ABSTRACT

Background: One of the best-known and most often used invasive techniques for assessing
coronary artery circulations and assessing heart health is cardiac catheterization. This cross-
sectional study aims to evaluate nurses' knowledge, attitudes, and practices around cardiac
catheterization.

Methods: The cross-sectional study carried out at the Cardiology Institute in Faisalabad. In this
study, 100 female nurses made up the study sample. Resources for gathering data socio
demographic survey, knowledge-gathering interview questionnaire, safety-attitude survey, and
observational checklist for implementation Version 23 of the SPSS program was utilized to
analyze the data.

Results: The study's conclusions indicate that 59 (59.0%) of the nurses who underwent cardiac
catheterization were between the ages of 33 and 40, and 100 (100.0%) of the nurses are female.
There were 96 married nurses, 62% of nurses knew what factors influence cardiac
catheterization, and 64% of nurses knew when to perform a cardiac catheterization. 76 hospitals
(76.0%) have well-coordinated nursing care; 91 (91.0%) nurses explain the post-procedure; 89
(89.0%) nurses monitor for bleeding at the catheter site. Excellent training is provided to new
hires by 84 hospitals (84.0%).

Conclusion: The study's results indicate that, on the whole, nurses have inadequate knowledge
about cardiac catheterization, while over half of them have satisfactory experience with the
procedure. Additionally, nurses' attitudes toward cardiac catheterization are inadequate across
five safety-related dimensions.

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 CHAPTER # 1

INTRODUCTION

1.1 Background:
One of the most well-known and widely used invasive procedures that can be used to
assess coronary artery circulations and ascertain the condition of the heart is cardiac
catheterization. Many heart diseases, such as arrhythmias, angina, and issues with the cardiac
valves, can be diagnosed and treated using cardiac catheterization. Heart failure, congenital
cardiac disease, coronary artery disease, and microvascular heart disease can all be diagnosed or
treated by cardiac catheterization (Ghareeb, et al., 2022).

The most effective method for locating, evaluating, and treating issues associated with
cardiac diseases is believed to be cardiac catheterization. This procedure has reduced the
mortality and morbidity associated with cardiovascular disease, but there are still many
unresolved issues (Hasballah, et al., 2019).

One of the leading causes Coronary artery disease, or CAD, is still the world's top cause
of death and morbidity in many areas, as well as a major contributor to public health problems.
Additionally, CAD is the primary cause of mortality among persons over 35 in the United States,
accounting for almost one-third of all fatalities in this demographic. Globally, coronary artery
disease affects over 71 million people. Approximately 75% of all deaths from cardiovascular
disease are caused by coronary artery disease. In the US, there are about 6 million cardiac
catheterizations done annually. According to the cardiac catheterization unit's records at the
Assiut University Hospital, around 3600 cardiac catheterization cases are completed for every
300 cases that are admitted on average each month (Thabet, et al., 2019).

Worldwide Cardiovascular diseases (CVDs) are the leading cause of death. 56.4 million
fatalities were reported worldwide in 2015. Thirty million of the five6.4 million deaths globally
were attributable to the top ten primary causes of mortality, which also included stroke and
ischemic heart disease (IHD). With 17.5 million deaths overall, IHD and stroke are the leading
causes of death. In Pakistan, coronary artery disease accounts for 9.87% of all deaths, but in the

4
US, cardiovascular ailments are the leading cause of death. In America, one in 635,000 people
suffers a heart attack every 34 seconds. Every year, coronary artery disease, or CAD, affects
around 385,000 individuals in the US. Research indicates that cardiovascular diseases are rapidly
increasing in death. Within a similar vein, Pakistan is witnessing a rise in the prevalence of
cardiovascular diseases. An estimated 200,000 deaths in Pakistan each year are attributed to
cardiovascular diseases (CVD), accounting for 34% of all deaths. In Pakistan, cardiovascular
illnesses take the lives of twelve people every hour (Yaqoob, et al., 2019).

Nurses’ knowledge regarding cardiac catheterization These are highly qualified

cardiovascular nurses with a specific role whose primary responsibility is to offer nursing care to
patients undergoing cardiac catheterization. The first set of responsibilities begins with
admission and ends with discharge. It entails health screening, patient education before surgery,
support for the surgeon throughout the procedure, and patient follow-up till discharge. The
survey revealed that over half of the nurses had acceptable levels of practice and knowledge
(52% and 62%, respectively) (Bakr, et al., 2020).

