Evaluation of the Nursing Management for Patients on Underwater Chest Drainage at Kenyatta National Hospital

Angeline Kirui,Anthony Chege,James Mwaura

doi:10.4236/ojog.2018.812124

Abstract

Aim: To evaluate the nursing management for patients undergoing underwater chest drainage (UWCD) management at Kenyatta National hospital (KNH). Methods: A cross-sectional study conducted at the medical and surgical wards of KNH. Data were obtained from 101 consenting nurses selected through simple random sampling using a researcher administered questionnaire. Ten participant observations were made among nurses who were systematically sampled. Ten key informant interviews were conducted among nurse managers of these departments who were purposively sampled. Data were analysed using SPSS version 21. Findings: Most participants (46.5%) had average knowledge while 6.9% were poor. This means that 46.5% of the participants either had to refer to guidelines on UWCD management or assisted by a more competent nurse while 6.9% were unable to manage UWCD patients. Factors affecting the levels of knowledge and competence included level of nursing education (p = 0.043), length of working experience (p = 0.022) and the attitude of the participants towards UWCD nursing management (p = 0.022). There was low adherence to the Nursing Council of Kenya (NCK) guidelines (17%). Most nurses used “shortcuts” in provision of care. Majority (62.6%) faced challenges in provision of care. The challenges include inadequate knowledge (37.1%), heavy workload (27.4%) and lack of guidelines (16.9%). Conclusions: There is a knowledge and competence gap in the nursing management of UWCD patients at KNH. Majority used “shortcuts” in nursing care with low adherence to NCK guidelines. There is a need to improve the knowledge and competence in order to ensure patients safety and reduce complications.

Highlights

Underwater chest drain is a safe and efficient procedure that is used to drain pleural collections including blood, air, pus and lymphatic fluid both in trauma and nontraumatic origins [1] [2] [3] [4]
Most participants (46.5%) had average knowledge while 6.9% were poor. This means that 46.5% of the participants either had to refer to guidelines on underwater chest drainage (UWCD) management or assisted by a more competent nurse while 6.9% were unable to manage UWCD patients
Factors affecting the levels of knowledge and competence included level of nursing education (p = 0.043), length of working experience (p = 0.022) and the attitude of the participants towards UWCD nursing management (p = 0.022)

Summary

Introduction

Underwater chest drain is a safe and efficient procedure that is used to drain pleural collections including blood, air, pus and lymphatic fluid both in trauma and nontraumatic origins [1] [2] [3] [4]. Patient safety is promoted when the nurses are competent and their knowledge, skills, attitude and performance are related to evidence based practice protocols and standards of care [5] [6] [7] [8] [9]. Nurses at Kenyatta National Hospital have been increasingly faced with the burden of managing patients on underwater chest drainage treatment both complicated and uncomplicated. Over 500 UWCD patients are managed at KNH annually. This is partly due to the increase in chest trauma secondary to gunshot injuries and road traffic accidents which account for 61% of pre-hospital trauma related deaths in Nairobi [10] [11] [12]. Due to the high prevalence of HIV related pleural effusion in most regions within the country [13]

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