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Effect of Nursing Care Standards on Nurses Perfomance Regarding
Caring for Patients with Cardiac Arrhythmias
Rawia Ali Ibrahim, Medical surgical nursing, Faculty of Nursing, Benha University
Pro.Dr. Kamelia Fouad Abd-Allah, Medical Surgical Nursing, Faculty of Nursing, Ain
shams Univeristy.
Pro.Dr. Osama Sanad Arafa, Cardiology department, Faculty of Medicin ,Benha University.
Dr. Sabah Said Mohammed Medical surgical nursing, Faculty of Nursing, Benha
University.
Abstract: The nursing care should be guided by clearly defined standards to ensure the
high quality of care. Standards of care are definitive statements that describe a common or
acceptable level of patients care or performance. The aim of this study is to evaluate the
effect of nursing care standards on nurses' performance regarding caring for patients with
cardiac arrhythmias in coronary care unit (CCU) at Benha university hospital. Research
hypothesis are: the mean score of nurses' knowledge and practices level post NCSs
implementation may be higher than their score pre NCSs. A quasi-experimental research
design was utilized to conduct the aim of this study. This study was conducted in coronary
care unit (CCU) at Benha University Hospital. Two groups of subjects were included in the
study, namely experts and staff nurses working in CCU. Three data collection tools were
used in the different phases of this study: First: Experts opinionnair sheet was designed to
test the face and content validity of the designed NCSs. Second tool: Self-administered
questionnaire sheet for nurses to assess nurses’ knowledge. Third tool: Nurses' practice
observational checklist based on the designed NCSs. The results of the study showed that,
the majority of jury group agreed upon the general form (face and content validity) of the
NCS, the jury agreement ranged between(85.7% to 100%). Furthermore, the findings
revealed that a statistical significant improvement in the total mean knowledge scores of
nurses in all items of the study post implementing the standards (P= 0.000) as compared to
pre implementing period. Also there was statistical significant improvement in the total mean
practices scores of nurses in all items of the study post implementing NCSs (P= 0.000).
Conclusion: there is a statistically significant improvement in nurses' performance regarding
caring of patients with cardiac arrhythmias in CCU post NCSs implementation. The study
recommended NCSs for management of patient with cardiac arrhythmias should be revised,
updated and available in CCU in both Arabic and English language.
Key Words: Nursing care standards, Cardiac arrhythmia, and Nurse’s performance
1
Introduction:
Cardiac arrhythmia is an irregular heart rate,
which actual performance can be compared.
rhythm, or both. Arrhythmias are often
Their main purpose is to promote, guide and
grouped according to where in the conduction
direct professional nursing practice and
system the abnormality occurs: the SA node,
optimal quality of care (Linda, 2014).
the atria, the AV junction (the area around the
Several frames are used in establishing
AV node and the bundle of His), or the
standards. According to American Nurses
ventricles (Carter and Stegen, 2010).
Association, (2010) the nursing process is
suited to formulate standards based on valid
Approximately one third of people with
principle: assessment, diagnosis, planning,
arrhythmia do not exhibit any symptoms,
preventing
their
timely
diagnosis
implementation
and
patient's care goal. Process standards include
or pounding heart, chest pain,
of
breath,
dizziness,
procedure, practice guidelines, plans and
light
documentation (Masters, 2014).
headedness, anxiety, fainting or near fainting,
Significant of the study:
and reduced capacity to exercise, which can
In Egypt, Approximately 4 million people
impair the quality of life in some cases,
symptoms
can
be dangerous
and
have arrhythmias. (Statistics by country for
life-
arrhythmias, 2011).On the duration of 2011-
threatening, and may even lead to sudden
cardiac death
(Schmidt,
Kisselbach
2012, the number of patients admitted to CCU
&
were 2315 patients, about 50-60% having
Schweizer, 2011).
arrhythmias.