Nurses’ knowledge regarding cardiac catheterization are attempting to mitigate the

effects of heart disease. Being by the patient's bedside all the time puts a nurse in the best
position to closely observe and initiate resuscitation if difficulties are identified. As such, an
experienced, well-educated nurse with practical expertise is an invaluable asset to any healthcare
organization. An explanation of the "spider-in-the-web" quality of a nurse's involvement in post-
coronary intervention care for patients is given. A specialized nurse can successfully manage
cardiovascular emergencies, which include emergency medication administration, early
defibrillation, and rhythm detection. Nurses can have a significant role between the patients and
the attending consultants. Treating patients as a "physician" and providing care as a "nurse" can
be combined to act in the capacity of a mediator. It is imperative that nurses exhibit these
competencies by gaining comprehensive knowledge and gaining experience in practical skills so
that their role can be comprehended (Yaqoob, et al., 2019).

Nurses attitude regarding cardiac catherizations is to provide patient safety in hospitals by

which implementing the right treatments. To ensure that their patients receive high-quality care,

5
nurses in the Cardiac Catheterization Lab (CCL) are essential. Developing into an effective and
efficient nurse requires knowledge and current evidence-based practice. When feasible, problems
should be minimized and treated when they do arise. This requires collaboration between CC
personnel and nurses who are caring for patients following cardiac catheterization procedures.
Regarding patient safety in the cardiac catheterization unit, 77.5 percent of nurses had a negative
attitude and 22.5 percent had a favorable attitude (Hasballah, et al., 2019).

Nursing practice for cardiac catheterization calls for a knowledgeable nurse with the
evaluation skills to spot such problems and awareness of them. In addition to improving physical
and emotional wellness, the integration of nursing knowledge and skills before to and following
cardiac catheterization aims to ensure a precise and safe process. Prior to cardiac catheterization,
patient education is essential; the nurse should inform the patient about the process. In addition
to visiting the catheterization laboratory, patients must also watch a video of the process. This
survey found that 34% of nurses had unsatisfactory practice, whereas 66% of nurses had
satisfactory practice (Jabr, et al., 2022).

Nurses have a specific role, regardless of where they collaborate with other surgical
health care providers. As a result, if there are limitations or a lack of access to high-quality pre-
operative education and preparation, the need for more surgical support to treat underlying
medical conditions that are expected to develop may rise. Heart catheterization can cause a
variety of issues, such as the following: Contrast dye can result in blood clots, damage to the
urinary organ, pain and irritation at the IV or sheath insertion site, and infection. It is commonly
used in renal sickness and diabetes mellitus patients (Mahmoud, et al., 2022).

Nurses with increased knowledge also have higher levels of self-efficacy when it comes
to nursing management of patients undergoing cardiac catheterization. It is crucial that safety
procedures are followed, particularly in critical care environments like cardiac catheterization
units. The nurse on this unit is expected to adhere to safety protocols in order to safeguard
patients from healthcare risks and to protect themselves from workplace hazards. As a result,
developing nursing care protocols for patients having cardiac catheterizations is empirical.
Providing cardiac catheterization patients with nursing care necessitates experience and

6
knowledge of the typical challenges that patients may encounter. To provide safe and appropriate
care and enhance both physical and mental health, nurses should integrate their knowledge and
abilities prior to, during, and after cardiac catheterization (Mohamed, et al., 2023).

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1.2 PROBLEM STATEMENT

This research aims to investigate why nurses in cardiac care units perform poorly and
have insufficient knowledge of cardiac catheterization. Nurses' expertise and experience
with cardiac catheterization are also found to be restricted in earlier investigations. Due to
their lack of training and experience, many nurses develop a bad attitude regarding cardiac
catheterization. Because of this, the patient does not receive the appropriate treatment during
the cardiac catheterization operation. The cardiac catheterization practical mistake is
identified in this investigation. To enhance nurses' cardiac catheterization practices and the
standard of care provided to patients, it is critical to evaluate the knowledge and attitudes of
the nurses.

