AN INVESTIGATION INTO THE KNOWLEDGE, ATTITUDES, AND PRACTICES (KAP) OF  INTRA-ABDOMINAL PRESSURE MONITORING AMONG PEDIATRIC INTENSIVE CARE NURSES

CHAPTER ONE

INTRODUCTION

Background of the study

The steady-state pressure in the abdominal cavity brought on by the interplay of the internal organs and the abdominal wall is known as intra-abdominal pressure (IAP) [Li, Wang & Lu, 2023]. Children in good health had baseline IAP values of around 3e5 mmHg (1 mmHg ¼ 0.133 kPa), 4e10 mmHg in critically sick children, and 7 ± 3 mmHg in children on mechanical ventilation [Li, Wang & Lu, 2023]. A persistent or repeated pathological rise in IAP larger than 10 mmHg is referred to as intra-abdominal hypertension (IAH), and it has been demonstrated that IAH is a separate cause of mortality in critically sick patients [Horoz et al, 2015]. Elevated IAP is linked to new or worsening organ dysfunction in cases with abdominal compartment syndrome (ACS). It is a high-mortality consequence that is becoming more well acknowledged in severely sick children who have undergone medical and surgical diagnosis [Thabet & Ejike, 2016]. According to reports, children in a single-center mixed paediatric intensive care unit (PICU) population had an incidence of ACS ranging from 0.6% to 4.7% [Thabet et al, 2016]. Even though ACS is infrequently reported, it progresses quickly and is frequently a deadly illness in children that goes mostly unrecognised. In critically sick patients, multiple organ failure is significantly impacted by IAH and ACS. Increased IAP has significant pathophysiological consequences on critically sick patients' haemodynamic, respiratory, gastrointestinal, neurological, and renal functions [Bozer, Rodgers, Qureshi, Griffin & Kenney, 2023]. Inadequate detection of ACS may cause significant delays in its diagnosis and treatment (medical or surgical), raising the risk of morbidity and death. ACS-related mortality in children referred to the PICU has been observed in as many as four to six studies [Horoz et al, 2015]. Since preventing IAH's harmful effects is the best course of action, recognising its risk factors and clinical signs is crucial to improving the results of critical care units. Every critical care patient has common physiological measures including blood pressure, heart rate, electrocardiography, and haemoglobin saturation regularly monitored. Although the idea of measuring IAP is not new, its significance and potential therapeutic applications in the intensive care unit have just now come to light. IAP measures, on the other hand, are often taken only in response to the identification of a particular risk factor or the presence of IAH. measures of IAP have seldom been utilised as a regular component of monitoring. It is generally acknowledged that intermittent IAP measures through the bladder should be performed every 4–6 hours in individuals who are symptomatic or who have a strong clinical suspicion of developing IAH [Horoz et al, 2015]. To anticipate the onset of ACS and improve treatment, several experts highly advise doing a basic IAP monitoring approach on ICU patients. In addition to performing IAP measurements for high-risk patients, routine clinical evaluation of IAH signs should become a part of the bedside assessment for every patient in the ICU. This will enable immediate IAP monitoring in cases of any suspicion of IAH development, even though it is currently not possible to provide clear guidelines for selecting patients who should accept IAP measurements. When it comes to closely observing and recognising minute and dynamic shifts in a child's IAP, paediatric critical care nurses are invaluable. Prior research has provided an account of the experiences of paediatric medical professionals, highlighting the limited knowledge of IAP/IAH/ACS definition, IAP measurement, and therapeutic care [Liang, Tang, Huang, Xu & Zhang, 2015]. According to a survey on IAH/ACS awareness by Ejike et al. [2015], barely half (51%) of paediatric healthcare professionals reported handling children with IAH/ACS, and only 46.8% of paediatric medical staff understood the right terminology. Additionally, 24.2% of paediatric healthcare workers had never assessed IAP previously. Only 7.2% of participants (10/138) in a survey by Liang et al [2020] on medical staff awareness of IAP/IAH/ACS at the paediatric critical care conference knew the definition; of those using intravesical pressure measurement, only 57.1% (20/35) knew the appropriate amount of perfusion volume.. The World Society of the Abdominal Compartment Syndrome (WSACS) developed medical management algorithms regarding IAH/ACS, and these developments, along with changes in treatment paradigms for critically ill patients, have probably contributed to the decline in the development of ACS [Li, Wang & Lu, 2023]. Critical care nurses must still routinely check IAP, comprehend the criteria and clinical indicators of IAH/ACS, and take the initiative to manage IAH/ACS in critically ill children. It is yet unknown how well paediatric critical care nurses in China are aware of IAP monitoring and how well it is being implemented. There is still need for more discussion on how to conduct clinical practice and if IAP monitoring has gotten enough attention in paediatric critical care. Therefore, the researcher sought to investigate the knowledge, attitudes, and practices (KAP) of  intra-abdominal pressure monitoring among pediatric intensive care nurses.

