الفهرس 
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Abstract
Introduction:
Acute GVHD is the consequence of interaction between antigen presenting cells of the recipient and mature T-Cell of the donor, in which the new transplanted cells attack the recipient target organs e.g. Skin, liver and intestine. It is classified according to time of onset after transplantation as Classic (at or before 100 days of HSCT), Recurrent or Persistent (after 100 days of HSCT) and Overlap syndrome (No limit time)(Ikeda et al., 2015).
Aim of the study
The Current Study aimed to
Assess the nurses` performance regarding acute graft versus host disease.
1- Research design:
Setting:
A descriptive study was conducted the pediatric Bone marrow transplant unit at 57357 Cancer Hospital in Cairo.
Subjects:
A Convenience sample that included 30 nurses with different educational background and years of experience and also 50 children were included in the study with different ages, gender and diagnoses.
2-Technical Design:
Data collection tools:
Tool I: Predesigned questionnaire sheet:
It was designed by the researcher after reviewing the related literature to assess the following:
1. Characteristics of the studied nurses including (age, gender, qualifications, years of experience, Occupation).
2. Characteristics of the studied children including the following (age, gender, diagnosis, complications)
3. Knowledge of the studied nurses regarding acute graft versus host disease including (definition, clinical manifestations …….etc).
Scoring system:
The total score of the questionnaire was 30 grades (equal 100 %). Studied nurses answers were checked using a model key answers and accordingly. Their knowledge was categorized into satisfactory knowledge score 18 grades (60%) or more and unsatisfactory knowledge score less than 18 grades(less than 60 %).
Tool II: An observational Checklist: the daily nurse performance for the patients clinical assessment was included in a checklist and the accuracy of their documentation, that was retrieved from the Cerner documentation system including the patient vital signs, manifestations of GVHD and pain assessment ………etc)
- The checklist was re-designed from a previously published article (Oliveira, 2014).
Scoring system:
According to the nursing interventions done by studied nurses and checked from Cerner documentation system, a scoring system was followed to obtain the outcome of nurses `practice, each intervention had one grade.
Each procedure score 5-10 grades according to the weight of the steps that made total score 100 degrees (100%). Studied nurses practices were checked using a model of checklist and accordingly. Their performance was categorized into satisfactory practice (60%) or more and unsatisfactory practice less than 60 %.
3 -Operational Design:
A-Preparatory phase:
During this phase, the study tool was prepared through reviewing the available local and international related literature to be oriented with the various aspects of the research problems.
A- Content validity and reliability: It was ascertained by a group of experts in pediatric nursing. Their opinions were elicited regarding clarity, comprehensiveness, the format, layout, consistency, accuracy and relevancy of the tools.
Field work: The actual field work was carried out from 21 January to the end of June 2019 for data collection. Each nurse was interviewed and assessed individually using the study tools.
First of all the purpose of the study was explained by the researcher to all nurses involved in the study.
The researcher was available 2 days / week by rotation from day and night shifts for 3 hours in the previously mentioned setting from 8 am to 12 pm.
4-Administration design:
Before conducting the study, an official permission was obtained from scientific research department and director of inpatient BMT unit at 57357.
An official approval to carry out the study was obtained by submission of official letter issued to the Dean of the Faculty of Nursing, Ain Shams University, and Director of the above mentioned study setting.
5-Ethical consideration:
First, the research approval was obtained from scientific Research Ethical Committee in Faculty of Nursing - Ain Shams University before starting the study.
All the gathered data were used for research purpose only. The study sample was informed about the purpose and expected outcomes of the study and reassured that the information obtained will be confidential and used only for the purpose of the study. The study sample was be assured also that anonymity and confidentiality was guaranteed and they had the right to withdraw out from the study at any time, Also confidentiality as well as anonymity of the subjects was assured through coding of all data and an informed consent will be obtained
6- Statistical Design:
Data were collected, organized, revised, coded, tabulated and statistically analyzed by using the program Statistical Package for the social Sciences (SPSS) version 25.
Numerical data were presented as numbers, percentage, mean and standard deviation. The relation between study variables done by using chi-square (X2) and P-value.
7- The finding of the present study summarized as follows:
• 66%the studied nurses were female and the rest of them (33%) were males. Regarding the age of the studied nurses it was observed that, one third (33%) of them their age was more than 30 years with mean of age =28.33± 3.49 and more than half (53%) of them had years of experience more than 5 years with mean =5.33±3.01 while the majority (66%) of them were bachelor graduates of nursing.
• More ever three fifths (60%) of the studied children were males and more than two thirds (70%) were diagnosed as acute myeloid leukemia
• Majority of the studied nurses (86.6%) had satisfactory knowledge about Acute Graft Versus Host Disease and Minority of them (13.3%) had unsatisfactory knowledge.
• More than half (57%) of the studied nurses had satisfactory practice regarding Acute Graft Versus Host Disease and the rest (43%) had unsatisfactory level of practice.
• There was a significant relation between the level of knowledge of studied nurses and their gender. Only forty percent of males had satisfactory knowledge while 75% of females had satisfactory knowledge which means that knowledge level of females was higher than males.
• There was no significant relation between the level of practice of studied nurses and their characteristics.
• More than half (53.4%) of the studied nurses with satisfactory knowledge had satisfactory level of practice with children with Acute Graft Versus Host Disease, Also there was a positive correlation between level of knowledge and practice in dealing with children with Acute Graft Versus Host Disease.
Conclusion:
The study concluded that majority of the studied nurses had satisfactory knowledge about Acute Graft Versus Host Disease and Minority of them had unsatisfactory knowledge.
More than half of the studied nurses had satisfactory practice regarding Acute Graft Versus Host Disease and the rest of them had unsatisfactory level of practice.
More than half of the studied nurses with satisfactory knowledge had satisfactory level of practice with children with Acute Graft Versus Host Disease; also there was a positive correlation between level of knowledge and practice in dealing with children with Acute Graft Versus Host Disease.
Recommendations:
1- Establishing Standards and strategies of nursing care regarding children with acute GVHD Disease to improve quality of nursing care towards them.
2- Designing and carrying out an educational program about GVHD for the nurses in the bone marrow transplant unit at 57357 in Egypt.
3- Increase the number of the study subjects to include nurses outside the BMT unit to be aware of the knowledge degree towards acute GVHD.