1.3 SIGNIFICANCE OF THE STUDY

This study aims to provide a better understanding about the knowledge of the cardiac
catheterization procedure and how nurses' knowledge, attitude, and practice can be used to
improve the quality of life of such patients. More importantly, the findings of this study will
benefit nurses and healthcare practitioners in general to improve nurses' intervention during
cardiac catheterization. Finally, the study will significantly assist nurses in developing better
programs that would enhance cardiac catheterization patients to promote their quality of life

1.4 OBJECTIVES OF THE STUDY:

The objective of this study is:

To Assess the knowledge, attitude and practices of nurses regarding the cardiac
catheterization at Faisalabad institute of cardiology at Faisalabad.

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1.5 HYPOTHESIS:

Null Hypothesis: H0

There is no correlation between the knowledge, attitudes, and practices of nurses with regard
to cardiac catheterization.

Alternative Hypothesis: (HA/H1)

There is a correlation between cardiac catheterization knowledge, attitudes, and practices

among nurses.

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 CHAPTER # 2

LITERATURE REVIEW

2.1 Search strategy:

Reading, processing, evaluating, synthesizing, and summarizing information are the

primary components of a literature review in order to effectively evaluate the relevance of the
literature examined. Google Scholar was one of the strategies for searching databases. Other
search strategies of this study are PubMed, Opera etc. These are the term used to initiate research
cardiac catheterization knowledge attitude and practice.

2.2 Literature review:

Ali (2023) was carried out a study at Mania University Hospital's cardiac catheterization
and cardiac care units. Purposive sampling was used to choose 50 nurses for the sample. The aim
of this study was to evaluate the performance of cardiac nurses with respect to patient safety.
Three instruments were being utilized. Nurse Knowledge Questionnaire (Tool I). The Instrument
for Observational Checklist (II). A third tool is the Nurses' Attitude Scale. The Statistical
Program for Social Science (SPSS) version 25 and an IBM computer were utilized to tabulate
and statistically analyze the gathered data. Before instructional standards were implemented,
their level of awareness of cardiac catheterization and safety precautions grew from 30% to 90%.
Additionally, they demonstrated a considerable change in their optimistic outlook regarding
patient safety, with positive attitude values of 30% and 70% for the corresponding pre- and post-
educational instructions. The entire practice mean score before the recommendations were
implemented was 95.8 and 11.3; after the guidelines were implemented, the mean SD was 160.6
and 1.4. Between total practices, total knowledge, and overall practice, a statistically significant
association was found. The results of the study showed that cardiac nurses' performance in terms
of patient safety during cardiac catheterizations can be improved by implementing instructional
recommendations. The study recommends that cardiac catheterization unit nurses participate in

10
ongoing educational sessions to increase their understanding of and proficiency with safety
measures ideas. (Ali, et el., 2023).

Mohamed & Fathy (2023) was carried out a study at Egypt's Benha University Hospital.
Convenient sampling was used to choose the forty sample sizes. With an emphasis on the
attitudes, actions, and knowledge of nurses who provide care for patients undergoing cardiac
catheterization, the purpose of this study was to assess the outcomes of a safety-focused
intervention process. Positive attitudes prior to and immediately following the intervention
strategy demonstrated how seriously we took patient safety, as evidenced by the percentages of
27.5% and 60%, respectively. The results of the study show a significant improvement in the
general understanding, behaviors, and attitudes of nurses with regard to cardiac catheterization
and safety precautions taken right after the intervention. According to research findings, nurses
employed in cardiac catheterization units actively participate in ongoing education and training
initiatives. These programs are essential for maintaining nurses' current knowledge and
improving their application of safety measures principles in real-world situations. This kind of
continuous professional development guarantees that nurses stay up to date and capable of safely
caring for patients having cardiac catheterization (Mohamed, et al., 2023).

Jaber & Taha (2022) was out a descriptive cross-sectional study at the cardiac care units
of the Egyptian hospitals affiliated with Zagazig University. Convenient sampling was used to
choose the sample size of 50 nurses. This study set out to evaluate the knowledge and practices
of nurses with regard to the care of patients having cardiac catheterization. Two instruments
were used to gather the data: an observational checklist served as Tool II and an interview
questionnaire for nurses served as Tool 1. collecting data on the past, basic clinical evaluations,
laboratory research, and outcome measures Data entry, coding, and analysis were done using
Microsoft Excel software. The data were then imported and examined using the Statistical
Package for the Social Sciences (SPSS version 20.0) program. According to the study's findings,
66% of the nurses who were examined had adequate cardiac catheterization practices, although
Of the nurses surveyed, 78% lacked sufficient information. While over two thirds of the nurses
in the study reported having adequate experience caring for patients undergoing cardiac
catheterization, over three quarters reported having insufficient knowledge about such patients.