Nursing care standards (NCSs) may be
defined
as
authoritative
statements,
Process
activities necessary to achieve the desired
symptoms, these may include feelings of a
shortness
evaluation.
standards focus on the specific nursing
treatment. For individuals who do have
racing
and
(Benha
university
hospital
statistical office, 2012).As well as from the
the
clinical experience and observation for the
standard is a written rule or measuring criteria
actual situation in cardiac care unit for 5 years
to measure the quality of care, all standards of
,the
practice provide a guide to the knowledge,
arrhythmias
skills; judgment and attitudes that are needed
encountered in CCU and represented a major
to practice safely .They reflect a desired and
source of morbidity, there are a dangerous
achievable level of performance against
arrhythmias lead to sudden death and heart
2
researcher
are
noticed
that
common
cardiac
problem
failure ,so this study has been conducted to
2-Experts :( No 21).The jury group of experts
increase knowledge and practice of nurses
consisted of
caring for patient with cardiac arrhythmias
Nine nursing educators from Medical –
through implementing NCSs and to help them
Surgical Nursing departments of Faculty of
in promoting the quality of nursing care and
Nursing
decreasing morbidity and mortality for such
University and Ain-Shams University, they
group of patients.
consisted of 2 professor,2 assistant professor
Benha
University,
Zagazig
Aim of the study
and 5 lecturer. Nine physician representing
This study aims to evaluate the effect of
clinical
cardiologists
from
Faculty
of
nursing care standards on nurse's performance
Medicine at Benha University Hospital, they
regarding caring for patients with cardiac
composed of 4 residents, 2 assisstant lecturer,
arrhythmias in CCU at Benha University
1 lecturer and 2professors and three nursing
Hospital.
administrator members representing head
nurse
Research hypothesis: The mean score of
nurses’
knowledge
level
post
manager
from
Benha
University
Hospital.
NCSs
implementation may be higher than their
Data collection tools:
score pre NCSs implementation and the mean
Tool (1): Experts opinionnair sheet .This
score of nurses' practice level post NCSs
tool was designed to test the face and content
implementation may be higher than their
validity of the designed NCSs through
score pre NCSs implementation.
eliciting opinions of the jury group regarding
Subjects and methods:
agreement upon the proposed standards. The
jury group members' response to the standards
Design:
statement and its criteria with either agree or
Quasi experimental design was used to was
disagree and comments.
utilized to conduct the aim of this study.
This sheet consisted of three parts:
Setting:
Part
This study was conducted in coronary care unit
I:
This
part
consisted
of
jury
characteristic (demographic characteristics)
at Benha University Hospital.
such as the job title, age, gender, educational
Subjects:
level, and years of experience. Part II: This
1-Nurses:All available nurses (No =30) who
part was designed to test the agreement of
were working in CCU at the time of study
jury group upon the general form of the
were included in this study.
designed NCSs (face validity). It consisted of
3
10 items. Part III: This part was designed to
Ahmed,( 2008), Shaaban, (2012) and AHA,
test the agreement of jury group upon the
(2011). It based on the designed NCSs.
designed NCSs (content validity), this part
It concerned with process standard of care
consisted of (232) criteria under main (9)
for patients with cardiac arrhythmias in CCU.
standards statements that identify the specific
This part consists of (232) items under main
nursing activities for patients with cardiac
nine headings that identify the specific
arrhythmias.
nursing activities for patients with cardiac
arrhythmias as follows:
Tool (2) Self-administered questionnaire
sheet for nurses: It was developed by the
1. Nursing assessment (9 Items)
researcher based on
review of related
2. Nursing diagnosis (3 Items)
literature. It compromised Arabic structured
3. Nursing planning (13 Items)
items
4. Nursing implementation (12 Items) as follow
related
to
different
aspects
of
assessment the nurses’ knowledge about
caring of patients with cardiac arrhythmias .It
sub items:
■ Intervention regarding management of
consisted of two parts:- Part 1: Demographic
characteristics of
nurses such as: age, sex,
arrhythmias.(9 Sub items)
■ Nursing care in case of emergency
level of education, marital status, years of
arrhythmias.(15 Sub items )
experiences and previous attendance of
■ Connecting patient to monitor. (18 Sub items)
training
■ Obtain 12 leads ECG and interpretation. (17
courses
related
to
cardiac
arrhythmias. Part 2: Nurses' knowledge about
Sub items)
■
cardiac arrhythmias, standards of care.
