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Background: Assessment of clinical competence is an essential, mandatory requirement and critical norm for accountability of educational objectives as the traditional testing tools cannot evaluate clinical competence. But it became a tough job for nurse educator as it poses several challenges in terms of objectivity and reliability. In spite of increasing usage of OSCE in nursing and the huge number of studies published about it, it is still debatable about advantages of its using. OSCE costs remain an obstacle facing its use. The aim of this study: was to assess challenges affecting quality of OSCE and suggestions of improvement as perceived by academic nursing staff.Design: A descriptive exploratory research design was used.Setting: Faculty of Nursing, Minia University.Subjects: A purposive sample of 40 clinical instructors and assistant lecturers at medical-surgical, pediatric, obstetric, and community health nursing that using OSCE in students' clinical evaluation.Tools: I-Socio-demographic data sheet II- Self-administered questionnaire to assess the perceived challenges affects quality of OSCE among study participants and to obtain their suggestions to overcome these challenges.Results: The highest manpower related challenges perceived by participants were insufficient faculty members (83%) and OSCE is stressful for students (81%). For non-human challenges, the most prominent ones were that some procedures require longer time than others (90%), unsuitability of the available settings to the number of students (83%) and insufficient needed materials/equipment (73%).Conclusion: The founded human and non-human challenges of the current study may affect the quality of OSCE in all steps, from preparation to application and subsequent suggestions are interrelated. Staff suggested improving in labs preparation and increasing labs numbers. Also, allocating sufficient budget and increasing number of trained staff.Recommendations: Increase the number of clinical instructors, budget and the work hours of OSCE to accommodate with the increased number of students and permit periods of rest for both staff and students.

Trauma injury is the leading cause of mortality and hospitalization worldwide and the leading cause of potential years of productive life lost. Hypercatabolism after trauma may lead to acute protein malnutrition that ultimately results in multiple organ failure. Therefore, nutritional support is an essential component of the care of critical trauma patients for optimizing outcomes. Evidence-based practice improves the quality of care through patient-centered care, the utilization of patient resources, provider resources and experiences, current research and scientific information. The main objective; of this study was to assess and evaluate the effect of evidence-based enteral nutrition (EN) protocol on complications prevention among trauma patients. The research hypothesis; evidence-based enteral nutrition protocol will prevent complications among trauma patients. The study subjects consisted of 50 adult patients diagnosed with trauma and divided equally into two groups; control group who received the routine hospital nutrition and study group who received evidence-based enteral nutrition protocol at the Intensive Care Unit (ICU) El-Minia University Hospital. The tools of data collection were; 1) Assessment sheet, it includes two parts, 1st part included socio-demographic data of the patient. 2nd part included five items that cover medical data, 2) Evidence-based enteral nutrition protocol, and 3) Evaluation sheet, it includes two parts, 1st part included the laboratory investigations. 2nd part covers the vital signs. Results: This study revealed that the majority of the control group less than thirty years old compared to study group equal or more than forty years old. There are statistically significant differences regarding mouth condition, severe infection, and nutritional assessment, among study and control groups. The result also revealed that the highest percent regarding the time of start enteral feeding and body positioning were among the study group. Conclusion: Evidence-based enteral nutrition protocol had significantly prevention of complications among trauma patients. Recommendation: Hospital should be following evidence-based enteral nutrition protocol to prevent complications among trauma patients at intensive care unit.

Background: Acid-base disorders are very common in critically ill as well as contribute significantly to morbidity and mortality. Aim: To evaluate the effect of acid-base disorders on mortality and level of consciousness for patients admitted to ICU. Design: descriptive exploratory research design was utilized to conduct this study .Setting: This study was carried out in anesthesia intensive care units at Assiut university hospital. Sample: One hundred sixty adult male and female patients. Tools: Two tools were used in this study, the Critically Ill Patients Characteristics tool, and Acid-base parameters assessment tool. Result: more than one third of the patients (36.3%) had respiratory alkalosis and was the most common acid-base disorder observed on admission . Metabolic acidosis and respiratory acidosis was associated with higher mortality (36.4%), and (22.75). Length of ICU stay was significantly higher in non-survivors (10.23±6.91 versus 7.60±4.69, p= 0.007). Mortality was significantly higher in the GCS < 9 group with metabolic acidosis (37.5 % versus 33.3 %, p=0.033). Conclusion: Respiratory alkalosis was a common acid base disorder. Acidemia whether due to metabolic or respiratory acidosis is associated with increased mortality in ICU patients. Low GCS low is associated with increased mortality especially in the patients with metabolic acidosis. Recommendation: Closely monitoring and early managment is important to correct acid-base imbalance to avoid poor patient outcomes.

