الفهرس 
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Abstract
Tracheoesophageal fistula represents one of the most common lifethreatening conditions due to the pulmonary complications among critically ill mechanically ventilated patients. Acquired TEF in the adult carries a high mortality risk. When this condition is associated with severe pulmonary insufficiency requiring continuous ventilator management with high airway pressure. Thus, good nurse ’knowledge and practice of care are crucial in limiting incidence of TEF. Also knowledgeable nurses have a vital role in enhancing their practice and improving patients’ outcome. Aim of the study: To evaluate the effect of educational nursing intervention programs on nurses’ performance for minimizing TEF among mechanically ventilated patients. Setting: The research study conducted at two areas in Tanta university hospitals, first place was Traumatology and Emergency Medicine ICUs at Tanta emergency Hospital, and second area was Anesthesia ICUs at Tanta Emergency Hospital. Subjects: The sample of this study consisted of: - Nurses: (80) nurses who are working in the previously mentioned settings and give direct nursing care and directly contact with critical ill patients - Patients: A convenience sampling of (30) critically ill patients in each group who were founded at intensive care unit at Tanta university hospitals fulfilling the inclusion criteria Tools of data collection: Four tools were used for data collection of this study: Tool (I): A Structured questionnaire: This tool was developed by the researcher after reviewing the relevant literature for collection of the baseline data regarding critical care nurses’ knowledge about tracheoesophageal fistula and it comprised of two parts as follow: - Part (1): Nurse’s socio demographic data as: age, gender, level of education, years of experience, training regarding TEF for patients‘ undergoing MV and previous lectures regarding TEF during undergraduate study. - Part (2): Nurses’ knowledge regarding TEF for patients‘ undergoing MV before, immediately and one week post educational intervention: This part was developed by the researcher after reviewing the relevant literature. Tool II: Nurses’ observational Checklist: This tool was used to observe nurses mesures on the TEF for patients‘ undergoing MV: This tool had been developed by the researcher after reviewing the relevant literature as a monitoring and evaluative tool for nurses’ practice. It was used to evaluate the critical care nurses’ practice before, immediately and one week post educational intervention program through a designed observational checklist. Tool III: Mechanically ventilated patient’s assessment tool: This tool was developed by the researcher after reviewing the relevant literature for collection of the baseline data regarding mechanically ventilated patients before and after implementing nurses‘ educational intervention program patient, to determine effect of implementing educational intervention program. It was consisted of four parts as the following: - Part (1): patients’ bio-Socio demographic data. - Part (2): patients‘ Clinical data, which consisted of, past medical history, current medical history such as date of admission, clinical diagnosis. - Part (3): Patient‘s hemodynamic parameters; it consisted of vital signs, FIO2 and CVP. - Part (4): Mechanical ventilation parameters, which included data on MV, mode and parameters of MV. Tool IV: Tracheoesophageal fistula clinical evaluation assessment tool: This tool was developed by the researcher after reviewing the related literatures to evaluate the occurrence of TEF among mechanically ventilated patients before and after nurses’ educational intervention program. It consisted of two parts as the following: - Part A: Clinical manifestation assessment, which include: Abdominal manifestation; which included bubbling heard over the stomach synchronous with the ventilator, abdominal breathing, aspiration of liquids or gastric contents from tracheobronchial tree and a progressive abdominal dilatation under positive pressure ventilation. (15,16) Thoracic manifestation: which included seal of the tracheal cuff, air leak when cuff was sealed or hyper- inflated, gurgling in throat, tachypnea, secretion with good suctioning, an unexplained discrepancy between inhaled and exhaled tidal volumes in ventilator, and bronchopulmonary suppuration. (15,16) Signs and symptoms of infection such as inflammation at the site of insertion, secretions and pus around tracheostomy, elevated body temperature above38oC, tachycardia, redness, hotness, tenderness, and swelling. - Part B: Laboratory investigation; It was used to assess the presence of infection at the tube insertion site as: blood leukocytes count per mm3, blood sample for isolation of different microorganisms and swap culture for determination of the colony count of organisms, measuring arterial blood gases to detect and chest x-ray. Main results: Depending on the finding of the present study, it was clarified that: - More than two- thirds of studied nurses (71.3%) were within the age group of less than 30 years and the majority of the studied nurses (88.8%) were females. - More than two thirds of studied nurses (86.2%) were technical, while only (13.8%) were bachelor degree. - The studied patients sample clarified that 30% of studied patients were within the age group of 50-60 years and the majority of studied patients (80%) were males. - The implementation of nursing educational program has appositive effect of improving nurse ’knowledge and practice. - Regarding TEF for patients undergoing MV - There was significant statistical improvement in the total knowledge and practice mean score post implementation of nursing educational program. - There was a positive significant correlation between total knowledge and total practice post a week implementation of educational program - Improving patients‘ clinical outcomes post a week implementation of educational program. - Improving level of total TEF occurrence post a week of educational program. Depending on the results of the present study, it was recommended that: Replications of the study on larg probability sample to confirm and generalized the results of the current study.