The scoring system of self administered
Emergency medication for arrhythmias. (13
Sub items)
■
questionnaire sheet:
Each right answer was given one score
Cardiopulmonary
resuscitation.
(13Sub
items)
with total scores of 85.
■ Emergency defibrillation .(28 Sub items)
≥ 80% considered satisfactory knowledge.
■ Emergency cart preparation. (8 Sub items)
< 80% considered unsatisfactory knowledge.
■ Care for patient with pacemaker.(16 Sub items)
■ Help patient for mobilization (6 Sub items)
Tool(3):
checklist:
Nurses’ practice observational
It
was
constructed
by
the
■ Hygienic care (3 Sub items)
■ Encourage patient to sleep (4 Sub items)
researcher after reviewing relevant literature.
5. Safe environment. (20 items).
It was adapted from Mahrous, (2003),
6. Ethics and patient rights. (4 items)
4
7. Health education. (13 items).
action must take place in order to achieve
8. Communication. (13 items).
them.
9. Nursing evaluation. (7 items).
2-Tools validity and reliability: Tools
Scoring system of observational checklist
validity were tested though a jury of (21)

Each item was scored as follows
Zero =not done.
experts. The experts reviewed the tools for

(1) = done incorrectly
simplicity

(2) = done correctly
modification were done. This phase took one
The total scores were (464) as follows;
month from May 2014 to June 2014.Testing
≥ 80 % considered satisfactory level of
reliability of proposed tools was done by
clarity,
relevance,
and
comprehensiveness,
applicability,
minor
practice.
Cronbach alpha test.
< 80 % considered unsatisfactory level of
3- A Pilot study was carried out on 5 nurses
practice.
of the studied subjects, who were included in
Operational design:
the main study. The pilot study was done to
1-Preparatory
included
the
phase:
following;
This
phase
the
conduction of the study tools, and time
available literature and different studies
needed for each tool to be filled in. Few
related to research problem, and theoretical
modifications were done according to the
knowledge of its various aspects of the study,
pilot study findings.. This phase took one
using
month from (July 2014 to August 2014).
textbooks,
reviewing
ensure clarity, applicability, feasibility of
evidence-based
articles,
internet periodicals and magazines in order to
4-Field work: The process of data collection
collect tools of this study . This period
was carried out from the beginning of
extended
September 2014 to the end of March 2015.
from
(October
2013
to
January2014).
The researcher visited the CCU three days
Designing nursing care standards: This was
weekly (morning & afternoon) to collect the
taken period of time from January 2014 to
data by using previous tools. The researcher
April 2014.It based on literature review, the
interviewed with available nurses in CCU and
researcher designed the NCSs for patients
explained the aim of the study and took their
with cardiac arrhythmias to be applicable by
approval to participate in the study prior to
staff nurses working at CCU in Benha
data collection, then the researcher assessed
university hospital. The standards used in this
the nurses' performance level (knowledge and
study "Process Standards" describe what
practice) regarding caring of patients with
5
cardiac arrhythmias by using questionnaire
helped to evaluate the effect of implemented
sheet and observational checklist (pre NCS
standards .This was done immediately after
implementation) as following:
the intervention. This phase took about
Firstly, the researcher observed nurses'
6weeks.
practice during caring for patients with
Administrative Design: Permission was
cardiac arrhythmias using the observational
granted from the hospital directors and head
checklist based on NCSs. Each skill was
of the department of cardiac care unit at
evaluated 3 times and the mean was
Benha university hospital. After obtaining the
calculated.
approval for data collection. The objectives
Secondly, The questionnaire sheets were
and the nature of the study were explained
administered by the researcher to all nurses
and then it was possible to carry out the study
individually to assess their knowledge about
with minimum resistance. Additional to oral
standards of care for arrhythmic patients and
consent was taken from the nurses who
explanation of the questionnaire sheet was
participate in the study after explanation of
done by the researcher. The average time
the nature, aims and expected outcomes of the
needed for the completion of each interview
study.