11
The results of this study's researchers recommend that a curriculum created to teach nurses in
cardiac catheterization care units about patient safety and how to avoid problems after the
procedure (Jaber et al., 2022).

Khaliel & Mehmoud (2022) We out a cross-sectional descriptive study in the cardiac
catheterization unit of Benha University Hospital. Convenient sampling was used to choose the
40 members of the sample. Assessing nurses' adherence to safety procedures in cardiac
catheterization units was the aim of this study. Three instruments were used in the questionnaire-
based data collection process: I. A safety measure knowledge assessment using structured
interviews; II. A practice evaluation using an observational checklist for safety measures; and III.
An attitude assessment using a safety attitude questionnaire sheet. The statistical analysis was
performed using the Statistical Package for Social Sciences (SPSS), version 22. The safety
culture of the cardiac catheterization unit was viewed favorably by 77.5% of the study's nurses;
yet, 60% of the nurses in the 75% lacked sufficient practical knowledge overall, and the study's
participants generally knew too little about safety procedures. When it came to safety
precautions, the nurses' performance fell short. Between the total knowledge, practice, and
attitude of the examined nurses and demographic factors such years of experience, educational
attainment, and training course attendance, there was a highly statistically significant relationship
(P= < 100). According to this research, assessing how a safety-related education program affects
nurses' performance (Khaliel, et al., 2022).

Sania & Raja (2022) were carried out at Pakistan's Ziauddin University's tertiary care
facility in Karachi. Non-probability convenient sampling was used to gather the sample size of
thirty. The purpose of this study is to evaluate how educational training affects nurses'
comprehension of patient safety protocols during cardiac catheterization. The sample size was
determined using the Open Epi 3.0 application. Along with the necessary tools, information on
patient safety after cardiac catheterization was gathered using the open-access Assess Structured
Knowledge About Practices questionnaire. The data were entered and assessed using SPSS
(Statistical Package for Social Sciences) version 21.0. Before the commencement of educational
training, 30% of the participants lacked sufficient knowledge. Following educational instruction,
the level of knowledge increased to good knowledge (70.0%), and P-value ≤0.001 indicated

12
statistical significance in the outcomes. Likewise, there were notable variations in the nursing
practices before to and during the execution of the educational initiative. After the intervention,
83.3% of them had appropriate practice, whereas 66.7% had inadequate practice beforehand.
Based on research indicating that nurses' understanding of patient safety procedures during
cardiac catheterization was enhanced by the introduction of educational training (Sania, et al.,
2022).

Mehmood & Ibrahim (2021) In the hospital in Mosul, Iraq, a cross-sectional study was
done. Random sampling yielded a sample size of 110 nurses. This research aims to assess the
nurses' knowledge of post-cardiac catheterization patient care. Three sections comprised the
questionnaire designed to achieve the study's objectives. The first component contained six items
pertaining to demographic information. The subsequent section comprises ten issues that address
nurses' overall comprehension of cardiac catheterization. A cardiac catheterization nurse's skill
set (18 items) is the third one. Analytical techniques for inference as well as descriptive statistics
are applied to the data analysis. Based on the data, it was found that 56.4% of men and 43.6% of
women were in the 25 to 29, most nurses had one to five years of experience. According to the
study, the sample percentage is high and the outcome is unacceptable given the amount of data
on cardiac catheterization risk factors. The age of the nurse and her knowledge of the dangers
involved in cardiac catheterization were found to be statistically significantly correlated (P=0.05)
in the study. According to the study's findings, the sample percentage is high and the outcome is
unacceptable given our current understanding of the risk factors for cardiac catheterization.
According to research, nurses should take part in training programs to enhance the nursing care
they give to patients and their families during cardiac catheterization (Mahmood, et al., 2021).

