Evaluating Nursing Competency Checklist on Free Flap Failure Rates

This report presents the findings of a quality improvement project conducted in a surgical specialty unit to assess the impact of a nursing competency checklist and education on reducing free flap failures in breast reconstructive surgeries. The study employed a quasi-experimental, pretest-posttest design, analyzing demographic data, nurses' knowledge, and statistical outcomes using SPSS software. The project included nurses working in Surgical Specialty (n=20) with age between 18 and 50 years. The findings revealed a significant increase in nurses' knowledge and a reduction in flap failure rates after the implementation of the training program. The study highlights the importance of post-graduate training and the need for continuous education to improve nurses' skills and patient outcomes. It also discusses the direct association of flap failure with the patient's socio-demographic characteristics. The study concludes that the training program effectively prepared the nurses to handle patients, leading to improved patient outcomes and a decrease in complications.

Presentation of Findings
Data Analysis
How did you analyze the demographic data?
The questionnaire included two parts: Socio Demographic data sheet and the knowledge of
nurses about the surgery. The demographic involved the general characteristics of the nurses like
age, education level, work experience, occupation, the attendance on the earlier training
programs attended by them and the duration and place of earlier training sessions.
The knowledge of nurses regarding this surgery was reviewed with help of authentic most recent
literature review. It involved the questions to assess their applied and theoretical knowledge
associated with free flap failures and breast re-constructive surgeries.
The project included nurses working in Surgical Specialty (n=20) with age between 18 and 50
years (mean SD= 29.6+- 7.4) with a work experience of 5 to 20 years (mean SD = 10.7 +- 8.1).
The education level was diploma (52.5%), technical degree (37.5%) and bachelors’ degree
(10%). In terms of the occupation, 92.5% nurses were bedside nurses while 7.5% were head
nurses. 70% of the nurses were single and majority of them had urban background. All the
participants were females. It reflects that the nursing profession is dominated by the women
(Sabur, Elgamil & Elhadi, 2017).
The demographics of the patients included 60% of the patients were aged between 18 to 45 years
with mean SD (31.5+- 8.9). Most of the patients were males living in rural locations, having
average education levels and low income occupations.
How did you analyze the study data?

Majority of nurses had a fair knowledge about the breast re-constructive surgeries prior to the
educational program (65%). After the implementation of training program, they had good
knowledge (100% and 97.5%) for the post test and after 3 months of the surgery. They also
improved their practice level.
What statistical tests did you conduct and what did they show? Which software and
version did you use to conduct statistical tests?
The statistical analysis was performed using SPSS software for Windows version 20.0. The data
was evaluated for the distribution of normality before initiating any quantitative study. Normally
continuous data was distributed and expressed in mean +-SD. The categorical data was expressed
in percentages. The comparisons were performed using ANOVA test in form of one way
analysis of variation. The statistical significance was maintained at p<0.05 and Chi square test
was done to evaluate the categorical data with the variables.
Summarize and evaluate the findings from your project.
The study found that the nurses received no in-service training about the breast re-constructive
surgeries during their studies. Most of them had a work experience of just 2 years. It shows, after
the graduation course they were not fully prepared to perform such microsurgeries using free
tissue transfer. Many of them achieved experience while working in the surgical unit only. It is
essential to prepare the nurse to effectively handle such specializations at the post graduate level.
The study found a lack of practice and knowledge in nurses about free tissue transfer surgeries
prior to application of training program. It shows the lack of scientific preparations in such
operations. It may be attributed to the fact the reconstructive microsurgery has been recently
introduced in the hospitals as a distinct specialty.
It concludes that before the training program, these nurses were not prepared effectively to
handle these patients in the unit. After the implementation of training program, their knowledge
score level about free tissue transfer surgeries sufficiently increased.

The study assessed the knowledge and practice of the nurses at different intervals to evaluate the
retention of knowledge. Periodic follow ups improve the skills and retention ability of nurses
(Mohamed, Elmonium, Elmowafi & Shebl, 2019). It deteriorates gradually if not updated
regularly (Taylor, Lillis & Lynn, 2015). Te comparison of pre test and post test scores was
considered to evaluate the effectiveness of training program. The study found that mere 1% of
the patients developed failure of flap after attending the teaching program while one year ago,
20% of the patients got flap failure. One patient developed infection after the surgery due to
incomplete wound excision and venous obstruction. The study illustrates that the development of
flap failure is directly associated with socio demographic characteristics of the patients like cause
and site of injury, gender and the type of tissue transferred. This finding is in compliance with
the study of Kleban et al., (2018) who found that the age, site, sex and mechanism of injury were
the evident factors of survival for after the free tissue transfer.
The free flap failure is generally associated with complications like hyperthermia, infection, post
operative shivering, pain, venous obstruction and arterial obstruction (Copelli, 2017).

References
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