(by nurses) was between 25 – 35 minutes.
Results
This period of pre tests (knowledge and
weeks.
Table(1) illustrates the agreement of all jury
The
groups upon designed NCSs for patients with
implementation phase was achieved through
cardiac arrhythmias. It is illustrated that
sessions at a period of 18 weeks. The total
agreement of jury ranged between (85.7%) to
numbers of sessions were 12. It divided as
(100%).
follows: four sessions for knowledge, and
Table
practice)
took
Implementation
6
of
NCSs:
(2)
shows
the
demographic
eight sessions for the practice. The duration of
characteristics of staff nurses. Data in this
each session ranged between 45 minutes to 6o
table reveals that more than two fifth of
minutes for each group including 10 minutes
studied subjects (43.3%) their age ranged
for discussion and feedback.
between (25-<30) years old, the majority of
4-Evaluation phase: After implementing of
them (98.3%) were female and the highest
nursing care standards, the post tests were
percentageof them (80%) were married. As
administered to assess nurses' knowledge and
well as two thirds of them (66.6%)
practice using the same forms of pre tests, this
having from (5-<10) years of experience and
6
were
most of them (40%)
holding bachelor of
resuscitation, nursing care for emergency
nursing degree.
medications, arrangement of emergency crash
Figure (1) Distribution of the studied nurses
cart
knowledge score
respectively
.while
post
its
according to their total
implementation they had satisfactory level of
levels pre and post NCSs implementation ,this
practices related to obtaining 12 lead ECG,
figure
nursing care in emergency defibrillation, and
documented that only one third of
nurses (33.3%) were having a satisfactory
nursing
knowledge level pre NCSs implementation.
arrhythmias with percent (93.3%,90%,86.7%)
However,
the
respectively. With statistically and highly
majority of nurses (86.7%) were having a
statistically significant difference between pre
satisfactory
and post NCSs implementation in all items of
post
its
implementation,
knowledge
level.
care
in
case
of
emergency
nursing activities. (P<0.05 and p<0.001).
Table (5): shows the total mean practices
Table (3) demonstrates the mean score of
nurses’
knowledge
pre
and
post
scores of study subjects pre and post NCSs
NCSs
implementation.. It is noted that a general
implementation. It shows that a general
improvement in the total mean practices
improvement in the total mean knowledge
scores of nurses in all items post NCSs
scores of nurses in all items post NCSs
implementation
as
compared
to
pre
implementation as compared to pre its
its
implementation with mean (82.53±11.91) and
(45.96±17.48)
respectively.
With
highly
implementation
with
(404.33±20.73)
and
the
mean
(232.73±25.88)
respectively. There were highly statistically
statistically significant differences (P= 0.000).
significant differences observed between
pre and post implementation in all items
Table (4) describe
nurses’ practices
with P= 0.00.
regarding nursing activities implementation
Discussion
component of the designed NCSs for patients
The aim of this study is to to evaluate the
with cardiac arrhythmias at CCU .It can be
effect of nursing care standards on nurse's
noted from this table that, nearly two thirds of
performance regarding caring for patients
the studied subjects(66.7%,70%, and 63.6% )
has
unsatisfactory
implementation
practices
pre
with cardiac arrhythmias in CCU at Benha
NCSs
University hospital.
related to most of nursing
activities such as performing cardiopulmonary
As regard to agreement of jury on designed
7
NCSs, the findings of the present study
learning module with highly statistically
showed that majority of the experts group
significant differences.
agreed upon all criteria of process standards
Also, This results supported by Ahmed,
(content validity). Their agreement ranged
etal,(2015), who stated that nurses had
between (85.7%to 100%). This finding is
unsatisfactory knowledge related to standard
supported by Sabra,etal (2014) , Shaaban
of care for patient after coronary artery bypass
(2012), and Saleh (2007) who found that the
graft surgery pre NCSs implementation and
great majority of jury group agreed upon the
post
its
implementation
showed
an
improvement in nurses’ knowledge.
proposed standards.