Amal Bakr (2020) took place Both the Al-Azhar University Hospital in New Damietta
City and the cardiac catheterization facility at Port Said General Hospital in Port-Said City used
a descriptive research design. Convenient sampling was used to choose the sample size of fifty.
Evaluation of the nursing care given to patients undergoing cardiac catheterization was the aim
of this study. Three different instruments were used. Tool I: Nurses' Knowledge Questionnaire.
Tool II: Observational Checklist. The Nurses' Attitude Scale (Tool III). The analyses were
performed using version of the statistical package for social science (SPSS). The study's

13
conclusions demonstrated that, although 68% of the nurses had a positive attitude toward caring
for patients having cardiac catheterizations, over half of them had adequate levels of practice and
knowledge (52%, 62%).More than half of the nurses in the study had adequate training and
experience, and the majority of them had a favorable outlook on caring for patients having
cardiac catheterization. Furthermore, no statistically significant link was observed between the
aggregate scores of nurses' knowledge, practice, and attitude. Based on research, it is
recommended that educational and training initiatives be implemented to enhance nurses'
expertise, methods, and dispositions with regard to caring for patients having cardiac
catheterization (Bakr, et al., 2020).

Hasballah & Shoar (2019) In the cardiac catheterization unit of the Heart Hospital at
Assiut University Egypt, a descriptive cross-sectional study was carried out. Forty nurses
comprised the study's sample. Evaluating nurses' attitudes and knowledge about patient safety in
cardiac catheterization units was the goal of this study. The structured interview form comprised
three sections: personal information, nursing knowledge, and nursing attitudes toward patient
safety. Data entry and analysis were finished using SPSS version 19 (Statistical Package for
Social Science). All nurses (100%) were determined to have inadequate knowledge on patient
safety. In contrast, 22.5 percent of nurses in the cardiac catheterization unit had a good attitude
toward patient safety, compared to 77.5 percent who had a negative attitude. In the interval of
nursing age groups (0.047), nurse There were statistically significant variations in educational
attainment (0.002) and knowledge scores. The cardiac catheterization unit nurses were found to
have inadequate knowledge and a poor attitude toward patient safety. Based on research
findings, nurses doing cardiac catheterization should participate in an educational program
regarding patient safety to enhance their understanding and disposition toward patient safety
(Hasballah, et al., 2019).

Yaqoob & Rubina (2019) a cross-sectional study was carried out at Pakistan's Agha Khan
University's tertiary care hospital in Karachi. Convenient sampling was used to select the sample
size of 70. Evaluating nurses' post-cardiac catheterization patient care practices and knowledge
was the goal of this study. Data from 70 individuals were collected using two techniques.
Knowledge was assessed using a fifty-item multiple-choice questionnaire, while practices were

14
assessed using a twenty-item observational checklist. The collected data were entered and
reviewed using SPSS version 20, a statistical program for social sciences. Of the nurses, around
40% had insufficient knowledge, about 54.7% had outstanding knowledge, and about 54.3% had
sufficient knowledge scores. Furthermore, 87.1% of nurses reported unethical behavior, whereas
only 12.9% of respondents mentioned unfinished business. Ninety-five percent of the data were
included, and the significance criterion was less than 0.05. The mean scores for knowledge and
practice were 27.2 + 6 and 10.3 + 2.2, respectively. Based on the study's proposal that procedures
were seen in every department, more research is required in order to evaluate nurses' attitudes
using a qualitative method and to create and execute a uniform post-cardiac catheterization care
routine (Yaqoob, et al., 2019).

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 2.3 Gap Analysis:
The study evaluates nurses' practice, knowledge, and attitude toward cardiac catheterization.
Research gaps still need to be filled, according to the Faisalabad Institute of Cardiology. After
reviewing related literature, it was discovered that nurses' knowledge of cardiac catheterization
was acceptable, but their attitudes toward the procedure were not sufficiently positive, and they
performed the procedure in an inexpert manner. The lack of an educational program, the inability
to attend national and international conferences and workshops, the lack of ongoing evaluation of
nurses, and the inadequate training program are some of the variables that have an impact on
nurses' knowledge, attitudes, and practices. By offering training and educational programs, as
well as opportunities to attend workshops and seminars. The principal aim of this research is to
improve the knowledge, attitude and practice of nurses.

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 CHAPTER # 03

METHODOLOGY

3.1 Study design:

The knowledge, attitudes, and practices of nurses regarding cardiac catheterization will be
evaluated using a cross-sectional descriptive study methodology.

3.2 Study Variable:

Dependent variables:

 Attitude

 Practice

Independent variables:

 Cardiac catheterization
 Knowledge

3.3 Operational definition:

Knowledge:

Knowledge is the awareness about something, such as a skill, facts. That is gained from
education and experience.

