A STUDY ON HOW LEADERSHIP INFLUENCES THE PROMOTION OF PSYCHOLOGICAL SAFETY AMONG HEALTHCARE PROFESSIONALS IN NIGERIA

CHAPTER ONE INTRODUCTION 1.1 Background of the Study Intra-abdominal pressure (IAP) refers to the steady pressure within the abdominal cavity, influenced by the interaction between internal organs and the abdominal wall (Li, Wang & Lu, 2023). In healthy children, IAP typically ranges from 3 to 5 mmHg (with 1 mmHg equaling 0.133 kPa). For critically ill children, the range increases to 4–10 mmHg, and those on mechanical ventilation may have an average IAP of 7 ± 3 mmHg (Li, Wang & Lu, 2023). When IAP persistently or repeatedly exceeds 10 mmHg, it is classified as intra-abdominal hypertension (IAH)—a condition independently linked to mortality in critically ill patients (Horoz et al., 2015). Elevated IAP can cause or worsen organ dysfunction, especially when it leads to abdominal compartment syndrome (ACS), a life-threatening complication that is gaining increased recognition in severely ill pediatric patients who undergo both medical and surgical interventions (Thabet & Ejike, 2016). Studies have reported that the incidence of ACS in pediatric intensive care units (PICUs) ranges between 0.6% and 4.7%, though the condition often goes undetected due to its rapid progression and subtle onset (Thabet et al., 2016). Recognizing risk factors and early clinical signs of IAH is essential in preventing its harmful consequences and improving outcomes in critical care settings. While common physiological parameters like heart rate, blood pressure, oxygen saturation, and ECG are routinely monitored in critical care, regular monitoring of IAP is not widely practiced. Although IAP monitoring has been known for some time, its clinical significance and usefulness in intensive care have only recently gained attention. Typically, IAP is only measured when specific risk factors are identified or when IAH is suspected. However, intermittent bladder-based IAP measurements every 4–6 hours are generally recommended for symptomatic patients or those with a high clinical risk of developing IAH (Horoz et al., 2015). Experts have suggested that IAP monitoring should become part of the basic assessment for all ICU patients, especially those considered high-risk. This would enable prompt IAP measurement when there is any suspicion of IAH. Despite the absence of precise guidelines for selecting which patients should undergo IAP monitoring, the need for bedside assessments remains essential. In pediatric intensive care settings, nurses play a critical role in observing and identifying subtle and dynamic changes in a child’s IAP. Previous research highlights gaps in pediatric healthcare professionals’ understanding of IAP, IAH, and ACS—including measurement techniques and appropriate clinical management (Liang, Tang, Huang, Xu & Zhang, 2015). A survey conducted by Ejike et al. (2015) found that only 51% of pediatric healthcare providers had cared for children with IAH or ACS, while just 46.8% understood the correct definitions. Moreover, 24.2% of respondents had never performed IAP monitoring. In a separate study by Liang et al. (2020), only 7.2% (10 out of 138 participants) at a pediatric critical care conference could correctly define IAP, IAH, and ACS. Among those using the intravesical method for pressure measurement, only 57.1% (20 out of 35) knew the correct perfusion volume. To address these gaps, the World Society of the Abdominal Compartment Syndrome (WSACS) has proposed clinical management protocols for IAH and ACS. These, along with advancements in critical care, have contributed to a decline in ACS incidence (Li, Wang & Lu, 2023). Nevertheless, it remains imperative for pediatric critical care nurses to consistently monitor IAP, recognize clinical indicators of IAH/ACS, and take proactive steps in managing these conditions in critically ill children. Currently, there is limited information on how well pediatric critical care nurses in China understand and implement IAP monitoring. The need to explore this area further is evident, particularly regarding how IAP monitoring is integrated into clinical practice. This study, therefore, aims to explore the knowledge, attitudes, and practices (KAP) of pediatric intensive care nurses concerning IAP monitoring. 