Knowledge and Practice of Blood Transfusion: A Survey of Nurses in Abu Dhabi, United Arab Emirates. Dr. Belal M. Hijji 1, Proff. Kader Parahoo 2, Proff. Mohammad M. Hossain 3, Dr. Owen Barr 2, Shirley Murray 4 1 Faculty of Nursing, Philadelphia University, Jordan 2 Institute of Nursing Research, Faculty of Life & Health Sciences, University of Ulster, UK 3 Institute of Medicine, Universiti Brunei Darussalam 4 Royal Group of Hospitals, Belfast, UK 4 Royal Group of Hospitals, Belfast, UK

The Second JNC International Nursing Conference, April 23rd - 24th 2008, Jordan2 Contents Background Background Aims Aims Methods Methods Results Results Recommendations Recommendations

The Second JNC International Nursing Conference, April 23rd - 24th 2008, Jordan3 Background

4 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

The Second JNC International Nursing Conference, April 23rd - 24th 2008, Jordan5 Aims

6 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

The Second JNC International Nursing Conference, April 23rd - 24th 2008, Jordan7 Methods

8 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

The Second JNC International Nursing Conference, April 23rd - 24th 2008, Jordan9 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

The Second JNC International Nursing Conference, April 23rd - 24th 2008, Jordan10 PopulationSample Observations:140 nur.50 (random) Survey439 nur.263 (random) Focus groups----29(convenience) Population and/ or samples

The Second JNC International Nursing Conference, April 23rd - 24th 2008, Jordan11 Methods of data collection A structured observation schedule Knowledge questionnaire Focus group interviews

The Second JNC International Nursing Conference, April 23rd - 24th 2008, Jordan12 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 (9 items), general issues relating to the care of transfusion patient (27 items), complications related to transfusion (13 items), and issues related to local policies (2 items).

The Second JNC International Nursing Conference, April 23rd - 24th 2008, Jordan13 Allocation of scores to knowledge and practice items  Questionnaire: For the majority of the items, one point was awarded for each correct response and no point for the incorrect one. The maximum score of 70 points was allocated. The test item formats used were multiple choice and response, true – false, and short answers. The Flesch Reading Ease (RE) Index is 68.3 suggesting that the questionnaire is easily understandable.  Observation schedule: For most items, one point was given for the performance of an observable activity and no point for the non-performance or for unnecessary practices. This resulted in a maximum score of 21 points. The items were linked with the relevant ones on the questionnaire and were given identical weight.

The Second JNC International Nursing Conference, April 23rd - 24th 2008, Jordan14 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

The Second JNC International Nursing Conference, April 23rd - 24th 2008, Jordan15 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

The Second JNC International Nursing Conference, April 23rd - 24th 2008, Jordan16 Results

The Second JNC International Nursing Conference, April 23rd - 24th 2008, Jordan17 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.

The Second JNC International Nursing Conference, April 23rd - 24th 2008, Jordan18 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)

The Second JNC International Nursing Conference, April 23rd - 24th 2008, Jordan19 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

The Second JNC International Nursing Conference, April 23rd - 24th 2008, Jordan20 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 Knowledge and Practice Scores MeanMedianModeRange Knowledge scores Practice scores

The Second JNC International Nursing Conference, April 23rd - 24th 2008, Jordan21 The relationship between nurses’ blood transfusion knowledge and practice scores Spearman’s rho correlation coefficient = 0.22, p. =0.14)

The Second JNC International Nursing Conference, April 23rd - 24th 2008, Jordan22 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 Barriers influencing nurses’ knowledge and practice of blood transfusion (focus groups) Human, organisational, societal, and educational

The Second JNC International Nursing Conference, April 23rd - 24th 2008, Jordan23 Recommendations

The Second JNC International Nursing Conference, April 23rd - 24th 2008, Jordan24 Action is needed, simultaneously, on several fronts to rectify the current situation 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 Replicate the study in Jordan Replicate the study in Jordan

The Second JNC International Nursing Conference, April 23rd - 24th 2008, Jordan25 Thank You Principal Investigator

The Second JNC International Nursing Conference, April 23rd - 24th 2008, Jordan26 REFERENCES Bayraktar, N. and Erdil, F. (2000). Blood transfusion knowledge and practice among nurses in Turkey [Special Focus Issue: Hematology]. Journal of Intravenous Nursing, 23(5), British Committee for Standards of Haematology (1999). The administration of blood and blood components and the management of transfused patients. Transfusion Medicine, 9,