Measuring tool: The tool Interviewing questionnaire for nurses was to measure nurses’
knowledge it was developed by Chen and Croizer in (2014).

Likert scale was used for scoring system (strongly agree=1 agree =2 neutral=3 disagree=4
strongly disagree=5) total sore is 0-126.

Attitude:

The way someone expresses their feelings through their behavior is called their attitude.

17
 Measuring tool: The Safety Attitudes Questionnaire (SAQ)tool was used to measure the
attitude of nurses it was developed by Sexton et al., (2000).

Scoring system was using a Likert scale to score (Disagree=1, Neutral =2, Agree =3). The total
score is 0-126.

Practice:

Practice is a repeated behavior to help master in skills.

Measuring tool: An observational checklist tool was used to a measure the practice of nurses it
was developed by Eisen et al., (2013)

Likert scale was used for scoring system (Always=1 Sometime=2 Never). The total score is 0-
140.

Cardiac catheterization:

Cardiac catheterization is used to diagnose problems with the heart or its arteries or to investigate
the many roles of the heart. An arm, neck, or groin vein or artery is formed a tiny incision. The
catheter enters the heart by passing through an artery or vein.

3.4 Study setting:

Data will be collected from staff nurses working in cardiac care unit Faisalabad Institute of
Cardiology at Faisalabad.

3.5 Study population:

Staff nurses who will work in Faisalabad Institute of Cardiology .

3.6 Sampling technique:

This study will use a simple random sampling technique.

3.7 Sample Size:

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Sample size will be 150 for this study.

2
N × Z P ( 1−P )
n=
E × ( N−1 ) + Z 2 × P × (1−P )
2

N=246
Z score Z=1.96
Margin of error E=0.05
Proportion P=0.5
216.20
n= =100
1.58

3.8 Study Duration:

The study will be conducted in September 2023 to February 2024.

3.9 Inclusion criteria:

• Head nurses and Staff Nurses

• Age limitation:25 to 50 years

• Experience Of Staff Nurses: More than one year work in in Catheterization lab.
• Qualification: Diploma in nursing, Degree in nursing, Diploma in midwifery
• Voluntary participate and give consent

3.10 Exclusion criteria:

• Nurses who did not hold a Pakistan Nursing Council registration

• Age limitation: Below 25 years and above 50 years
• Experience Of Staff Nurses: less than one year
• Qualification: Paramedical staff and student
• Refuse to participate in study

3.11 Research tool:

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  Social demographic questionnaire
 Knowledge-based interviewing questionnaire
 Attitude-based safety attitude questionnaire
 Practice observational checklist

3.12 Validity and Reliability:

Validity of data collection tools was done to ensure that, the study contents cover all assessment
items related to the study, and each tool contains assessment item that cover aim of the study and
research questions. The content validity was established by a panel of five expertise who
reviewed the tool for clarity, relevance, comprehensiveness, understanding, applicability and
ease for implementation and according to their opinion minor modification were applied.

Reliability of data collection tools was done by using Cronbach’s alpha test. Cronbach’s alpha
test is a reliability coefficient that provides a method of measuring internal consistency of test
and measures. The tool safety attitude questionnaire's Cronbach's Alpha test resulted in a score of
0.87 for the knowledge interview questionnaire. Alpha Cronbach test resulted in (0.807), and the
practice Cronbach alpha test's tool observational checklist yielded (0.87).

3.13 Data Collection Procedure:

Data were collected after approval of synopsis. For data collection a structured
questionnaire adopted by the related article. First the permission for data collection will be
obtained from medical Superintendent and Head nurse of ward Faisalabad institute of cardiology
at Faisalabad. The questionnaire will be filling from Staff nurses after signed the consent from
participant. Before singing the informed consent, detailed information gives to participant about
the study and also ensure that confidentiality of data. The questionnaire will hand delivered to
selected staff nurses. The questionnaire contained four parts, demographic, knowledge, attitude
and practice. The demographic and knowledge of nurses the data will be collected by face-to-
face interview. The completion time for knowledge questionnaire ranged from 10 to 15 minutes
per nurse. The completion time for the observational checklist for practice between 15 and 25
minutes per nurse. Additionally, a form to evaluate the attitudes of nurse’s range of time between
20
5 to 10 minutes to complete per nurse. The informed consent will be attached to questionnaire to
ensure all participations get the same direction and information.

