الفهرس 
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Abstract
Summary
Therapeutic plasma exchange is an extracorporeal therapy used in the treatment and management of various diseases and is achieved through the removal , discarding of selected blood constituents and replacing plasma with physiological fluids such as albumin or donated plasma from a healthy person and other colloids or crystalloids (Solanki et al., 2021). Separation of plasma components can be performed through centrifugal apheresis or filtration. The main mechanism of action of TPE is the rapid removal of specific pathogens, such as abnormal antibodies, paraproteins, antigen, antibody complexes, alloantibodies, endogenous toxins or exogenous poisons. (Calça et al., 2020).
The role of nurse is very important and multiple in managing patients undergoing TPE, as the nurses should have responsibility in knowledge, practice, education, psychological, research and communication. (Hamza et al., 2019). In TPE procedure, the nurse should be able to manage anticoagulation in the extracorporeal circuit, manage replacement fluids, maintain patent venous access , observe side effects in the patients, evaluate patient`s laboratory values and manage electrolyte imbalances. (Ravi et al., 2021)
The therapeutic plasma exchange`s nurse has to ensure patients that have an understanding of their disease, treatment options and support services in conjunction with the responsible doctors (Hematologists, Nephrologists or others) and provide effective coordination for patients undergoing TPE within the hospital. (Barth et al., 2020)
Aim of the study:
The present study was conducted to assess nurses’ performance regarding Patients undergoing therapeutic plasma exchange through the following:-
1. Assess nurses’ level of knowledge regarding patients undergoing therapeutic plasma exchange.
2. Assess nurses’ level of practice regarding patients undergoing therapeutic plasma exchange.
Research questions:
The study was conducted for answering the following questions:
1. What is the nurses’ level of knowledge regarding patients undergoing therapeutic plasma exchange?
2. What is the nurses’ level of practice regarding patients undergoing therapeutic plasma exchange?
Subjects and methods:
Study design:
A descriptive exploratory design was followed to achieve the aim of this study.
Study setting:
The study was conducted at the therapeutic plasma exchange room in the combined dialysis unit affiliated to Ain Shams University Hospitals.
Subject:
A convenience sample of all available nurses (no= 35) who are working in the previously mentioned setting and providing care for patients undergoing therapeutic plasma exchange were recruited in this study.
Tools of data collection:
Two tools were used in current study for data collection as following:
Tool I: Nurses’ Self-Administered Questionnaire: (Appendix Ι)
It was developed by the investigator in a simple Arabic language to evaluate nurses’ level of knowledge regarding patients undergoing therapeutic plasma exchange, it was guided by (Reddy, 2021), (Sergent & Ashurst, 2022), (International Society for Apheresis, 2019), (National Health Service blood and transplant, 2019), (Neyrinck & Vrielink, 2019), filled by the studied nurses and it composed of the following 2 parts:
• Part one: Demographic data of nurses: It is concerned with assessing demographic characteristics of nurses under study.
• Part two: Nurses’ Knowledge Questionnaire: This part composed of four sections in the form of multiple choices question (MCQ).
First section: General knowledge about therapeutic plasma exchange that was included 19 questions.
Second section: The role of the nurse before the therapeutic plasma exchange procedure was included 9 questions.
Third section: The role of the nurse during the therapeutic plasma exchange procedure was included 9 questions.
Fourth section: The role of the nurse after the therapeutic plasma exchange procedure was included 8 questions.
Tool II: Nurses’ practice Observational Checklist (Appendix ΙΙ)
This tool was adapted from (Sergent & Ashurst, 2022), (National Health Service blood and transplant, 2019), (Kozier et al., 2019), (Lister et al., 2018), (Berman et al., 2017), (NHS, 2017) to evaluate nurses’ practice regarding patients undergoing therapeutic plasma exchange (pre, during and post procedures) and modified by the investigator after reviewing the related literature and reviewed by supervisors to achieve the aim of this study. It composed of three sections:
First section: Pre procedure of therapeutic plasma exchange, 37 steps composed of (No 1-15 steps) in patient`s preparation and from (No 16-37 steps) in machine`s preparation.
Second section: During the procedure of therapeutic plasma exchange, included 29 steps from (No 1-29 steps).
Third section: Post procedure of therapeutic plasma exchange, included 13 steps from (No 1- 13 steps).
Operational Design:
The operational design for this study consisted of four phases, namely preparatory phase, ethical considerations, pilot study, and fieldwork.
Preparatory Phase:
It includes reviewing of related literature and theoretical knowledge of various aspects of the study using books, articles, internet, periodicals and magazines.
Testing Validity and reliability:
Tools Validity:
Face and Content validity was conducted to examine the tool by a jury of (7) experts, two professors, four assistant professor and one lecturer from the medical surgical nursing staff at the Faculty of Nursing Ain Shams University. The experts reviewed the tools for format, clarity, relevance, simplicity, accuracy, comprehensiveness, and applicability, and minor modification was done.
Tools Reliability:
Testing reliability of the proposed tools was done statistically by Cronbach alpha test. Tool I: Nurses’ Self-Administered Questionnaire was 0.821 and Cronbach alpha for Tool II: Nurses’ practice Observational Checklist was 0.847.
