الفهرس 
AcknowledgmentsOnly 14 pages are availabe for public view
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Abstract
SUMMARY
Intensive care nurses play a key role in patients‘ recovery. They must respond continuously and quickly to the needs of patients and families, carry out procedures accurately, and interact with the most intense emotional aspects of life. They work in demanding and stressful work environments to help patients in critical conditions.
In addition, patient safety and quality of care are major problems in intensive care units. characteristics of the ICU work environment can create obstacles for nurses in performing patient care tasks, therefore threatening the quality and safety of care provided by nurses. Factors affecting on performance such as absenteeism, overwork, fatigue, lack of information about the patient, and problems with equipment can increase the nursing workload.
Performance obstacles have significant impact on nursing workload, perceived quality and safety of care, and quality of working life (QWL). Workload mediates the effects of performance obstacles on perceived quality and safety of care and quality of working life.
The present study was conducted with the aim of investigating the relationships among performance obstacles, workload, and quality of working life, quality & safety of care, among ICUs nurses at Assuit University Hospitals, Study the effect of performance obstacles and workload on quality of working life, and quality and safety of care, determine the effect of workload as a mediator variable (performance obstacles, quality of working life and quality and safety of care), and suggest corrective actions to balance out identified the impact of the system flows and redesign the work system.
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Data were collected using a structured questionnaire: - it consists of five parts
Part -1- Personal characteristic of study subjects: It is designed to gather data about the respondents’ gender, age, marital status, nurse qualification, current job title, years of experience, and shift hours of work. Five questions about information unit‘ system of work.
Part -2- Performance obstacles questionnaire: it consists of two parts a, b
a- 40 items which divided into six sub items as follows: -Physical work environment (10 items). Family relations (4 items). Supplies and Equipment’s (8 items). Cooperation and helping others and getting help from others (7 items) Records and reports (4 items). Information transfer and communication (7 items).
b- One open question for any special event or circumstance that affected (increased or decreased) nurse workload during shift.
Part-3- Measuring quantitative workload ”the National Aeronautics and Space Administration Task Load Index (NASA-TLX)”, it consists of three parts: - a, b
a- Including six dimensions that deal with the workload nurses experience in their job. At the first, four dimensions (Mental demand, physical demand, temporal demand and frustration).Fifth dimension, (Effort of the work) sixth dimensions (degree of satisfaction about performance). The scoring system for all dimensions were measured by(low=0 or high=100).
In addition, another scale measure, Rating Scale Mental Effort (RSME): RSME is a one-dimensional subjective workload scale ranging from 0 to 150, (horizontal line), the scale has nine descriptive indicators along its axis Scale ranging from (0 = absolutely no effort) to (120=Extreme effort) and extended to 150. b- Nursing Activity score tool for nursing activities system (NAS) focus on the time spent with the patient. Indirect patient activities and other daily activities that are important to the measurement of nursing workload, it
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consisted of 23 items measured by, (scale points, yes or no). one-point NAS = 14.4 minutes. Comprised of 23 items.
Part 4- Quality of working life questionnaire. It consists of three scales. The first, one statement was measuring job satisfaction, measured by five points Likert scale that ranged from (Not satisfied at all =one to Very satisfied =five). The second, six statements were measuring stress. Measured by five points Likert scale that ranged from (strongly disagree = one to strongly agree = five).
The last was measuring mood status and degree of fatigue. Measured by five points Likert scale that ranges from (not at all = one to extremely = five).
Part 5- Quality and Safety of care questionnaire: - This construct of five statements to assess the quality and safety of care. All of them measured by three, likert scales.
Methods: -
An official approval to carry out the study was obtained from responsible persons in the selected hospitals to be able to collect the necessary data. For the pilot study and then to collect the necessary data for the present study. This phase took about 6 months to reviewing the available literature concerning the study topic. In addition, an Arabic translation of all study tools was done. A Pilot study was fulfilled on 20 nurses by using structured interview for testing its feasibility, understandability, reliability and validity. The first time, crombach alpha coefficient was 0.60, modification of study tools was done and pilot study was repeated again, it was 0.91.
The data phase of the present study was carried out within four months period started from June to October, (2016). The researcher selected seven head nurses every shift to help her to collect data from nurses. The researcher trained them, the session included, explaining each item included in the study tools after ensuring the clarity of the tools, the actual data collection started. Data was collecting in three shifts (morning, evening, and night) at the last 30 mints from shift.
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Results of the present study revealed that: -
All of the studied nurses in ICUs at Assuit university hospitals were females and were working bedside nurse (direct care). Vast majority of them in age group range between 25 < 35years, more than two thirds of them had less than 5 years of experience.
The great majority of the studied nurses were highly stressed; more than three quarters of them were fatigued although more than two thirds of them were satisfied. The mean for overall workload was high. Majority of the studied nurses reported that level of quality & patient safety was moderate.
The most influential items of performance obstacles were nursing staff not enough to handle the number of patient, Distractions from patient family‘s members, no enough of equipment, Use equipment was in poor condition. More than half of them reported that there was a delay in getting medications from pharmacy and positive effect on workload, haven‘t enough supplies for the patient, physician not available during need for patient.
Nearly half of the studied nurses mentioned other performance obstacles that increased workload during the shift, (bad interpersonal relationship and shortage of staff nurses). There was relation between dimensions of workload and quality of working life. There was statistically significant positive correlation between total quality and safety of care and some dimensions of workload (mental, temporal, efforts and RSME). There was statistically significant positive correlation between physical work environment and RSME, and between supplies & equipment and some dimensions of workload (mental, temporal, frustration level). While there was statistically significant negative correlation between cooperation and frustration level.
Twenty items of performance obstacles had statistical significant positive effect on workload while, three items had negative effect on workload.يلعب ممرضات العناية المركزة دورا رئيسيا فى شفاء المرضى يجب على الممرضات تستجيب بشكل مستمر وسريع لاحتياجات المرضى وعلاقاتهم بتنفيذ الاجراءات بدقة ويتفاعلن مع الجوانب العاطفيةويعملن فى بيئات عمل شاقة ومرهقة لمساعدة مرضى الحالات الحرجة.