Rational Drug Use in Preoperative and Postoperative Care: Improvement in Nurses' Knowledge of Use of Novel Oral Anticoagulants (NOACs)

Yıl 2024, Cilt: 33 Sayı: 5, 372 - 382, 13.12.2024

Tuğçe Seda Gün Gizem Kubat Bakır

https://doi.org/10.17942/sted.1549733

Öz

Objective: This study was conducted as a single-group, pre-test and post-test design, to determine the knowledge levels of nurses about Novel Oral Anticoagulants (NOACs) given before and after surgery and to examine the effect of the training provided on their knowledge levels.
Method: The research was conducted with a total of 70 nurses working in a foundation university hospital between November and December 2022. Data was collected with a questionnaire. The educational intervention consisted of ten 45-minute group sessions. The effectiveness of the training was re-evaluated with a questionnaire after two weeks.
Results: The pre-test and post-test results showed a statiscally significant improvement in knowledge scores, from 4.74±1.87 to 11.51±1.46 (p<0.001). While knowledge improvement was not statiscally significant associated with education level, professional experience, or clinical department, nurses with 6-10 years of experience in their current clinical setting scored higher than those with 1-5 years of experience (p=0.018).
Conclusion: It has been determined that the new generation oral anticoagulant training given to nurses increased their knowledge and awareness about NOAC. In line with this result, it is recommended that similar, comprehensive and continuous training programs be organized for nurses on NOAC drug administration.

Anahtar Kelimeler

education, novel oral anticoagulants, nurse, preoperative care, postoperative care

Ameliyat Öncesi ve Sonrası Bakımda Akılcı İlaç Kullanımı: Hemşirelerin Yeni Nesil Oral Antikoagülanlar (YOAK) Konusundaki Bilgi Düzeylerinin Artırılması

Öz

Amaç: Bu çalışma, hemşirelerin ameliyat öncesi ve sonrası verilen Yeni Nesil Oral Antikoagülanlar (YOAK) hakkındaki bilgi düzeylerini belirlemek ve verilen eğitimin bilgi düzeyleri üzerindeki etkisini incelemek amacıyla tek gruplu, ön test ve son test tasarımı ile yapılmıştır.
Yöntem: Araştırma, Kasım-Aralık 2022 tarihleri arasında bir vakıf üniversitesi hastanesinde çalışan toplam 70 hemşire ile gerçekleştirilmiştir. Veriler, bir anket aracılığıyla toplanmıştır. Eğitim müdahalesi, on adet 45 dakikalık grup oturumundan oluşmuştur. Eğitimin etkinliği, iki hafta sonra yeniden bir anket ile değerlendirilmiştir.
Bulgular: Ön test ve son test sonuçları, bilgi puanlarının istatistiksel olarak anlamlı derecede iyileştiğini göstermiştir; puanlar 4,74±1,87’den 11,51±1,46’ya yükselmiştir (p<0,001). Bilgi düzeylerindeki artışın eğitim düzeyi, mesleki deneyim veya klinik departman ile istatistiksel olarak anlamlı bir ilişkisinin olmadığı, ancak mevcut klinik ortamda 6-10 yıl deneyime sahip hemşirelerin, 1-5 yıl deneyime sahip olanlara göre daha yüksek puanlar aldığı bulunmuştur (p=0,018).
Sonuç: Hemşirelere verilen yeni nesil oral antikoagülan eğitiminin, YOAK konusunda bilgi ve farkındalıklarını artırdığı belirlenmiştir. Bu sonuç doğrultusunda, hemşirelere YOAK ilaç uygulamaları konusunda benzer, kapsamlı ve sürekli eğitim programlarının düzenlenmesi önerilmektedir.

Anahtar Kelimeler

eğitim, yeni nesil oral antikoagülanlar, hemşire, ameliyat öncesi bakım, ameliyat sonrası bakım

Etik Beyan

Araştırmaya başlamadan önce, araştırmanın İstanbul ili Maltepe Üniversitesi Tıp Fakültesi Hastanesi’nde yürütülmesi için Maltepe Üniversitesi Hastanesi Başhekimliğinden (10.05.2022/ E-32835138-900-197558) kurum izni ve Maltepe Üniversitesi Lisansüstü Eğitim Enstitüsü Etik Kurulu’ndan (2022/24-02) Etik Kurul Onayı alınmıştır. Ayrıca araştırmaya katılan tüm hemşirelerden yazılı onam alınmıştır.