1.2 Statement of the Problem Monitoring intra-abdominal pressure is vital in pediatric intensive care units, especially for the early detection and treatment of abdominal compartment syndrome (ACS)—a potentially fatal condition (Kirkpatrick et al., 2015). Despite the importance of IAP monitoring, there is limited research on the level of knowledge, attitudes, and practices (KAP) among pediatric intensive care nurses. Studies suggest that insufficient training and lack of standard procedures can compromise patient outcomes, especially since nurses play a pivotal role in identifying and managing elevated IAP early (Malbrain et al., 2018). Furthermore, little is known about the specific approaches nurses use in low-resource settings, where access to equipment and adequate training often presents challenges (Cheatham & Safcsak, 2018). Therefore, this study focuses on examining the KAP of pediatric intensive care nurses concerning IAP monitoring. 1.3 Objective of the Study The primary objective of this study is to assess the knowledge, attitudes, and practices (KAP) of pediatric intensive care nurses regarding intra-abdominal pressure monitoring. Specifically, the study aims to: i. Determine the level of knowledge pediatric intensive care nurses have about IAP monitoring. ii. Examine nurses’ attitudes toward the importance of IAP monitoring in the care of critically ill children. iii. Identify current IAP monitoring practices used by pediatric intensive care nurses. iv. Explore the challenges these nurses face in implementing IAP monitoring procedures. 1.4 Research Questions To guide the study, the following research questions are posed: i. What level of knowledge do pediatric intensive care nurses possess regarding intra-abdominal pressure (IAP) monitoring? ii. What are the attitudes of pediatric intensive care nurses toward the significance of IAP monitoring in managing critically ill children? iii. What monitoring practices are currently used by pediatric intensive care nurses for IAP? iv. What challenges do pediatric intensive care nurses face in implementing IAP monitoring procedures? 1.5 Significance of the Study The findings of this study are expected to highlight existing gaps in IAP monitoring practices, which could help improve patient outcomes by enabling timely interventions. By identifying the obstacles nurses face in pediatric intensive care units (PICUs), the study can inform hospital administrators and health policymakers about the need for targeted training and resource investment. Furthermore, this research will contribute to academic discourse, expanding existing literature, enriching library resources, and serving as a reference point for future research. 1.6 Scope of the Study This study centers on examining the knowledge, attitudes, and practices (KAP) related to intra-abdominal pressure monitoring among pediatric intensive care nurses. It will empirically assess the level of knowledge these nurses have, evaluate their attitudes toward the significance of IAP monitoring, explore the practices currently employed, and investigate challenges they encounter in implementing IAP monitoring. Geographically, the research will be limited to General Hospital, Maitama, in Abuja. 1.7 Limitations of the Study As with most research endeavors, this study encountered several constraints. Time Constraints: Balancing this research with other academic responsibilities, such as attending classes and completing assignments, posed a challenge. Financial Limitations: The study incurred various expenses, including printing, typesetting, sourcing materials, and collecting data. Availability of Materials: Finding adequate literature was challenging due to the specialized nature of the research topic, which somewhat limited the depth of the review. 1.8 Definition of Terms Intra-Abdominal Pressure (IAP): The internal pressure within the abdominal cavity, typically measured in mmHg. Elevated IAP can lead to serious conditions like intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Abdominal Compartment Syndrome (ACS): A serious medical condition resulting from sustained high IAP, impairing organ function, particularly within the respiratory, renal, and cardiovascular systems. Pediatric Intensive Care Unit (PICU): A specialized hospital unit dedicated to the critical care of infants, children, and adolescents who require constant monitoring and support. Knowledge, Attitudes, and Practices (KAP): A framework used to evaluate individuals' understanding, perceptions, and behaviors concerning a specific topic. In this context, it assesses nurses’ awareness, beliefs, and actions related to IAP monitoring. Intra-Abdominal Pressure Monitoring: The clinical practice of measuring pressure inside the abdomen to detect elevated IAP, which is crucial in preventing and managing ACS, especially in critically ill patients.