KNOWLEDGE AND PRACTICE OF BLOOD TRANSFUSION AMONG NURSES IN GHANA: EXPERIENCES FROM THE CAPE COAST TEACHING HOSPITAL, CAPE COAST

ABSTRACT
Blood transfusion saves lives but can result in poor client outcome when it is associated with errors. This study aimed at examining the knowledge of blood transfusion and practice errors among nurses in the Cape Coast Teaching Hospital. The study utilized a descriptive cross-sectional design approach using 140 registered nurses who were selected purposively. A modified Routine Blood Transfusion Knowledge Questionnaire (RBTKQ) was used to collect information in two sections. First part on demographic data and second part on knowledge and practice errors which were structured along a three-point Likert scale. Data was analysed with SPSS version 20, the binary logistic regression analysis was employed and all inferences were drawn at 5% significance level. Results showed that nurses have higher knowledge in the four phases of blood transfusion practices as they scored overall averages of 2.79, 2.80, 2.64 and 2.83 out of 3.0 for Phases I, II, III and IV, respectively. Although, majority of the nurses (72.0%) acknowledged they have not received any official training on blood transfusion since commencement of clinical work. A z-value of 165.29 and < .05 indicated that there was a significant difference in the knowledge level of the nurses on the four phases of the procedure. On commonest errors, 40 (28.6%) nurses reported that they sometimes forgot to check vital signs throughout the transfusion process. This study concludes that nurses have very good knowledge on blood transfusion process but some practice errors exist that put patients at risk. Periodic training and auditing of the transfusion process is therefore recommended.


CHAPTER ONE
INTRODUCTION
Background to the Study
Blood transfusion is the transfer of blood or a blood component from one person (a donor) to another (a recipient). Transfusions are given to improve the blood’s ability to increase its oxygen carrying capacity, restore any blood deficit, improve immunity, and correct clotting problems. Depending on the reason for the transfusion, a physician may order whole blood or a blood component, such as red blood cells, platelets, blood clotting factors, fresh frozen plasma (the liquid part of blood), or white blood cells (Shander, & Popovsky, 2005). Demand for blood is driven by an array of factors that include obstetric hemorrhage, road traffic accidents, armed conflict, sickle cell disease and childhood anemia, malnutrition, HIV, malaria, and parasitic infections (Tapko, Mainuka & Diarra-Nama, 2006).

Every second, someone in the world needs blood. In every country, surgery, trauma, severe anaemia and complications of pregnancy are among the clinical conditions that demand blood transfusion (World Health Organization [WHO], 2006). The WHO report on blood transfusion safety found that the pattern of blood usage is very different in many countries with a much greater proportion of transfusions being given to women with obstetric emergencies and children suffering from severe anaemia, often resulting from malaria and malnutrition. It is estimated the use of red blood cell transfusion in developing countries as pregnancy-related 37%, children 14%, surgery 12%, trauma 18% and medical 19%. This is in sharp contrast to red blood cell transfusion in the developed countries where red blood cell is used for purposes of complicated procedures such as open-heart surgery, organ transplantation and other medical conditions such as leukaemia and thassalaemia with pregnancy-related (6%) and child anaemia (3%) been the least for red blood cell transfusion (Cable, Fatemeh & Edwards, 2007). A closer look at these findings from the World Health Organization (WHO) report suggest that blood transfusion are given in developing countries to treat basic conditions to avert mortalities that would otherwise happen in the advance countries.

The above findings are agree with a research finding from another studies from WHO, The United Nations Children's Fund (UNICEF), The United Nations Population Fund (UNFPA) and The World Bank (2012), which stated that , each year, an estimated 287,000 women die worldwide from complications related to pregnancy and childbirth. More than half of these maternal deaths (56%) occur in Sub-Saharan Africa with haemorrhage (severe bleeding) as the leading cause. Therefore, among other strategies to prevent maternal deaths from haemorrhage, child anaemia and other blood transfusion driven conditions, the WHO, UNICEF, UNFPA and the World Bank states that it is important to make available rapid access to adequate blood and highly knowledgeable personnel to safely administer blood. Whatever the degree of development of the health care system, blood transfusion is the only choice for survival for many patients and this is where the essence of nurses’ knowledge and practice of blood transfusion is imminent.

Blood transfusion is usually a life-saving component of health care systems. Nevertheless, it can also be a quick and easy method of exposing patients to risks, particularly the transmission of infectious agents to recipients. Despite improvements in the safety of transfusion services worldwide the procedure still subject patients to many risks. Lee (2003), reported on a study of the differences between clinicians’ and laypersons’ perceptions of the risks involved in blood transfusion. He found that clinicians’ concerns revolve around the appropriateness of transfusion as a treatment and its risks, administration, and costs; patients’ concerns often centre on transmissible disease and comfort. Transfusion of blood saves life. An error in blood transfusion, at the same time, takes life. Clinical demand for blood is perennial and transfusion errors are must be accountable. This accountability of transfusion errors comes to light with the numerous reports on total blood transfusion errors. The discovery that HIV could be transmitted by blood transfusion in 1982 has given rise to strict regulations on blood donation and screening procedures. Apart from HIV, HBV and HCV risks have also been well addressed in blood transfusion process.

The blood transfusion process is manned by a multidisciplinary healthcare team which include nurses. Although the decision to transfuse rests with the physician, the actual transfusion is conducted entirely by the nurse who is at the point-of-care and therefore has an essential role in patient safety during a blood transfusion. Nurses have an opportunity to provide essential contributions to the national transfusion safety initiatives and to nursing science by conducting research that is focused on the gaps in transfusion knowledge, surveillance, and reporting transfusion adverse events. Blood transfusion procedure lies largely in the domain of nursing practice. Bishop (2008) indicated that the transfusion process is composed of five interrelated phase; four of which are relevant to routine nursing practice, such as, patient preparation before blood bag collection, blood pack collection, pre and post transfusion nursing activities and where the safety of blood transfusion is, amongst others, dependent on nurses' knowledge and skills.

