secial taining ogam designed and constucted fo nuses in this aea to einfoce thei actical skills. Ugading nuses' actice about caing of atient's with dysnea though encouage nuses attend national and intenational woksho about caing atients with dysnea. Release hand book fo nuses' actices concening with management a dysnea fo atient at the emegency units, it included bief exlain with text and ictues Refeences Abbas, A. (2014). Nusing Intevention Fo Management Of Patient With Dysnea At Emegency Units In Baghdad Hositals; 2:3, Booke R. (2014). The effective assessment of acute beathlessness in a atient. Nusing Times; 2004, 100: 24, Humhis, D., and Masteson, A.(2000) Develoing New Clinical Roles. A Guide fo Healthcae. London, Chuchill, Livingstone Janssen DJ, Suit MA, Leue C. Gijsen C, Hamelees H, Schols JM, Woutes EF. Cio netwok. (2010) Symtoms of anxiety and deession in COPD atients enteing ulmonay ehabilitation. Chon Resi Dis. 2010;7(3): Jatuaaton D, Moan E, Obwanga C, Husain A. (2010). Patients exeience of oxygen theay and dysnea: a qualitative study in home alliative cae. Suot Cae Cance;18(6): Joyce MM. Dysnea. In: Bown CG, ed. (2010). A Guide to Oncology Symtom Management. Pittsbugh, PA: Oncology Nusing Society Loeb M. (2004). Pneumonia in the eldely. Cu Oin Infect Dis 2004; 17 (2): Mahle DA. (2006). Mechanisms and measuement of dysnea in chonic obstuctive ulmonay disease. Poc Am Thoac Soc;3(3): Mohamed, S., and Wafa, A. (2011): The effects of an educational ogam on nuse's knowledge and actice elated to heatitis c vius: a etest and osttest quasi exeimental design. Austalian Jounal of Basic and Alied Sciences, 5(11): Nauck F, Alt-Eing B. (2008). Cises in alliative cae via comehensive aoach. Lancet Oncol.;9(11): O'Donnell DE 1, Banzett RB, Caiei-Kohlman V, Casabui R, Davenot PW, Gandevia SC, Gelb AF, Mahle DA, Webb KA. (2007). Pathohysiology of dysnea in chonic obstuctive ulmonay disease:a oundtable. Poc Am Thoac Soc;4(2): Penland, K. (2010): The elationshi between nuse nutition knowledge and unintentional weight loss in nusing home esidents. Dissetations of the Univesity of Aizona: Shahin, M., Mohamed, W., and Sayd, M. (2012): Nuses Knowledge and Pactices Regading Enteal Nutition at the Citical Cae Deatment of Al- Manial Univesity Hosital in Egyt: Imact of a Designed Instuctional Pogam. Jounal of Ameican Science, 8 (11) Shibe, J.; and Santana, J. (2006). Dysnea. Med. Clin. Noth Am; 90 (3):

9 Intenational Jounal of Caing Sciences Setembe Decembe 2016 Volume 9 Issue 3 Page 1074 Solano JP, Gomes B, Higginson IJ. (2006). A comaison of symtom evalence in fa advanced cance, AIDS, heat disease, chonic obstuctive ulmonay disease and enal disease. J Pain Symtom Manage;31(1): Tishelman C, Petesson LM, Degne LF, Sanges MA. (2007). Symtom evalence, intensity, and distess in atients with inoeable lung cance in elation to time of death. J Clin Oncol.; 25(34): Thomas JR.. (2009). Management of dysnea. In: Ettinge DS, ed. Cance and Dug Discovey Develoment: Suotive Cae in Cance Theay. Totowa, NJ: Humana Pess Voll-Aaneud M, Eagan TM, Plana E, et al. Resiatoy symtoms in adults ae elated to imaied quality of life, egadless of asthma and COPD: esults fom the Euoean community esiatoy health suvey. Health Qual Life Outcomes. 2010;8:107.