Pilot study
Before performing the actual study, a pilot study was carried out on 6 nurses 20% of the nurses from the study subjects to test the clarity, applicability and feasibility of the constructed tools. According to the results of the pilot, no corrections and no omissions of items were performed, so the pilot subjects were included in the study subjects.
Fieldwork:
- An approval was obtained from the Dean of Faculty of Nursing, Ain Shams University.
- An approval was obtained from hospital director and nursing director of Ain Shams University Hospital.
- An approval of the nurses was obtained written before collecting data and after explaining the purpose of the study.
- The purpose of the study was simply explained to the nurses under study prior to any data collection.
- Data were collected in four months from the beginning of June 2021 to the end of September 2021.
Administrative design:
To carry out this study in the selected setting, official letters were issued from the Faculty of Nursing Ain Shams University explaining the aim of the study to obtain the permission for collecting of the data; this letters were submitted to the hospital director and the director of dialysis unit at Ain Shams University Hospital.
Statistical design:
The statistical analysis of data was done by using the computer software of Microsoft Excel Program and Statistical Package for Social Science (SPSS) version 25. Data were presented using descriptive statistics in the form of frequencies and percentage for categorical data, the arithmetic mean (X̄) and standard deviation (SD) for quantitative data. Qualitative variables were compared using chi square test (x2), P-value to test association between two variables and Pearson correlation test (r- test) to the correlation between the study variables.
Degrees of significance of results were considered as follows:
- P-value > 0.05 Not significant (NS)
- P-value ≤ 0.05 Significant (S)
- P-value ≤ 0.01 Highly Significant (HS).
Results:
The results of the study showed that:
• In relation to age, more than one third (42.8%) of the studied nurses were their age ranged between 20-<30 years, the Mean ± SD of age is 33.7 ± 8.09 years and more than two third (68.6%) of them were females.
• As regard the educational level, less than half (42.9%) of the studied nurses had nursing diploma and near to half (48.6%) of the studied nurses had 5-< 10 years of experience in therapeutic plasma exchange, the Mean ± SD of years of experience is 7.48 ± 4.01 years.
• Regarding attendance of training courses, near to one third (31.4%) of studied nurses had attended courses about therapeutic plasma exchange and the majority of studied nurses (91.4%) stated that there was written policy in the unit regarding therapeutic plasma exchange.
• More than three quarters (80%) of the studied nurses had unsatisfactory level of total knowledge regarding patients undergoing the therapeutic plasma exchange. While, less than one quarter (20.0%) of them had satisfactory level of total knowledge.
• More than three quarters (77.1%) of the studied nurses had incompetent level of total practice regarding the patients undergoing therapeutic plasma exchange, while near to one quarter (22.9%) of the studied nurses had competent level of total practice regarding the patients undergoing therapeutic plasma exchange.
• There was a highly statistically significant relation between total nurses’ knowledge with their education level and attendance of training courses for therapeutic plasma exchange (P=0.001 and 0.000) respectively.
• Also, there was statistically significant relation between total nurses’ knowledge with nurses` years of experience and availability of a written policy in the unit regarding therapeutic plasma exchange (P=0.048 and 0.035) respectively.
• There was no statistically significant relation between total nurses’ knowledge with nurses` age and gender at (P=0.741 and 0.619) respectively.
• There was a highly statistically significant relation between total nurses’ practices with their education level and attendance of training courses for therapeutic plasma exchange (P= 0.001 and 0.003) respectively.
• There was statistically significant relation between total nurses’ practices with their years of experience and availability of a written policy in the unit regarding therapeutic plasma exchange (P= 0.046 and 0.027) respectively.
• There was no statistically significant relation between total nurses’ practices with their age and gender (P= 0.821 and 0.503) respectively.
• there was highly significant positive correlation between total knowledge score and total practices score regarding patients undergoing therapeutic plasma exchange among the studied nurses (P= 0.000).
Conclusion:
Based on findings of the current study, this study concluded that, more than three quarters of the studied nurses had unsatisfactory level of total knowledge and had incompetent level of total practice regarding the patients undergoing therapeutic plasma exchange.
As well as, there was a highly statistically significant relation between total nurses’ education level, attendance of training courses for therapeutic plasma exchange and nurses` knowledge and practice. Moreover, there was statistically significant relation between nurses` years of experience, availability of a written policy in the unit regarding therapeutic plasma exchange and nurses` knowledge and practice. While, there was no statistically significant relation between nurses` age, gender and nurses` knowledge and practice. Also, the present study results showed that, there was highly significant positive correlation between total knowledge score and total practices score regarding patients undergoing therapeutic plasma exchange among the studied nurses.
Recommendations
1- Ongoing and regular in service educational programs regarding evidence-based guidelines should be including care of patients undergoing TPE.
2- Nursing educators and clinical facilitators must incorporate strategies using learning opportunities to raise awareness of nursing staff about topics of TPE` knowledge and practice.
3- In service training and educational program prior to the work in TPE room, nursing staff must be knowledgeable and skillful in providing professional care for patients undergoing TPE.
4- Ongoing and regular in-service training regarding basic procedures as: pre procedure, during procedure and post procedure of TPE.
5- The study should be replicated on large samples and in different hospital setting in order to generalize the results.