As regarding to nurses knowledge about
In this respect, Change (2006); mentioned
standards of care for patients with cardiac
that nurses must be able to expand their
arrhythmias .The current study revealed that
knowledge of this area through ongoing
an obvious improvement in the total mean
education,
knowledge scores of nurses post NCSs
Consequently, teaching programs for nursing
implementation as compared to pre its
staff constitute an important part.
implementation
programs are urgently designed to assess
significant
with highly statistically
difference. This
improvement
nursing staff
might be related to the fact that majority of
Journal
and
seminars.
These
in developing and enhancing
the skills needed to provide high standards of
them are young and are enthusiastic to learn.
care to their patients.
In addition to, the highly expressed needs of
As regard to nurses’ practices after NCSs
this group of nurses to learn more about
implementation, the results of present study
certain areas like arrhythmia interpretation.
revealed that, the majority of nurses had
Also this finding reflects that standards of
unsatisfactory
care had good effect in improving nurses’
implementation. This might be due to lack of
knowledge and this could be due to the
standardized nursing care recorded. Post
concise presentation of each session using a
NCSs implementation, there is a general
simple
improvement in nurses’ practices score with
language
and
clear
educational
methods and instructional media.
practice
before
NCSs
highly statistically significant differences
This finding is congruent with Ali (2012)
between pre and post phase.
who found an improvement in nurses’
This result agreed with Shaaban (2012)
knowledge score after implementing of self
who
found
that
statistically
significant
improvement in all criteria of process
8
standard post application of the designed
With
NCS.
regard
to
practice
score
of
implementation nursing activities, there was
As regard to assessment, the present study
plainly enrichment in nurses’ practices score
showed that there is a highly statistically
in all nursing activities in post phase with a
significant difference in nurses practices
highly statistically significant differences.This
related to initial and physical assessment
result supported by Ibrahim (2014), who
between pre and post implementation phases.
stated that there was an improvement in
This finding is in agreement with Munroe
nurses’ practices score in intervention phase.
and Curtis, (2013) who identified that
As regards of nurses’ performance about
assessment is the first integral step of the
connecting patient to monitor, the study
nursing care process. A comprehensive
demonstrated that there was statistically
patient assessment is necessary to understand
significant
the condition of the entire patient, comprising
performance.
of a complete health history and full physical
findings,
examination. Findings resulting from patient
improvement in nurses practice score post
assessment forms baseline data through which
program implementation related to cardiac
any changes in the patient’s condition can be
monitor. Also Collins (2001) emphasized on
measured
the importance of cardiac monitoring as an
against
and
treatment
needs
determined.
Regarding
improvement
In
of
agreement
Taha(2006)
nurses’
with
these
that
their
stated
important first step in the treatment program
to
nursing
diagnosis
and
regardless of patient condition on admission
planning the study revealed that the most
as it is indicative of any arrhythmias to give
common neglected practices among nurses
meaning to the concept of CCU and to
pre implementing the standards were analyze
prevent
and interpret data to drive a nursing diagnosis,
monitoring system is a necessary component.
cardiac
crisis.
An
electronic
develop time schedule to achieve plan and
Nurse’s practices about recording a 12-
documentation of plan ,while post standards
implementation ,the nurses practices
score
lead ECG and arrhythmia interpretation. The
was improved in these items with statistically
present study showed that there was a highly
significant
significant
differences.
This
findings
improvement
of
nurse’s
supported by Shaaban (2012) who found that
performance. Post NCSs implementation, the
most nurses apply nursing diagnosis and
nurses’ performance scores were satisfactory.
planning post application of the standards.