Kaynakça

• Hawes EM. Patient Education on Oral anticoagulation. Pharmacy (Basel, Switzerland), 2018;6(2):34. https://doi.org/10.3390/pharmacy6020034
• Steffel J, Collins R, Antz M, Cornu P, Desteghe L, Haeusler KG, et all. 2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation. Europace: European pacing, arrhythmias, and cardiac electrophysiology: Journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2021;23(10):1612–76. https://doi.org/10.1093/europace/euab065
• Kim KS, Song JW, Soh S, Kwak YL, & Shim JK. Perioperative management of patients receiving non-vitamin K antagonist oral anticoagulants: Up-to-date recommendations. Anesthesia and Pain Medicine, 2020;15(2):133–42. https://doi.org/10.17085/apm.2020.15.2.133
• Gassas RS, & Ahmed ME. Development and psychometric evaluation of nurses’ perception towards the gap between knowledge and practice. Nursing Open, 2022;9(2):1497–1505. https://doi.org/10.1002/nop2.1174
• Cohen AT, Hamilton M, Mitchell SA, Phatak H, Liu X, and et al. Comparison of the Novel Oral Anticoagulants Apixaban, Dabigatran, Edoxaban, and Rivaroxaban in the ınitial and long-term treatment and prevention of venous thromboembolism: Systematic review and network meta-analysis. PloS one, 2015;10(12):e0144856. https://doi.org/10.1371/journal.pone.0144856
• Cohen M. New education programme to improve medication safety in US. Reactions Weekly, 2016;1619:6. https://doi.org/10.1007/s40278-016-21189-8
• Cuker A, Burnett A, Triller D, Crowther M, Ansell J, and et al. Reversal of direct oral anticoagulants: Guidance from the Anticoagulation Forum. American Journal of Hematology, 2019;94(6):697–709. https://doi.org/10.1002/ajh.25475
• Douketis JD, Spyropoulos AC, Duncan J, Carrier M, Le Gal G, Tafur AJ, and et al. Perioperative management of patients with atrial fibrillation receiving a direct oral anticoagulant. JAMA Internal Medicine, 2019;179(11):1469–78. https://doi.org/10.1001/jamainternmed.2019.2431
• Ehsani M, Farahani MA, Haghani S, Khaleghparast S, & Memar MM. Assessment of knowledge and practice of cardiovascular nurses regarding warfarin. Journal of Education and Health Promotion, 2022;11:270. https://doi.org/10.4103/jehp.jehp_1240_21
• Baysal E, Midilli TS. Effects of structured patient education on knowledge level and INR control of patients receiving warfarin: Randomized Controlled Trial. Pakistan Journal of Medical Sciences, 2018;34(2):240–6. https://doi.org/10.12669/pjms.342.14216
• Shaha M, Wüthrich E, Stauffer Y, Herczeg F, Fattinger K, Hirter K, Papalini M, & Herrmann L. Implementing evidence-based patient and family education on oral anticoagulation therapy: aA community-based participatory project. Journal of Clinical Nursing, 2015;24(11-12):1534–45. https://doi.org/10.1111/jocn.12743
• Yıldırım JG, Bayık Temel A. The Effect of Nurse Home-Support Program on self-management of patients receiving oral anticoagulation (warfarin) therapy. Florence Nightingale Journal of Nursing, 2020;28(1):13–22. https://doi.org/10.5152/FNJN.2020.19020
• Kılıç S, Çelik A, Çekirdekçi E, Alta S, Elçik D, Akboğa M, et al. The prevalence and risks of inappropriate combination of aspirin and warfarin in clinical practice: Results from WARFARIN-TR Study. Balkan Med J; 2019;36:17–22. https://doi.org/10.4274/balkanmedj.2017.1472
• Njovane XW, Fasinu PS, & Rosenkranz B. Comparative evaluation of warfarin utilisation in two primary healthcare clinics in the Cape Town area. Cardiovascular Journal of Africa, 2013;24(2):19–23. https://doi.org/10.5830/cvja-2012-072m
• Baysal E, Ergin E, Pakyüz SÇ. Does in-service training affect to nurses’ knowledge level about the anticoagulant drugs? Journal Of Human Sciences, 2016;13(3):4725-37. https://doi.org/10.14687/jhs.v13i3.4040
• Durusoy MA. Knowledge and practices of nurses regarding subcutaneous heparin injection (Unpublished master’s thesis). Near East University, 2010. Institute of Health Sciences, Cyprus.