A lack of awareness of good transfusion practice has been identified as a reason for poor compliance (Parris, 2007). Hijji (2010) highlighted problems associated with Nurses’ blood transfusion practice and adherence to recommendations. According to Hijji, blood transfusion errors often include administration of blood to wrong recipient, phlebotomy errors & blood bank errors including testing of wrong specimen. According to Linden (2000), the most important of all those errors has been the failure to detect at the bedside before transfusion of the blood unit .This is where nursing action is independent of any member within the multidisciplinary team. Therefore an error committed during this stage is largely a nursing error though the decision to transfuse a patient was initiated and prescribed by the physician. Nurses are responsible for the final bedside check before transfusion and therefore have the opportunity to prevent a mis-transfusion (Mole, 2007). Deficiencies in the knowledge of blood transfusion can adversely affect patient safety (Gallagher-Swann, 2011). Blood transfusion is a highly effective and potentially life-saving treatment for many patients (Bradbury & Cruickshank, 2000) and an essential component of modern health care. Red cell transfusions are the backbone of blood transfusion therapy as they account for the majority of components issued to patients (Taylor et al., 2010). Surprisingly, transfusions of blood products, a practice which is intended to save life, have been found to be associated with several complications, many of which can be grouped as immunological or infectious. There is also increasing focus on complications arising directly or indirectly from potential quality degradation during storage (Wang, 2009).

Improper identification of patient as the main cause of mistransfusion resulting in significant transfusion mortality may indicate similar lack of knowledge (Myhre & McRuer, 2000). Lack of knowledge of various aspects of blood transfusion by clinical staff, including nurses, continues to be a real threat to patient safety (Taylor et al., 2010). For example, errors in practice involving remote checks at nurses' stations (Whitehead et al., 2003) may indicate that nurses are unaware that such checks serve no purpose; they detract from performing proper bedside identification of patient, and contribute to mistransfusion (Whitehead et al.). Mistakes in blood transfusion and insufficient control of patients who receive blood during the transfusion are among causes of death for such patients (Clark et al., 2001). Since there is no substituting product for human blood, the need for blood transfusion is still continuing.

Despite decades of nurses’ involvement with blood transfusions, there is scant research to describe the practice of nurses as it relates to blood transfusions (Fitzgerald, Hodgkinson, & Doughty, 2000). The overwhelming majority of articles in the nursing literature that focus on blood transfusion described case studies and provided education on recognizing transfusion reactions, but there are only limited reports of research involving nurses’ knowledge on blood transfusions. It is quiet surprising to note that evidence used to guide blood transfusion practices in Africa has almost exclusively been generated by wealthy countries in Europe and North America. This trend is often inappropriate for low-income countries such as Ghana yet research from within Africa about nurses’ knowledge on blood transfusion and practice is seriously lacking. It is against this background that this study was conducted.

Statement of the Problem
Adequate knowledge and proper practice of blood transfusion are essential elements in modern clinical therapy. In a situation where practice is mostly associated with error then the knowledge underpinning the practice for the therapy has to be investigated. Rowe, (2000), revealed that most published guidelines highlight that most serious transfusion complications occur within the first fifteen minutes of transfusion. Therefore, a close monitoring has been recommended before and fifteen minutes after commencement of each unit of blood. The guidelines also recommend careful monitoring in the areas of sample collection, preadministration checking to avoid adverse reactions (Hainsworth, 2000).The above practice activities are all within the time frame of nursing care in the blood transfusion process.

The practice of blood transfusion has evolved as therapy for many patients and still continues to serve as the only hope for the survival of those who require blood to live. Despite its existence for many decades in Ghana’s health care system, research in the area of nurses’ knowledge that underpins their practice of blood transfusion is very scanty. The justification for this study is the paucity of nursing research in Ghana on blood transfusion knowledge and practices, the national focus on transfusion safety including adverse event reporting, and the emerging innovations in technology that have the potential to enhance transfusion safety. Although many advances in donor-screening and blood testing have made Ghana blood supply very safe, recommendations for further improvements in transfusion safety consistently point to a safety-gap in the administration process, a process that is primarily within the domain of nursing.

Thomas and Hannon (2010) linked the national focus to improve transfusion safety in Ghana with the need to address the knowledge and performance gaps of the bedside transfusionist. However, a description of Ghana nurses’ preparation and practices with blood transfusions is lacking. Research is needed to address this important clinical issue to validate or refute the findings of quality reports on nurses’ transfusion practices which has generated much debate.

It has been shown that errors associated with blood transfusions in which nursing failure was often identified as the source of error was recognized by (Wilkinson & Wilkinson, 2001, Heddle et al., 2012). Additionally nurses’ lack of familiarity with the patient and language barriers and lack of compliance with recommended practices promoted error (Dzik et al., 2003 & Hyson, 2009). Most of these findings were generated by individuals outside Ghana .However researching coming from within Ghana on errors nurses commit and the reasons for the occurrence of these are lacking. Therefore the purpose of this study was to examine the knowledge and practice errors among Ghanaian nurses on blood transfusion processes.

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Item Type: Ghanaian Postgraduate Material  |  Attribute: 125 pages  |  Chapters: 1-5
Format: MS Word  |  Price: GH110 ($20)  |  Delivery: Within 30Mins.
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