1 Faculty of Nursing, Philadelphia University, Jordan

1. Knowledge and Practice of Blood Transfusion: A Survey of Nurses in Abu Dhabi, United Arab Emirates. Dr. Belal M. Hijji1, Proff. Kader Parahoo2, Proff. Mohammad M. Hossain3, Dr. Owen Barr2, Shirley Murray4 1Faculty of Nursing, Philadelphia University, Jordan 2Institute of Nursing Research, Faculty of Life & Health Sciences, University of Ulster, UK 3Institute of Medicine, Universiti Brunei Darussalam 4Royal Group of Hospitals, Belfast, UK

2. Contents • Background • Aims • Methods • Results • Recommendations

3. 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

5. 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

7. Methods

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

9. Study settings and access 2 medium-sized, public, general hospitals (A, B) in Abu Dhabi Emirate, UAE Approvals were obtained from the Ministry of Health and hospital A research ethics committees, and hospital B administration 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

10. Population and/ or samples Population Sample Observations: 140 nur. 50 (random) Survey 439 nur. 263 (random) Focus groups ---- 29(convenience)

11. Methods of data collection A structured observation schedule Knowledge questionnaire Focus group interviews

12. An overview of data collection 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 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).

13. 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.

14. 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 reliabilityObservation 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

15. 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

16. Results

17. 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.

18. Blood transfusion knowledge and practice among nurses (n = 48)

20. Knowledge and Practice Scores

21. The relationship between nurses’ blood transfusion knowledge and practice scores Spearman’s rho correlation coefficient = 0.22, p. =0.14)

22. Key Findings • Nurses’ knowledge was not sufficiently put into practice • Nurses’ lack of knowledge was reflected in practice • 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

23. Recommendations

24. Action is needed, simultaneously, on several fronts to rectify the current situation • Urgent training and education • Human and material resources • Improving image and status of nursing • Replicate the study in Jordan

25. Thank You Principal Investigator bhijji1@hotmail.com

26. 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), 310-317. British Committee for Standards of Haematology (1999). The administration of blood and blood components and the management of transfused patients. Transfusion Medicine, 9, 227-238.