Knowledge and Practice of Blood Transfusion: A Survey of Nurses in Abu Dhabi, United Arab Emirates. Belal M. Hijji 1, Kader Parahoo 1, Mohammad M. Hossain 2, Owen Barr 1, Shirley Murray 3 1 Institute of Nursing Research, Faculty of Life & Health Sciences, University of Ulster, UK 2 Institute of Medicine, Universiti Brunei Darussalam 2 Institute of Medicine, Universiti Brunei Darussalam 3 Royal Group of Hospitals, Belfast, UK 3 Royal Group of Hospitals, Belfast, UK

September 7-8/ th EDNSC, Vienna, Austria Contents Background Background Aims Aims Methods Methods Results Results Recommendations Recommendations

Background

September 7-8/ th EDNSC, Vienna, Austria Nurses play a crucial role in the administration of blood transfusions Their relevant knowledge and practice are important determinants of the safety of transfusions Published information about nurses' blood transfusion knowledge and practice and what influences them is lacking To fill this information gap, this study was undertaken in Abu Dhabi Emirate, UAE

Aims

September 7-8/ th EDNSC, Vienna, Austria Principal aims To observe and document nurses’ actual blood transfusion practices To investigate nurses’ level of knowledge of blood transfusion To examine the relationship between knowledge and actual practice To explore the reasons for potential knowledge- practice gap

September 7-8/ th EDNSC, Vienna, Austria Methods

Data were collected between January and October 2005 This was a 3-phase study where a mixed method design incorporating quantitative and qualitative methods was used to meet its aims

September 7-8/ th EDNSC, Vienna, Austria 2 medium-sized, public, general hospitals (A, B) in Abu Dhabi Emirate, UAE Observations were conducted in 3 wards in each hospital; the survey involved 21 wards; and 11 departments (administrative, clinical, quality) provided volunteers for the focus groups Study settings and access Approvals were obtained from the Ministry of Health and hospital A research ethics committees, and hospital B administration

September 7-8/ th EDNSC, Vienna, Austria PopulationSample Observations:14050 (random) Survey (random) Focus groups (convenience) Population and/ or samples

September 7-8/ th EDNSC, Vienna, Austria Methods of data collection A structured observation schedule Knowledge questionnaire Focus group interviews

September 7-8/ th EDNSC, Vienna, Austria Data on nurses’ actual practice was collected via an observation schedule developed by Bayraktar and Erdil (2000) and new items were added based on the BSCH (1999) guidelines, experts’ advice, and local practice. Nurses were observed 10 minutes before blood collection until 15 minutes after the initiation of transfusion An overview of data collection Nurses’ knowledge of blood transfusion was measured via a questionnaire developed following consultation with nursing literature on caring for transfusion patients. It covered nurses’ demographics and training, general issues relating to the care of transfusion patient, complications related to transfusion, and issues related to local policies.

September 7-8/ th EDNSC, Vienna, Austria The interview guide had 4 questions focusing on the reasons for the knowledge practice gap, evidence for warming blood, reasons for knowledge deficits, and ways to improve nurses’ blood transfusion practices Validity and reliability Observation schedule and questionnaire: Transfusion experts and pilot testing. CVI 95% (questionnaire) Interview guide: Check on content validity with a nurse manager and 1 pilot focus group

September 7-8/ th EDNSC, Vienna, Austria Data analysis For the quantitative components, descriptive and inferential statistics as well as parametric and nonparametric tests and correlation methods were used, as appropriate. For the qualitative component, content analysis was used to produce themes generated from the focus groups data

September 7-8/ th EDNSC, Vienna, Austria Results

49 nurses (98%) were observed 248 nurses (95.4%) filled in the questionnaire. The knowledge and observed practice of 48 nurses is only reported here Five focus groups (5-7 members in each), including the pilot, were undertaken.

September 7-8/ th EDNSC, Vienna, Austria The nursing activity (Selective) Nurses who knew Nurses who performed Blood administered no later than 30 minutes following removal from blood bank 4427 Informing the patient (or relative) about: Reasons/ benefits of blood transfusion 480 Risks of blood transfusion 270 Reaction symptoms 4313 Blood transfusion knowledge and practice among nurses (n = 48)

September 7-8/ th EDNSC, Vienna, Austria The nursing activity Nurses who knew Nurses who performed Asking the patient to state his name 183 Asking the patient to state his date of birth 10 Checking the patient ID band 3821 Comparing together the information on patient's ID, blood bag, blood bank form and prescription chart 32 Recording BP before transfusion 4415 Recording pulse before transfusion 4418 Recording temperature before transfusion 4433

September 7-8/ th EDNSC, Vienna, Austria The nursing Activity Nurses who knew Nurses who performed Recording pulse 15 minutes after starting the transfusion 3712 Recording temp. 15 minutes after starting the transfusion 3716 Blood transfusion completed within 4 hours after collection 4122 Key findings Nurses’ knowledge was not sufficiently put into practice Nurses’ knowledge was not sufficiently put into practice Nurses’ lack of knowledge was reflected in practice Nurses’ lack of knowledge was reflected in practice Patients were at risk of developing complications, in particular bacterial infection and misidentification Patients were at risk of developing complications, in particular bacterial infection and misidentification

September 7-8/ th EDNSC, Vienna, Austria The relationship between nurses’ blood transfusion knowledge and practice scores Spearman’s rho correlation coefficient = 0.22, p. =0.14) Human, organisational, societal, and educational Barriers influencing nurses’ knowledge and practice of blood transfusion (focus groups)

September 7-8/ th EDNSC, Vienna, Austria Recommendations

Urgent training and education Urgent training and education Human and material resources Human and material resources Improving image and status of nursing Improving image and status of nursing

September 7-8/ th EDNSC, Vienna, Austria Thank You Principal Investigator