3.14 Data Analysis Plan:

The computer program SPSS Version 21 will be used to analyze the data. Inferential and
descriptive statistics will both be used in the analysis. When dealing with continuous variables,
descriptive statistics will be employed, and when dealing with categorical values, descriptive
While proportions and frequencies are utilized for categorical data, mean and standard deviation
are computed for continuous variables.

3.15 Ethical Consideration:

The medical superintendent of the Faisalabad Institute of Cardiology will grant

permission for the collection of data. Data will be gathered from staff nurses at the Faisalabad
Institute of Cardiology who work in surgical departments and who willingly choose to
participate in the study after receiving approval from the institute's nursing superintendent and
receiving participants' signed consent. The right to participate or not will be explained to the
participant, along with the assurance that their information would be kept private. All of the
study's participants remained anonymous. The study's procedure carries no risks or downsides, as
the subjects were informed.

21
 CHAPTER#4

RESULTS

Table 1 revealed that, of the nurses undergoing cardiac catheterization, 59 (59.0%) were between
the ages of 33 and 40, and 100 (100.0%) of them were female. There were 96 (96.0%) married
nurses. Of the nurses, 88 (88.0%) had expert status and 99 (99.0%) had diploma.

Table 2. The definition of cardiac catheterization is known by 44 nurses, or 44.0% . Of the 56

(56.0%), none knew what a catheterization was.52 (52.0%) of the nurses are aware of the many
types of cardiac catheterization. About the causes of cardiac catheterization, 58 nurses (58.0%)
are knowledgeable. 64 percent of respondents knew when a cardiac catheterization is
necessary.53 nurses (53.0%) are aware that cardiac catheterization is contraindicated. About the
danger of cardiac catheterization, 62 nurses, or 62.0%, were knowledgeable. The number of
nurses who are aware of the cardiac catheterization complication is 58 (58.0%).Sixty-one
(61.0%) of the nurses are aware of the way to avoid cardiac catheterization complications. The
complications associated with delay removing dressing are known to 57 (57.0%) nurses.
91(91.0%) was displayed .

Table 3. Post-procedure explanations from nurses, 89(89.0%) Nurses monitor the catheter
insertion site for bleeding, 85(85.0%). Nurses measure the temperature and color of
skin89(89.0%) Nurses evaluate vital signs, 80(80.0%), and the stability of discomfort,
76(76.0%). Nurses observe the extremities, 88(88.0%), and record the patient's ECG (86(86.0%).
Following a 24-hour procedure, nurses monitor intake output. Ninety nine (90%) of them apply
pressure to the bleeding location.

Table 4 revealed that 70 employees, or 70.0%, inquire if they do not understand. 76 (76.0%)
nurses have well-coordinated work, 68 (68.0%) nurses would feel comfortable in their
surroundings,74 (74.0%) medical errors that are appropriately managed, 60 (60.0%) nurses that
enjoy their jobs, 72 (72.1%) positive work environment, 76 (76.0%) clinical staff morale. Nurses

22
receive sufficient information regarding the perception of the unit management in 81 cases
(81.0%).84 hospitals, or 84.0%, offer new hires excellent training, and 78 hospitals, or 78.0%,
provide the information needed to make diagnostic and treatment decisions.

23
 CHAPTER#05
DISCUSSION

5.1Discussion of result:
The knowledge, attitudes, and practices of nurses regarding cardiac catheterization are assessed
in a cross-sectional study conducted at the Faisalabad Institute of Cardiology. Based on the
study's results, 100 nurses (or 100.0%) are female, and 59 nurses (or 59.0%) who underwent
cardiac catheterization were in the 33–40 age range. 96.0 percent, or 96 nurses, were wed. 99
(99.0%) was the nursing diploma,88 nurses (88.0%) were very skilled. Sixty-two percent of
nurses are aware of the factors influencing cardiac catheterization, and sixty-four percent of
nurses are knowledgeable of the indications for cardiac catheterization. 91 (91.0%) nurses
explain the post-procedure, 89 (89.0%) nurses watch for bleeding at the catheter site, 85 (85.0%)
nurses examine skin color and temperature, 93 (93.0%) nurses assess vital signs, and 80 (80.0%)
nurses assess the stability of discomfort. These are the practices of nurses. According to nurses'
attitudes toward cardiac catheterization, 81 (81.0%) nurses receive sufficient knowledge
regarding the perception of the unit management, decisions; and 76 hospitals (76.0%) have well-
coordinated nursing 84 hospitals (84.0%) offer new hires excellent training; 78 hospitals (78.0%)
provide the information needed to make diagnostic and treatment staff.
According to this study, nurses are well informed about when a cardiac catheterization is
necessary. Based on this poll, nurses have a sufficient grasp of the risk factors associated with
cardiac catheterization. Mahmoud concurred with the study's findings, saying that most nurses
knew about cardiac catheterization contraindications to a respectable extent (Khaliel, et al.,
2022).
Previous studies have shown that while 2.9% of nurses knew too little about cardiac pathology,
the majority of nurses (55.7%) knew enough. 41.4% of the nurses have solid knowledge.
According to the findings of a recent survey, 64% of nurses are knowledgeable with what cardiac
catheterization is and why it is done. This current study is consistent with the research findings,
which demonstrated that Turkish nursing students had a good level of comprehension of cardiac
conditions (Yaqoob, et al., 2019).

