الفهرس 
History of Gastrointestinal SurgeriesOnly 14 pages are availabe for public view
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Abstract
Currently, congenital anomalies of the gastrointestinal tract present a tremendous challenge given the spectacular progress that has been made in the field of pediatric surgery. For, in this period of relatively safe surgery and anesthesia, supported by the superior preoperative and postoperative care available, the surgical team faces an unprecedented opportunity to salvage most pediatric patients with surgically correctable lesions. Further, in the absence of extreme prematurity and associated serious malformations. Fundamental is an acute awareness of the possible emergent nature of these problems. Emphasis is given to the importance of early diagnosis and treatment, the most important controllable factors affecting the prognosi. (Baltimore, 2016).
I-Technical design:
1) Research design:
A descriptive design was used in the conduction of this study.
a. Research settings:
This study was conducted at two different settings, the surgical departments of a pediatric hospital affiliated to Ain- Shams University Hospitals, and Abou El -Resh EL- Monera hospital affiliated to Cairo University hospitals.
b. Research subjects:
A convenient sample, the subjects of this study were composed of all available nurses (60) working in the previously mentioned settings, (24) from pediatric hospital affiliated to Ain- Shams University, and (36) from Abou El -Resh EL- Monera hospital affiliated to Cairo University regardless of their age, years of experience, qualification, and studied children composed of all available children who are undergoing gastrointestinal surgeries at previously mentioned settings.
I. Technical design:
Tools of data collection:
Data were collected using the following tools:
1. A pre-designed questionnaire sheet: (Appendix2)
A questionnaire designed by the researcher and written in simple Arabic language based on a scientific literature review to assess data about the following:
Part (1): characteristics of nurses including age, years of experiences, qualification, and place of work.
Table (2): Distribution of the studied children according to their diagnosis
Part (3): Knowledge of nurses about gastrointestinal surgeries such as Definition of disease, need for surgical intervention, signs and Symptoms, pre-immediate and postoperative care, and high-risk Problems.
Scoring system for knowledge questions:
The right answers were scored as a single point, and those wrong were scored as a zero, these scores were summed up and converted into a percent score. Nurses showed a satisfactory answer if the percent score was 70 % or more and an unsatisfactory one if less than 70 %.
2) Observational checklists: (Appendix 3):
It was adopted to assess the nurse’s performance (pre-immediate and postoperative care). It included oropharyngeal suction, tracheotomy suction, gavages feeding, gastrostomy care, and feeding, wound dressing, colostomy care. Nurses were observed and evaluated continuously during their actual care.
Scoring system for nurses’ actual practice:
- Score from 0 < 80% referred to incompetent practice
- Score from 80≥100% referred to the competent practice
Content and face validity and reliability:
- It was ascertained by a group of 5 experts in the pediatric nursing field.
They elicited their opinions regarding the format, layout, consistency, accuracy, and relevancy of the tools.
II.Operational design:
1-Preparatory Phase:
This phase was involved reviewing the available local and international current related literature to get acquainted with the various aspects of the research problem and also to develop the study tools.
2-Pilot study:
The pilot study was carried out on 10% of the study subjects to test the content validity, feasibility, and applicability of the study tools, and time consumed to complete the study tools. According to the results of the pilot study, the necessary modifications were done. Nurses included in the pilot study were excluded from the study of the sample.
Ethical consideration:-
The researcher’s approval was obtained from the faculty Ethical committee before starting the study. Verbal approval was obtained from the nurses before participation in the study. A clear and simple explanation was given according to the level of understanding, and their physical and mental readiness. They were assured that all the gathered data as confidential and used for research purposes only.
The researcher clarified the objectives and aim of the study to nurses included in the study before starting, Nurses were informed that they are allowed to choose to participate or not in the study and they have the right to withdraw from the study at any time.
III . Administrative design:
Approval was obtained from the Dean of Faculty of Nursing of Ain Shams University and directors of study settings and the nurses as well to conduct the study at the previously mentioned settings. Meanwhile, the aim and expected outcomes of the study were explained by the researcher.
Fieldwork:
To carry out the study, approval was obtained from the medical and nursing directors of the mentioned hospitals. An official letter was issued to them from the faculty of Nursing, Ain- Shams University; the aim of the study was explained to obtain their permission and cooperation.
Data were collected in six months, from the first week of November 2014 till the end of April 2015.
The researcher first met with the nurses who worked in the previously mentioned settings and explained the purpose of the study after introducing herself and was available 3 days/week at the morning shift to collect data and implement this study. The nurses were assured that the information collected would be treated confidentially, and it would be used only for the research. Then and individual interviewing was done after obtaining nurses’ consent to participate.