Introduction: Widespread use of chemotherapeutic drugs in the treatment of cancer can lead to higher health hazards among nurses who handle and administer such drugs, so they should know how to protect themselves from the effects of chemotherapy. Aim of study: was to evaluate the effect of implementing Safety Handling Protocol for Chemotherapy (SHPC) on nurses’ knowledge and practical skills. Research design: A Quasi – experimental research design was utilized to carry out this study. Setting: this study was conducted at Minia Oncology Center. Subjects: all available nurses (50) who are working in outpatient and inpatient chemotherapy department. Tools: three tools were designed by researcher and utilized; Arabic administered questionnaire, structured observational checklist and safe handling chemotherapy protocol (booklet). Results: nurses had poor knowledge regarding safe handling chemotherapy. The mean score of total nurses knowledge statistically improved from (12.9± 4.8 to 25.4 ± 2.0 & 22.7 ± 2.8 respectively) in pre, immediately, and after 2 months of implementing (SHPC) with p value (.0001**). Nearly all nurses have unsatisfactory practical skill level before implementing (SHPC) which significantly changed after implementing it (90%, 18%, 20% respectively) with p value (.0001**). Conclusion: the results of this study revealed significant improvement of nurses' knowledge, and practical skills among the nurses handling chemotherapeutic drugs after implementing (SHPC). Recommendations: health care professionals who are responsible for handling chemotherapeutic drugs should be adherent to implementation of (SHPC).

Context: Chemotherapeutic drugs are chemical substances used for cancer treatment and known to be carcinogenic, teratogenic, and mutagenic to humans. Occupational exposure to chemotherapeutic drugs has led to higher health hazards among nurses who handle them. Aim: Assess chemotherapy health hazards among oncology nurses and its possible relation to malpractice and workplace environment. Method: A descriptive and exploratory research design used in the present study. All available nurses from both sexes working in the chemotherapy department comprised of 50 nurses, of one-year experience at least. The study conducted at Oncology Center in Minia City, Egypt, in the outpatient and inpatient chemotherapy department. Three tools used to collect the study data. An interview structured questionnaire for nurses, designed to assess socio-demographic characteristics and medical history of the studied nurses. The second tool is nursing practice observation checklists to assess safe practice in chemotherapy handling. The third tool was environmental safety checklists to assess workplace environmental safety. Results: The main results of this study clarified that about half of the study sample (48%) complained of health hazards presented as skin irritation/allergy, chest allergy, and inflammation of eyes (45.8%, 16.7%, 37.5% respectively). Maternal hazards presented mainly as irregular menstrual bleeding (50%), menorrhagia, and abortion (33.3%). Decrease environmental safety presented mainly as absence of biological safety cabinet, specific personal protective equipment (PPE), safe handling chemotherapy guidelines. Along with certain nurses' malpractice as the majority of the study sample (74%) has poor practice score in the handling of chemotherapy. Conclusion: This study indicated the presence of general and maternal health hazards among nurses handling chemotherapy in the form of general and maternal health hazards. The study also clarified nurses’ malpractice among about three-fourths of nurses and provide evidence of an unsafe environment. The results strengthened the increased need for improving nurses' knowledge and practice regarding chemotherapy handling along with the provision of needed equipment/supplies to underpin safe and effective practice in this area.

Context: Exercise interventions are the cornerstone of cardiac rehabilitation. The exercise program consists of respiratory physiotherapy, neck and shoulder exercises, walking, and cycling. The purpose is preventing respiratory complications, neck and shoulder pain, and increasing the physical functional level. Aim: of this study is to evaluate the effect of applying nursing exercise protocol on hemodynamics and functional capacity among post-cardiac surgery patients. Methods: Quasi-experimental research design utilized in the current study. A purposive sample including 60 male and female patients, classified equally into two equal groups; study group (n= 30) and control group (n= 30), collected through 14 months. This study carried out in the inpatient cardiac surgery department and the outpatient cardiac clinic of Cardiothoracic Surgery Hospital at New Minia City. Four tools utilized in collecting data; named Health Assessment Record; Six Minute Walk Distance Test; Modified Medical Research Council Scale (MMRC) for measuring dyspnea; and Nursing Educational Protocol Checklist. Results: Current study findings displayed an improvement of total distance walked among study group compared to control group, it also showed highly statistically significant differences between both groups related to total distance walked after 12th-week post-discharge documented by p-value (0.000). Conclusion: The current study findings concluded that the nursing educational protocol in the form of deep breathing, incentive spirometer; coughing and early ambulation induces a significant improvement in hemodynamic variables and six minute walk distance recommending that hospitals should implement nursing educational protocol as a routine hospital policy among all cardiac surgical patients in all age groups.