Article review on the Essential of Nursing Research 9th Edition

Knowledge of blood transfusion among nurses
Belal Hijji, Kader Parahoo, Mohammad Moshaddeque Hussein and Owen Barr
Aims and objectives. To measure nurses’ knowledge of blood transfusion in the United Arab Emirates.
Background. Blood transfusion is a fundamental aspect of nursing practice and nurses’ knowledge of it is essential for safe
practice. Yet little is known about their blood transfusion practice and the knowledge that underpins it. The few studies that
have investigated this topic previously have shown deficiencies in both knowledge and practice. To date, no such study has been
carried out in the Middle East.
Designs. A descriptive, cross-sectional study.
Methods. A random sample of 248 nurses from two general hospitals in the Emirate of Abu Dhabi. The response rate was
94AE3%. A knowledge questionnaire comprising six sections and 49 items was developed for this study. Data were analysed
using descriptive and inferential statistics.
Results. The overall knowledge scores of nurses were generally low ranging from 27–56 of a possible score of 70. Data analysis
revealed knowledge deficits in several key aspects of blood transfusion. There were statistically significant relationship between
nurses’ knowledge and the work setting, the country where they trained and type of qualifications.
Conclusion. This survey highlighted knowledge deficits which could be detrimental to patient safety. These results have
implications for nursing education, policy and practice.
Relevance to clinical practice. Nurses have the responsibility to update their knowledge of and skills in carrying out blood
transfusion. The tool developed in this study may be useful for educators and managers to identify gaps in knowledge and
inform decisions to address them.
Key words: knowledge, nurses, practice development, questionnaire development, survey
Accepted for publication: 14 December 2011
Each year, millions of people worldwide receive much needed
and life-saving blood transfusions. In the UK alone, around
3Æ4 million blood components are transfused every year
(RCN 2005). Whilst in general, this is a safe practice,
morbidity and mortality can still occur in a small number of
cases when the procedure is not followed correctly (Oldham
et al. 2009). The actual figures for blood transfusion errors
are not known. Saillour-Glenisson et al. (2002) estimate the
incidence at 1/29,000 transfusions but they point out that
because of under-reporting, this is probably an underestimation.
Several audits in the UK have reported unsafe blood
transfusion practice, mainly with regard to patient identification,
the administration of wrong blood and monitoring of
vital signs (Parris & Grant-Casey 2007, Watkins 2007).
Nurses have a central role in performing blood transfusions.
Their skills and knowledge are crucial for them to
Authors: Belal Hijji, PhD, RN, Assistant Professor, Faculty of
Nursing, University of Ha’il, Ha’il, Saudi Arabia; Kader Parahoo,
PhD, RN, Professor in Nursing and Health Care Research, Institute
of Nursing Research and School of Nursing, University of Ulster,
Coleraine, UK; Mohammad Moshaddeque Hussein, PhD, MBBS,
Professor of Epidemiology, Institute of Medicine, Universiti Brunei
Darussalam, Bandar Seri Begawan, Brunei; Owen Barr, PhD, RN,
Head of School, School of Nursing, University of Ulster, Coleraine,
Correspondence: Belal Hijji, Assistant Professor, Faculty of Nursing,
University of Ha’il, Ha’il, PO Box 2440, Ha’il 81451, Saudi Arabia.
Telephone: +966 549270774.
2536 2012 Blackwell Publishing Ltd
Journal of Clinical Nursing, 22, 2536–2550, doi: 10.1111/j.1365-2702.2012.04078.x
transfuse blood safely and efficiently. Studies in Turkey
(Bayraktar & Erdil 2000), France (Saillour-Glenisson et al.
2002) and UK (SHOT 2008) have reported serious deficiency
in nurses’ knowledge underpinning their blood transfusion
practice. Knowledge gaps in blood transfusion practice are
not confined to nurses only. Gouezec et al. (2007), in their
study of medical staff in 14 state-run hospitals in France,
reported that they had deficiencies in their knowledge of
blood transfusion. The rate of correct answers ranged from
14–89%, according to the questions. To date, no similar
studies have been carried out in the Middle East.
