الفهرس 
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Abstract
Traumatic brain injury (TBI) is a major public health problem that causes significant morbidity and mortality within the community. A traumatic brain injury (TBI) is an injury to the brain caused by the head being hit by something or shaken violently. This injury can change how the person acts, moves, and thinks. The term TBI is used for head injuries that can cause changes in one or more areas, such as thinking and reasoning, understanding words, remembering things, paying attention, solving problems, thinking abstractly, talking, behaving, walking and other physical activities, seeing and/or hearing, and learning.
The management of a patient with an acute severe head injury is a complex and difficult task so it is important to begin emergency intervention within the so called golden hour. The role of nurses is important in the acute care and management of brain injured patients
This study aims to assess the nurses’ performance for patients with traumatic head injury during golden hour through the following:
1. Assessing nurses’ level of knowledge regarding traumatic head injury and their nursing management during golden hour.
2. Assessing nurses’ levels of practice for patients with traumatic head injury during golden hour.
3. Assessing the factors that affect nurses’ performance for patients with traumatic head injury during golden hour.
A descriptive exploratory design was followed to achieve the aim of this study. This study was conducted in Emergency Unit, Neuro-Surgery Intensive Care Unit at El-Demerdash hospital and Emergency Unit at Ain Shams specialized hospital which affiliated to Ain Shams University. A convenience sample of all available nurses (50) in the previous mentioned setting working with patients with traumatic head injury were recruited to this study.
Data collection took about 6 months started from March 2011 until august 2011. It has been done through Self administered questionnaire Sheet: It was used to assess nurses’ knowledge regarding: Anatomy and physiology of the nervous system, definition, causes and clinical manifestation, complication of traumatic head injury, diagnostic measures, medical treatment and nursing care for patients with traumatic head injury during golden hour. Nurses’ performance observational checklist: It was adopted from (Allen & Baranoski, 2009; Allen & Lynn, 2009; Carlson, 2009; Nettina & Sandra, 2010 and Proehl, 2009) and it was modified by the researcher to assess nurses’ practice for patients with traumatic head injury during golden hour.
The present study revealed that:
Regarding age, the results revealed that about two third (64%) of the study nurses were less than 30 years. As regards to gender, more than three quarter of them (78%) were females.
In relation to educational level, the result showed that more than half (58%) of the study nurses were nursing diploma. While regarding experience years, more than two third of the study group (68%) had experience less than 10 years.
In relation to marital status, results revealed that about half (52%) of the study nurses were single. While regarding attending the training courses, it was noticed that the majority of them (94%) didn’t attend any training courses.
As regards nurses’ knowledge, about two third (66%) of the study nurses had unsatisfactory knowledge regarding traumatic head injuries during golden hour and near two third (62%) of them had unsatisfactory practice regarding traumatic head injuries during golden hour.
Concerning factors affecting nurses’ performance, all of the study nurses (100%) stated inadequate number of nursing staff, lack of Job description & high work load. About three quarter (76%) of the nurses didn’t receive training courses and the minority of them stated availability of competitive rewards, administration support and opportunities for creativity (8%, 4% and 8%) respectively that represent job regulation related factors. In addition, the majority (90%) of the study group weren’t satisfied with their work. Also, the majority of them stated frequent nurses’ absenteeism and communication with patient, supervisors and colleagues (80%, 86%, 78% & 94%) respectively that represent nurses related factors affect their performance.
There was statistically significance relation between nurses’ knowledge and experience years (p˂0.05). Also, there was highly statistically significance relation between nurses’ knowledge and nurses’ age, gender and attendance of training courses (p˂0.01). While, there was no statistically significance relation between nurses’ knowledge and nurses’ educational level, marital status and place of work (p˃0.05). Also, there was statistically significance relation between nurses’ practice and their age and experience years (p˂0.05). Also, there was highly statistically significance relation between nurses’ practice and gender and absence of training courses. While, there was no statistically significance relation between nurses’ practice and nurses’ educational level, marital status and place of work (p˃0.05).
There was statistically significant relation between unsatisfactory nurses’ knowledge and job regulation related factors as inadequate number of nursing staff, high work load and lack of job description (P˂ 0.05). Also, there was highly statistically significant relation between unsatisfactory nurses’ knowledge and lack of competitive rewards, continuous training, administration support, job flexibility, opportunities for creativity and inadequate salary (p˂0.01).
there was statistically significant relation between unsatisfactory nurses’ knowledge and nurses related factors as their dissatisfaction with work (p ˂ 0.05), while there was highly statistically significant relation between unsatisfactory nurses’ knowledge and their frequent absenteeism, and Communication with patients, supervisors and colleagues (p˂ 0.001).
There was statistically significant relation between unsatisfactory nurses’ practice and job regulation related factors as inadequate number of nursing staff, high work load & lack of job description (p ˂ 0.05). Also, there was highly statistically significant relation between unsatisfactory nurses’ practice and lack of competitive rewards, continuous training, administration support, job flexibility, proper equipment, opportunities for creativity and inadequate salary (p˂0.01). There was statistically significant relation between unsatisfactory nurses’ practice and nurses related factors as their dissatisfaction with work (p˂0.05). Also, there was highly statistically significance relation between unsatisfactory nurses’ practice and their frequent absenteeism, communication with patients, supervisors and colleagues (p˂ 0.001).
There was no statistically significant correlation between nurses’ knowledge and nurses’ of practice regarding traumatic head injury during golden hour ((r= 0.138 at P ˃0.05).
In conclusion, the study revealed that about two third of the study nurses had unsatisfactory level of knowledge and practice regarding nursing management of patients with traumatic head injury during golden hour. Furthermore, there were many factors affecting nurses’ performance from their point of view as job regulation related factors and nurses related factors.
Based on the finding, the researcher recommended:
1- The importance of implementing an educational Training program for nurses in emergency units and Neuro-Surgery ICU regarding nursing management for patients with traumatic head injury during golden hour.
2- Further study is recommended to evaluate the reflection of educational training program regarding management of patients with THI during golden hour on nurses’ performance and consequently on the patients outcome.