Nurses' Knowledge versus Their Performance in Caring for Neonates Having Respiratory Distress Syndrome

Abstract

Respiratory Distress Syndrome is an acute lung disease that results from surfactant deficiency correlating with structural and functional lung immaturity. It is the most common neonatal emergency and the main cause of admission to neonatal intensive care units. Knowledge and performance must be assessed to determine whether nurses' performance are based on their knowledge or not for improving the neonatal nurses' quality of care during the care of neonates with RDS. Therefore, this study aimed to determine nurses' knowledge versus their performance in caring for neonates with RDS. The study was conducted at Neonatal Intensive Care Units (NICUs) of Ain-Shams University Hospitals and El-Fayoum University, General and Health Insurance Hospitals. All the nurses who cared for neonates with RDS, at NICUs in the previously mentioned settings were involved in the study (N= 60 nurse). Two tools were used for data collection: Structured observational checklist for nurses' performance in caring for neonates with RDS and structured questionnaire sheet for nurses' knowledge regarding care of neonates with RDS. The structured observational checklist was developed by the researcher guided by Abd El-Hameed (2010) and included the necessary aspects of care of neonates with RDS. The structured questionnaire sheet was developed by the researcher. It included biosocial data of both, nurses and neonates, nurses' knowledge about RDS and nurses' knowledge about care provided to neonates with RDS. Every nurse was observed closely for five days. After observations were completed for all the nurses, they were asked to answer the questionnaire. The main results of this study were as follows:  Slightly more than two thirds of the nurses' age was less than 30 years old (68.3%), with a mean age 26.78±7.41 year.  Slightly more than half of the nurses were having Diploma degree in nursing (55%) and 21.7% having Bachelor degree.  Almost half of the nurses were having less than 5 years' experience (46.7%), with mean years of experience 7.57±7.13 years.  Only 30% of the nurses attended educational classes about RDS.  More than four fifth of the neonates' gestational age were between 28 weeks to less than 32 weeks with a mean gestational age 32.98±2.8 weeks.  The chronological age of 41.7% of the neonates was more than 24hrs to less than 96hrs, with a mean chronological age 62.2±24.8hrs.  Slightly more than half of the neonates were males (51.7%) and 71.7% were delivered by cesarean section.  Only 18.3% of the nurses knew the definition of RDS.  Surfactant as the main cause of RDS was stated by 51.7% of the nurses.  Cyanosis was reported by 78.3% of the nurses, tachypnea by 46.7% while, 5% reported flaring of the external nares as manifestations of RDS.  Sixty three point three percent of the nurses knew that oxygen therapy is the main management of neonates with RDS, while 60% mentioned mechanical ventilation.  The majority of the nurses mentioned that all the neonates with RDS need oxygen therapy (95%).  More than three quarters of the nurses mentioned pulse oximetry (76.7%) and 48.3% reported ABGs as methods used to measure SaO2.  Only 43.3% of the nurses knew that retinopathy of prematurity is the main complication of oxygen therapy and 1.7% mentioned bronchopulmonary dysplasia.  About one quarter of the nurses knew how to measure capillary refill (26.7%)  Regarding indications of ventilator, 21.7% of the nurses stated hypoxemia, 1.7% mentioned acute respiratory acidosis and none of them knew severe respiratory failure.  Slightly more than four fifth of the nurses knew that the neonates with RDS need suctioning (83.3%).  Only 4 % of the nurses knew that the precautions before suctioning is giving the neonates full oxygenation, while, 13.3% knew that they must perform suctioning for 10: 15 seconds only.  Slightly more than four fifth of nurses knew that the neonates with RDS need ABGs examination (81.7%).  Although all the nurses did all the steps of oxygen therapy administration through nasal cannula or mask, minority of them knew these steps except, turn on flow meter to prescribed amount and place nasal prongs just inside external meatus of the nose were known to 82.1% and 67.9% of the nurses respectively.