A literature search of the BNI, CINAHL, MEDLINE and
Google identified only two studies on nurses’ knowledge and
practice of blood transfusion (Bayraktar & Erdil 2000,
Saillour-Glenisson et al. 2002). Searching the reference lists
of the retrieved articles did not yield new relevant studies.
The searches included English and non-English literature.
Saillour-Glenisson et al. (2002) surveyed a sample of 1090
nurses in 19 public hospitals in one French region on their
knowledge and practice of blood transfusion. Poor knowledge
was reported in several areas including pretransfusion
compatibility test, delay in administering blood and recognition
of abnormal reactions after blood transfusion.
In a study of the knowledge and practice of blood
transfusion among a sample of 100 nurses in Turkey,
Bayraktar and Erdil (2000) concluded that the nurses’
knowledge was poor (only a few had scores over 50 of a
total score of 100). These authors identified several aspects
where nurses’ knowledge was deficient, such as, explaining
the complications of blood transfusion, physical observation
on initiating a transfusion and vital signs recording after
initiating a transfusion. Several audits in the UK have also
highlighted serious deficiencies in blood transfusion practice
including checking the identity of those receiving the blood
transfusion and monitoring their vital signs (Serious Hazards
of Transfusion 2003, 2005, Parris & Grant-Casey 2007).
Nurses need knowledge for decision-making regarding
their practice and sound knowledge is essential to ensure
high-quality, safe and effective patient care. In a paper,
examining nurses’ role in preventing blood transfusion errors,
the American Society of Registered Nurses (2008)
concluded that there was an ‘urgent need for training
programmes in nursing units that educate nurses on blood
transfusion risk reduction, latest safety guidelines, nurse
interventions and decision making’ (p1). It is also important
that their practice and their knowledge underpinning it are
regularly investigated.
The aim of this survey was to measure nurses’ knowledge of
blood transfusion in the Emirate of Abu Dhabi.
Design and setting
A descriptive cross-sectional survey using an intervieweradministered
questionnaire was conducted. Nurses involved
in the administration of blood on 21 wards in two hospitals
(A and B) in the Emirate participated in this study. Hospital B
accepted mainly local nationals, with expatriate patients
having limited access. Hospital A accepted both UAE
nationals and expatriates. Access to study other hospitals in
the Emirate was not granted.
The target population was all 439 registered, direct care
nurses in in-patient areas who had more than three months of
experience. A computer software package running SPSS
(version 11; SPSS Inc., Chicago, IL, USA) was used to select
a simple random sample of nurses meeting these inclusion
criteria. Assuming a confidence coefficient of 95% and bound
on error of 6%, the required sample size was 267 nurses
(Marks 1982). Data were collected in 2006.
Data collection
The routine blood transfusion knowledge questionnaire
There was no existing questionnaire that could be used in this
study. Following a review of literature surrounding blood
transfusion and nursing care of transfused patient, in particular
the British Committee for Standards of Haematology’s
(1999) publication: ‘The administration of blood and blood
components and the management of transfused patients’, the
Principal Investigator (BH) developed a questionnaire
(Appendix 1) that had six sections and a total of 49 items of
various objective test formats as recommended by Oermann
and Gaberson (1998). Section A was about nurses’ demographic
details and training, Section B was related to blood
bag collection from blood bank and prior patient preparation,
Sections C and D focused on pretransfusion and posttransfusion
initiation nursing activities. Finally, Sections E
and F dealt with complications related to blood transfusion
and issues related to blood transfusion policies and procedures,
respectively. The inclusion of items was based on a
Education and competence Knowledge of blood transfusion among nurses
2012 Blackwell Publishing Ltd
Journal of Clinical Nursing, 22, 2536–2550 2