This might be due to the fact that the
9
procedure of ECG was practiced under
procedures manual and satisfactory after
supervision and guidance from the researcher
using the nursing procedures manual.
that would ensure the continuation of high
Regarding to nurse’s practices about crush
level practice, In the same line Mahdy( 2009),
cart, the present study showed that there was
revealed that the nurses had unsatisfactory
statistically
practice pre program regarding 12 lead ECG
nurses’
and arrhythmia interpretation .
implementation. This result agreed with Taha
significant
practices
improvement
post
of
standard
(2006), who reported that, the nurses’
Regarding to nurses performance about
performance about crash cart unsatisfactory
emergency medication, it was found that there
pre program and satisfactory post program.
was a highly significant improvement of the
nurse’s
performance
standards
and infection control in CCU, the present
implementation. This result agreed with El-
study reveals that an improvement in nurses
Metwally
highly
practices score post standards implementation
statistically significant differences in nurses’
with statistically and highly statistically
practices between pre and post phase related
significant differences. This results supported
to
by Ghoneim(2011) who documented that
(2012),
monitoring
after
Regarding to providing safe environment
who
intravenous
found
infusion
of
emergency drugs.
nurses practices score related to infection
As regard to nurses’ practices related to
control in ICU was improved after program
cardiopulmonary resuscitation (CPR) and
implementation.
defibrillation, the present study showed that
Regarding to follow ethics and patient
there was a highly significant improvement
rights, the present study showed that all of
post standards implementation than pre
nurses follow ethics and respect patient rights
implementation. This results supported by
after standards implementation. This result
Taha(2006), Mahdy( 2009) and El-Metwally(
disagreed with Ahmed (2008) who reported
2012), who stated that the nurses had
that the minority of nurses applied items of
adequate practice post program regarding
ethics and patient rights.
CPR with highly statistically difference . Also
Regarding health education for patient and
Abd –Elkareem, etal, (2012), mentioned that
the
nurses’
cardiopulmonary
satisfactory
performance
resuscitation
before
using
the
family, the present study revealed that nurses
about
is
had unsatisfactory practice pre standards and
not
satisfactory practice post standards regarding
nursing
patient teaching. This is in likeness with
10
Saleh (2004) reported that nurses had
Conclusion
Based on the findings of the current study, it
can be included that:
 The majority of nurses had
unsatisfactory practices related to patient
teaching pre program implementation. This
may be due to lack of health education from
unsatisfactory
medical staff related to treatment, nature of
knowledge
and
practices pre NCSs implementation.
disease and complication .In addition nurses

consider the education about disease is a
Post NCSs implementation, there was
an obvious improvement in nurses’
responsibility of doctors. This finding was
knowledge and practices score with
also supported by Sheta (2006) who found
highly
that there was highly statistically significant
statistically
significant
differences between pre and post
difference between pre /post phase in nurses
phase.
practices related to patient teaching before
Recommendations
discharge.
study
1-Standards of nursing care for management
there was a highly
of patient with cardiac arrhythmias should be
statistically significant differences in practice
revised ,updated and available in coronary
scores of nurses related to all items of
care unit in both Arabic and English language.
As
regards
to
evaluation,
documented that
evaluation
pre
and
post
the
standard
2-Continuous evaluation of nurses' knowledge
implementation. This result supported by
Urden, etal(2014) who stated that
and practice is essential to identify their needs
the
in
coronary care nurse must evaluate progress
plan
of
care,
evaluate
units
about
cardiac
3- Further study is needed to apply the
document revisions in diagnoses, outcomes,
the
care
arrhythmias.
towards attainment of outcomes through
and
coronary
standards with larger sample size including
the
structure and outcome standards in addition to
effectiveness of interventions in relation to
process standards &evaluate its impact on
outcomes and document the patient's response
nurses’ performance regarding caring for
to interventions .
patients
with
cardiac
patients’ outcomes.
11
arrhythmias
and
Table (1): Agreement of jury groups upon the designed NCSs for patients with cardiac
arrhythmias (Content validity) (No=21).
Items
Agree
Standard I-Assessing and Data gathering
I.1: The nurse shall identify competently patient base line
data.