Statement of the problem

As it helps with the early detection and treatment of abdominal compartment syndrome (ACS), a potentially fatal illness, intra-abdominal pressure (IAP) monitoring is essential in paediatric intensive care units (Kirkpatrick et al., 2015). Data on paediatric intensive care nurses' knowledge, attitudes, and practices (KAP) related IAP monitoring are few, despite the importance of the practice. Research indicates that inadequate knowledge and unstandardised instruction may lead to worse than ideal patient outcomes, given that nurses are essential in promptly identifying and treating elevated IAP (Malbrain et al., 2018). Moreover, there is a clear lack of research on the particular strategies used by paediatric intensive care nurses, particularly in low-resource environments where there are frequently equipment and training-related obstacles (Cheatham & Safcsak, 2018). Hence, the study investigate the knowledge, attitudes, and practices (KAP) of  intra-abdominal pressure monitoring among pediatric intensive care nurses.

1.3 Objective of the study

The broad objective of the study is to investigate the knowledge, attitudes, and practices (KAP) of  intra-abdominal pressure monitoring among pediatric intensive care nurses. The specific objectives is as follows

To assess the level of knowledge among pediatric intensive care nurses regarding intra-abdominal pressure (IAP) monitoring.

To evaluate the attitudes of pediatric intensive care nurses toward the importance of IAP monitoring in managing critically ill children.

To identify the current practices employed by pediatric intensive care nurses in monitoring intra-abdominal pressure.

To investigate the challenges faced by pediatric intensive care nurses in implementing IAP monitoring procedures.

1.4 Research questions

The following questions have been prepared to guide the study

What is the level of knowledge among pediatric intensive care nurses regarding intra-abdominal pressure (IAP) monitoring?

What is the attitudes of pediatric intensive care nurses toward the importance of IAP monitoring in managing critically ill children?

What are the current practices employed by pediatric intensive care nurses in monitoring intra-abdominal pressure?

What are the challenges faced by pediatric intensive care nurses in implementing IAP monitoring procedures?

1.5 Significance of the study

The findings will help identify gaps in the application of IAP monitoring, which could lead to improved patient outcomes through timely interventions. By revealing the challenges faced by nurses in the pediatric intensive care unit (PICU), the study can inform hospital administrators and policymakers about the need for enhanced training programs and resource allocation. Findings of the study will also be significant to the academic community as it will contribute to the existing literature, add to library resources and serve as a guide to future academic researchers.

1.6 Scope of the study

The study focus on the knowledge, attitudes, and practices (KAP) of  intra-abdominal pressure monitoring among pediatric intensive care nurses. Empirically, the study will assess the level of knowledge among pediatric intensive care nurses regarding intra-abdominal pressure (IAP) monitoring, evaluate the attitudes of pediatric intensive care nurses toward the importance of IAP monitoring in managing critically ill children, identify the current practices employed by pediatric intensive care nurses in monitoring intra-abdominal pressure and investigate the challenges faced by pediatric intensive care nurses in implementing IAP monitoring procedures.

Geographically, the study will be delimited to General hospital Maitama, Abuja.

1.7 Limitation of the study

Like in every human endeavour, the researchers encountered slight constraints while carrying out the study. The significant constraint are: 

Time: The researcher encountered time constraint as the researcher had to carry out this research along side other academic activities such as attending lectures and other educational activities required of her.

Finance: The researcher incurred more financial expenses in carrying out this study such as typesetting, printing, sourcing for relevant materials, literature, or information and in the data collection process.

Availability of Materials: The researcher encountered challenges in sourcing for literature in this study. The scarcity of literature on the subject due to the nature of the discourse was a limitation to this study.

1.8 Definition of terms

Intra-Abdominal Pressure (IAP): The pressure within the abdominal cavity, which is measured in millimeters of mercury (mmHg). Elevated IAP can lead to intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS), conditions that can result in organ dysfunction and increased mortality.

Abdominal Compartment Syndrome (ACS): A life-threatening condition caused by sustained elevated IAP, leading to impaired organ function, particularly affecting cardiovascular, renal, and respiratory systems.

Pediatric Intensive Care Unit (PICU): A specialized hospital unit that provides intensive care to critically ill infants, children, and adolescents requiring continuous monitoring and life support.

Knowledge, Attitudes, and Practices (KAP): A structured framework used to assess individuals' understanding, perspectives, and behaviors toward a particular subject. In this study, it refers to pediatric intensive care nurses' awareness, perceptions, and application of IAP monitoring techniques.

Intra-Abdominal Pressure Monitoring: The practice of measuring the pressure inside the abdominal cavity to detect elevated IAP, a critical practice in preventing and managing ACS, especially in critically ill patients.

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