Nurses’ Knowledge and Practice on Care of Critically Ill Adult Patients in Ward Settings at Mnazi Mmoja Hospital, Zanzibar

Abstract

Background: Many critically ill patients cared within the ward because of inadequate spaces in ICU. Nurses working in ward settings have been responsible for caring critically ill patients as well as preventing further deterioration of the patients. However, little is known on their knowledge, practices and challenges they face in caring such patients. The aim of the study: To assess nurse’s knowledge, practice and challenges on the care of critically ill patients in ward settings at Mnazi Mmoja Hospital, Zanzibar. Methodology: This is a descriptive, hospital-based cross-sectional study, conducted at Mnazi Mmoja Hospital – Zanzibar and recruited 172 nurses who were working in different wards and taking care of adult critically ill patients. Data were collected by using a questionnaire to assess knowledge and challenges are faced by the nurses in fulfilling their duties and checklist for the observation during caring of critically ill patients. Descriptive statistical data analysis from SPSS version 20 such as frequencies and percentages were used and the findings were summarized and presented in tables, pie charts, bar chart, and histograms. Result: The participants age ranged from 20 to 50 years with the majority of them were aged below thirty years (52.3%) and with the male to female ratio of 1:3.5. More than half of the nurses (83.1%) had Diploma level education, 58.7% of participants had working experience of one to five years and almost two-thirds (62.8% ) had not attended in-service training. The mean score of nurses knowledge on assessment of critically ill patients was 56.8% (SD =17.12). About (91.3%) of participants knew ABCDE as the initial approach of assessing critically ill patients. Half of the participants (51.2%) reported knowing that airway is the first parameter to assess when patient condition is deteriorating, though only (19.9%) knew to confirm patent airway, 44.2% knew to assess circulation and only 29.1% reported knowing all parameters used to assess peripheral perfusion. Likewise, (54.1%) were not knowledgeable on the parameter for high risk or deterioration of patients. Although (84.3%) of participants agreed that they do care critically ill patients in the wards, 40.7% participants used ABCDE approach on an initial assessment of critically ill patients and 38.4% done intervention post problem identification. In addition, the majority of participants (84.9%) measure vital signs although not all parameters were measured especially the level of consciousness and saturation level were often not measured. and only 26.2% monitored vital signs on regular basis, 32.6% done documentation and 64.5% delivered reports at the time of handover but not systematic. Major challenges for caring of critically ill patient were inadequate equipments or materials (91.3%), shortage of staff (72.1%) and lack or poor knowledge and skills (37.2%), Conclusion & Recommendation: Despite the majority of nurses care critically ill patients, the only few have on job training. There are inadequate knowledge and suboptimal practice on care of critically ill patients in the ward, thus it is mandatory to have on job training, CPR course, to develop and review the existing guideline and tools and to use them routinely when providing care in the ward.