I.2 The nurse shall perform the physical assessment for the
patient
Standard II-Nursing diagnosis
Standard III-Planning
Standard IV-Implementation
IV.1.Carry out interventions regarding management of
arrhythmia
IV.2-Provide nursing care in case of emergency arrhythmias.
IV.3-Connect the patient to monitor
IV.4-Obtain 12- LEAD ECG
Interpreting A 12- LEAD ECG
IV.5-Emergency medications
IV.6-Perform Cardiopulmonary Resuscitation
IV.7-Emergency defibrillation
IV.8-Emergency crash cart
IV.9-Pacemaker
IV.11-Nursing care for hygienic measures
IV.12-Nurse encourages the patient to sleep
Standard V:Safe Environment
Nurse shall provide safe environment for patient care within
available resources
Standard VI –Ethics and patient's rights
Nurse shall follow ethics and respect patient's rights
Standard VII -Health Education
VII.1 Nurse provide information to patient /family
Standard VIII-Communication
VIII .1:Written communication
VIII.2:Verbal communication with health team
VIII.3:Verbal communication with patient and family
Standard IX-Nursing Evaluation
Nurse shall evaluate continuously the patient's progress
toward attaining expected out comes
12
Disagree
%
No
0
.0
No
21
%
100.0
21
100.0
0
0
18
20
85.7
95.2
3
1
14.3
4.8
21
21
21
21
18
21
18
18
21
21
21
21
21
100.0
100.0
100.0
100.0
85.7
100.0
85.7
85.7
100.0
100.0
100.0
100.0
100.0
0
0
0
0
3
0
3
3
0
0
0
0
0
.0
.0
.0
.0
14.3
.0
14.3
14.3
.0
.0
.0
.0
.0
21
100.0
0
.0
21
100.0
0
.0
21
100.0
0
.0
21
100.0
0
.0
Table (2): Distribution of the nurses according to their demographic characteristics (N=30)
Socio demographic characteristics
Age in years
18-<25
25-<30
30-<35
No=30
10
13
7
Mean ± SD
Gender
Male
Female
Marital status
Single
Married
Percentage
33.3
43.3
23.3
25.30 ± 3.05
Educational qualification
Secondary nursing education
Technical nursing education
Bachelor of nursing
Years of experience
1-<3
3-<5
5-<10
Mean ± SD
training courses about cardiac arrhythmias
No
Yes
13
1
29
1.7
98.3
6
24
20.0
80.0
10
8
12
33.3
26.7
40.0
8
26.7
2
6.7
20
66.7
5.56±2.58
14
16
46.7
53.3
Figure (1): Distribution of the studied nurses according to their total knowledge score
levels pre and post implementing the standard
14
Table (3): The mean score of nurses’ knowledge regarding components of the designed NCSs for
caring patients with cardiac arrhythmias pre and post its implementation
Pre-implementing
standards
Post - implementing
standards
Paired t –
test
P value
Knowledge items
Mean± SD
Nurses' general knowledge
about cardiac arrhythmias
Concept of standards of care
Standard I: Assessment
Standard II: Diagnosis
Standard III: Planning
Standard IV: Implementation
ECG procedure and interpretation
connecting patient to monitor
Emergency medications for
cardiac arrhythmias.