IV. Statistical design:
The most important findings of the current study can be summarized as the following:
-Less than half (45.0 % and 43.3%) of the studies were in the age group of >25years and had more than 10 years of experience respectively.
-Meanwhile, less than two-thirds (63.3%) of the studied nurses held a bachelor’s degree in nursing science.
- The common gastrointestinal Surgeries in studied children are left lip and as represented by 40%, 20% respectively.
-80% of the studied nurses had satisfactory knowledge about the definition of cleft lip,
-Less than half (45%, 45%, 48.3%) of them had unsatisfactory knowledge about signs of cleft lip, suitable time of surgery, and follow up respectively.
- More than two thirds (71.7% and 68.4%) of the studied nurses had satisfactory knowledge about high-risk problems and follow up of cleft palate, while more than half (60% and 61.7%) of them had unsatisfactory knowledge about the position of feeding and position after surgery .
More than two thirds (68.3%, 68.3%, and 68.3%) of the studied nurse had satisfactory knowledge about the definition, feeding, and surgical intervention of esophageal atresia respectively, while less than one third (61.7%) of them had unsatisfactory knowledge about nursing care of esophageal atresia.
-Three quarters (76.7%, 76.7 and 75.0%) of the studied nurses had satisfactory knowledge about gastrostomy care, precautions of a gastrostomy to be followed pre/post/during, and its infection control for gastrostomy respectively, while more than half (60%) of them had unsatisfactory knowledge about factors aids gastrostomy feeding .
-Three fourth (75%) of studied nurses had satisfactory knowledge about the definition of corrosive esophageal obstruction, while more than third (66.7% and 46.7%) of them had unsatisfactory knowledge about the method of treatment and health teaching for nurse about corrosive esophageal obstruction respectively.
-Almost one-third (61.7 %) of the studied nurses had satisfactory knowledge about the duration of occurrence of pyloric stenosis in children, while less than half (45%) of them had unsatisfactory knowledge about signs and symptoms of pyloric stenosis.
-More than three fourth (78.3% and 73.3%) of the studied nurses had satisfactory knowledge about the definition, surgical intervention of intestinal obstruction respectively, while three fourth (75%) of them had unsatisfactory knowledge about the care of wound of intestinal obstruction.
-More than three quarters (81.7.0%) of the studied nurses had satisfactory knowledge about appropriate foods for colostomy, while less than three quarters (73.3%) of them had unsatisfactory knowledge about problems of Hirschsprung’s disease.
-Most (81.7%, 81.6%) of the studied nurses had satisfactory knowledge about the definition of intussusception and its suitable time of operation respectively, while more than one-third (38.3%) of nurses had unsatisfactory knowledge about the duration of occurrence of intussusception.
-Less than two thirds (61.7 %) of the studied nurses had satisfactory total knowledge about gastrointestinal diseases in children.
-Three quarters and most (75.0% and 81.7%) of the studied nurses had competent actual practice related to pre and post-operative care of gastrointestinal surgeries in children respectively.
-The great majority (90%) of the studied nurses had competent actual practice related to suction.
-The most majority (91.6%) of the studied nurses had incompetent actual practice related to gastrostomy care
-Most (88.3%) of the studied nurses had competent actual practices related to gastrostomy feeding.
-The great majority (96.7%-95 %) of the studied nurses had competent actual practices related to gavages feeding and colostomy care respectively.
-More than three quarters (76.7%) of the studied nurses had competent actual practices related to wound dressing.
-More than two-thirds (66.7%) of the studied nurses had competent actual practice related to the care of children undergoing gastrointestinal surgeries. While one third (33.3%) of them had incompetent actual practice.
-A strong positive correlation (r=0.81) between nurses age and their total knowledge regarding care of children undergoing gastrointestinal surgeries,
-A strong positive correlation (r=0.89) between years of experience of nurses and their total knowledge about regarding the care of children undergoing gastrointestinal surgeries.
-A strong positive correlation (r=0.92) between nurses’ qualification and their total knowledge regarding care of children undergoing gastrointestinal surgeries.
-A strong positive correlation (r=0.71) between nurses age and their total actual practice regarding care of children undergoing gastrointestinal surgeries.
-A strong positive correlation (r=0.85) between years of experience of nurses and their total actual practice regarding care of children undergoing gastrointestinal surgeries.
-Negative correlation (r=0.48) between nurses’ qualification and their total practice regarding care of children undergoing gastrointestinal surgeries.
- A strong positive correlation(r =0.86) between nurses’ total knowledge and total practice regarding the care of children undergoing gastrointestinal surgeries (table, 27).