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 The current investigation's findings support the satisfactory post-procedure care practices of
nurses. The present investigation's results aligned with those of Khaliel et al. (2022), who
reported that more than 75% of the nurses in question has sufficient experience in elucidating
post-procedure care to patients having cardiac catheterization. According to the study's findings,
nurses are properly trained to keep an eye on the afflicted extremity for four to six hours after
therapy. The results of this inquiry were consistent with those of Mahmoud, who found that the
majority of the nurses in question had a considerable deal of expertise monitoring the extremity
where the catheter was implanted right away for four to six hours after a cardiac catheterization
(Khaliel, et al., 2022).

The constant safety climate component is examined in this study, which looks at nurses' positive
attitudes toward catheterization. Therefore, establishing a welcoming atmosphere that
encourages dialogue and mutual learning is essential, as is providing precise feedback to cut
down on errors. The study discovered that the "management perception" component was more
likely to reflect nurses' favorable views regarding cardiac catheterization. This finding is
consistent with studies that demonstrated the highest percentage of healthcare providers' positive
perceptions of management. It is interesting to notice that the unit management's opinion, not the
hospital management's, might have had an impact on the result obtained in this category. It
seems that the unit management It better aligns with the patient safety culture that the entire
institution should adopt hug. According to the results of the current study, nurses' strong
favorable opinions regarding the patient safety culture were classified as "work conditions." This
is in line with the study's findings that the "work conditions" factor had the lowest percentage of
positive opinions among nurses. Thus, it is reasonable to conclude that inadequate staffing and
training are the main elements affecting the positive perception of the patient safety
culture(Mohamed et al.,2023)

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5.2 Conclusion:
According to the study's findings, nurses' attitudes toward cardiac catheterization are lacking in
five areas related to safety, and their knowledge of the procedure is generally inadequate, while
over half of them have had satisfactory experience with it.

5.3 Strength of study

The study's strengths in identifying gaps in knowledge, attitudes, and practices, as well as in
improving patient outcomes and safety, effective education and training programs, standardizing
practice, allocating resources efficiently, and fostering ongoing improvement, all contribute to
bettering nursing practice.

5.4 Limitation:

 There was insufficient time for data collection and analysis

 The small sample size prevented the findings from being generalized
 It was not possible to gauge the nurses' opinions of the practices because of time
restrictions.
 Due to overwork at the hospital, nurses don't respond to questions correctly or give clear
information.
 Only one tertiary care hospital was selected for the study.

5.5 Implication of the study:

 Accurate monitoring, prompt action, and efficient management all contribute to better
patient care.
 By raising understanding of the cardiac catheterization procedure, it enhances nursing
knowledge.
 It encourages multidisciplinary cooperation in the context of cardiac catheterization.

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  It upholds patient safety by implementing best practices that reduce procedure-related
complications.

5.6 Recommendation:
 The implementation of continuing education programs pertaining to problems and risk
factors for patients undergoing cardiac catheterization keeps nurses' knowledge and
practice current.
 Constant assessment of nursing knowledge and practice to determine needs.
 Promote and assist nurses in going to workshops, conferences, and training sessions at
home and abroad that are relevant to nursing care for patients having heart
catheterization.
 A program of education designed to help cardiac catheterization unit nurses become
more knowledgeable about patient safety and prevent issues following the procedure.
 To generalize the findings, the study needs be repeated with a sizable sample.

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