Emergency cart
Defibrillation
Cardiopulmonary resuscitation
Standard V: Safe environment
Standard VI: Ethics and
patient's rights
Standard VII: Health education
Standard VIII: Effective
communication
Standard IX: Nursing evaluation
Total knowledge score
Mean ±SD
7.83 ±2.46469
16.7667±1.71572
16.409
.000
.1667±.37905
.6333±.49013
.3667±.49013
1.3333±.60648
1.5333±.50742
1.0000±.00000
.8333±.37905
2.7667±.43018
9.786
4.097
4.065
9.607
.000
.000
.000
.000
10.3000±3.66860
7.7000±1.70496
17.5333±3.91049
8.8333±.37905
8.532
3.616
.000
.001
3.7667±1.54659
7.6667±.71116
14.085
.000
1.9333±.73968
2.7667±.43018
5.473
.000
2.8000±.99655
4.7333±.63968
10.435
.000
5.5333±1.75643
.2000±.40684
8.5000±.82001
1.6000±.49827
7.828
15.389
.000
.000
.2667±.44978
1.5333±.50742
15.425
.000
2.2333±.77385
4.6000±.49827
21.079
.4667±.50742
.9667±.18257
4.385
.000
.000
.4333±.50401
.9000±.30513
4.065
82.5333±11.9146
32.095
45.9666±17.48519
15
.000
.000
Table (4): Nurses ‘practices regarding nursing activities implementation component of the
designed NCSs for patients with cardiac arrhythmias at CCU (no=30)
Standards
Pre implementing
standard
N=30
Unsatisfact Satisfactor
ory
y
No
%
No
%
Post implementing
standard N=30
Unsatisf
actory
No %
Satisfactory
No
%
Chi
squar
e
Test
P
Value
Standard IV-Implementation
IV.1.Carry out interventions
regarding management of
arrhythmia:
IV.2.Provide nursing care in case
of emergency arrhythmias.
IV.3-Connect the patient to
monitor
IV.4-Obtain 12- LEAD ECG
IV.5-Nursing care for emergency
medications
IV.6-Perform Cardiopulmonary
Resuscitation:
IV.7-Nursing care in emergency
defibrillation
IV.8-Arrangment of emergency
crash cart
IV.9-Nursing care for pt with
pacemaker
IV.10-Nursing care in helping
patient for mobilization.
IV.11-Nursing care for hygienic
measures
IV.12-Nurse encourages the
patient to sleep
14
46.7
16
53.3
6
20.0
24
80.0
4.80
<0.05*
14
46.7
16
53.3
4
13.3
26
86.7
7.93
<0.05*
15
50.0
15
50.0
6
20.0
24
80.0
5.93
<0.05*
17
56.7
13
43.3
2
6.7
28
93.3
17.33
<0.001*
*
21
70.0
9
30.0
4
13.3
26
86.7
19.81
<0.001*
*
20
66.7
10
33.3
5
16.7
25
83.3
15.42
<0.001*
*
15
50.0
15
50.0
3
10.0
27
90.0
11.42
<0.001*
*
19
63.3
11
36.7
7
23.3
23
76.7
9.77
<0.05*
17
56.7
13
43.3
4
13.3
26
86.7
12.38
<0.001*
*
16
53.3
14
46.7
5
16.7
25
83.3
8.68
<0.05*
16
53.3
14
46.7
7
23.3
23
76.7
5.71
<0.05*
18
60.0
12
40.0
7
23.3
23
76.7
8.29
<0.05*
16
Table (5): The total mean practices scores of study subjects pre and post NCSs
implementation
Nurses Practices
Standard I: Assessment
Standard II: Diagnosis
Standard III: Planning
Standard IV :Implementation
Standard V: Safe environment
Standard VI: Ethics and
patient's rights
Standard VII: Health education
Standard VIII: Effective
communication
Standard IX: Nursing
evaluation
Total practice
Pre-implementing
standards
Post - implementing
standards
Paired t
–test
P
value
Mean± SD
Mean ±SD
9.3000±2.26137
.6000±.89443
11.0000±3.58156
167.2667±15.73692
20.4667±4.12506
18.7333±1.50707
3.7333±1.57422
20.3333±1.51620
265.6000±13.27066
32.9667±2.25118
19.608
11.788
14.456
54.748
20.823
.000
.000
.000
.000
.000
4.6000±1.45270
7.5667±.50401
11.395
.000
8.2667±3.85006
22.2667±1.77984
17.576
.000
7.9333±2.88795
21.8333±3.28091
19.619
.000
3.3000±1.80325
11.3000±2.56165
14.691
.000
57.320
.000
232.7333±25.88027
17
404.3333±20.73700
Practice.
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