• Adhikari R, Tocher J, Smith P, Corcoran J, & Macarthur J. A multi-disciplinary approach to medication safety and the implication for nursing education and practice. Nurse Education Today, 2014;34(2):185-90 https://doi.org/10.1016/j.nedt.2013.10.008.
• Wheeler J, & Chisholm-Burns M. The benefit of continuing professional development for continuing pharmacy education. American Journal of Pharmaceutical Education, 2018;82(3):6461. https://doi.org/10.5688/ajpe6461.
• Rouleau G, Gagnon MP, Côté J, Payne-Gagnon J, Hudson E, Dubois CA, & Bouix-Picasso J. Effects of e-Learning in a continuing education context on nursing care: Systematic review of systematic qualitative, quantitative, and mixed-studies reviews. Journal of Medical Internet Research, 2019;21(10):e15118. https://doi.org/10.2196/15118
• Vaismoradi M, Tella SA, Logan P, Khakurel J, & Vizcaya-Moreno F. Nurses’ adherence to patient safety principles: A systematic review. International Journal of Environmental Research and Public Health, 2020;17(6):2028. https://doi.org/10.3390/ijerph17062028
• Dager WE, Trujillo TC, & Gilbert BW. Approaches to precision-based anticoagulation management in the critically ill. Pharmacotherapy, 2023;43(11):1221–36. https://doi.org/10.1002/phar.2868
• Dsouza JP, Chakrabarty J, Ramachandran P, Guddattu V, Nayak BS, & George A. Effectiveness of a nursing ıntervention module on adherence, knowledge, quality of life, and complications among patients receiving anticoagulation therapy - a randomized controlled trial protocol. Patient Preference and Adherence, 2022;16:1723–31. https://doi.org/10.2147/PPA.S365585
• Wang Y, Kong MC, Lee LH, Ng HJ, & Ko Y. Knowledge, satisfaction, and concerns regarding warfarin therapy and their association with warfarin adherence and anticoagulation control. Thrombosis Research, 2014;133(4):550–4. https://doi.org/10.1016/j.thromres.2014.01.002
• Omoush A, Aloush S, ALBashtawy M, Rayan A, Alkhawaldeh A, Eshah N, Musa A, Hamadneh S, Al Qadire M, & Al Omari O. Nurses’ knowledge of anticoagulation therapy for atrial fibrillation patients: Effectiveness of an educational course. Nursing Forum, 2022;57(5):825–32. https://doi.org/10.1111/nuf.12770
• Yones F, Qalawa S, & Baker A. Assessment Of nurses’ performance regarding caring of patients on anticoagulant therapy In Port-Said Hospitals. 2019;6:1-15. https://doi.org/10.21608/pssjn.2019.66464
• Oterhals K, Deaton C, Geest S, Jaarsma T, Lenzen M, Moons P, Mårtensson J, Smith K, Stewart S, Strömberg A, Thompson D, & Norekvål T. European cardiac nurses’ current practice and knowledge on anticoagulation therapy. European Journal of Cardiovascular Nursing, 2014;13:261-9. https://doi.org/10.1177/1474515113491658.
• Ferguson C, Hickman L, Phillips J, Newton P, Inglis S, Lam L, & Bajorek B. An mHealth intervention to improve nurses’ atrial fibrillation and anticoagulation knowledge and practice: The EVICOAG study. European Journal of Cardiovascular Nursing, 2018;18:15-7. https://doi.org/10.1177/1474515118793051
• Bloe C. Review: A nurse-led randomised controlled trial of a structured educational programme for patients starting warfarin therapy. Journal of Research in Nursing, 2014;19:413-4. https://doi.org/10.1177/1744987113516223
• Köksal AT, and Avşar G. What do patients using oral anticoagulant drugs know and what do they do about anticoagulant treatment?. Evaluation of patients in a cardiology service. Balıkesir Journal of Health Sciences, 2015;4(3):137-42. https://doi.org/10.5505/bsbd.2015.61587
• Armstrong EP, Chemodurow L, Christensen S, & Johnson ES. A pre- post-evaluation of implementing an inpatient warfarin monitoring and education program. Pharmacy Practice, 2011;9(2):101–5. https://doi.org/10.4321/s1886-36552011000200007
• Eltheni R, Schizas N, Michopanou N, & Fildissis G. Effects of a personalized nurse-led educational program for new patients receiving oral anticoagulant therapy after mechanical heart valve prosthesis ımplantation on adherence to treatment. Journal of Chest Surgery, 2021;54(1):25–30. https://doi.org/10.5090/kjtcs.20.106