الفهرس 
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Abstract
SUMMARY
Osteogenic sarcoma (osteosarcoma) is a bone forming
cancer. It is the most frequent type of bone tumor and is most
common between the ages of 15 to 25 years. Over 90% of
tumors are located in the metaphysis (the growing ends of the
bone), the most common sites are the bones around the knee
which account for 80% of cases. Osteosarcomas vary greatly in
radiological and pathological features and therefore need
careful diagnosis to differentiate this from other bone tumors.
Most are high grade intramedullary osteosarcomas, about 5%
are low grade lesions, some are secondary osteosarcomas (for
example those caused by radiation therapy) (Khoury et al.,
2014).
Aim of the study:
The aim of this study was: Enhancing the periopertive care
provided by nurses for children with osteosarcoma and their
families.
Through:
1. Assessing the nurses’ knowledge and practices related to
periopertive care provided to the children with
osteosarcoma and their families.
2. Developing and disseminating a handout for nurses about
perioperative care.
3. Evaluating the effects of the educational program among
nurses about care given to the children with
osteosrcoma, perioperatively.
Summary
104
Subjects and Methods:
I. Research Design:
A quasi experimental design was utilized in the current
study.
A. Setting:
This study was conducted in 57357 children’s cancer
hospital in Egypt at the operating room, surgical department
and the post anesthesia care unit. Because nurses working in the
previously mentioned setting care and look after children
having surgical operation.
B. Subjects:-
A purposive sample was selected from nurses working at
57357 children’s cancer hospital in Egypt. Nurses’ number in
surgical department and the post anesthesia care unit was (48)
and operating room nurses were (22) regardless their level of
qualifications or experience.
2. Technical Design
Tools of data collection:
Data were collected through the use of the following tools:
a) A pre-designed questionnaire (Appendix II):
It was designed by the researcher based on recent
literature review. Questions were in the form of 35 multiple
choices questions written in simple Arabic language to
gather data that covered the following parts:-
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105
Part I:
The first part was concerned with the characteristics of
nurses: age, level of education, years of experience,
qualifications, marital status, and previously reported training
course.
Part II:
The second part was concerned with knowledge related
to definition, causes, types, signs and symptoms, complications,
methods of diagnosis, medical and nursing management of
osteosarcoma.
Part III:
The third part was concerned with knowledge related to
the health problems related to osteosarcoma.
Part IV:
The fourth part was concerned with knowledge
related to the surgical care provided for children having
osteosarcoma. Each questionnaire sheet was filed
individually by the nurses on spot.
Scoring system:
Scoring system for the questionnaire was ”100” marks.
The nurse’s answers were categorized into:
Score < 60 referred to poor knowledge.
Score 60 < 75 referred to average knowledge.
Score 75 < 100 referred to good knowledge.
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106
2- Observational Checklists (Appendix III):
Practice standardized checklists were used for care of
child to assess nurse’s practice related to osteosarcoma. It was
used to observe the actual nurse’s performance for children with
osteosarcoma. These included general pre-operative care check
list (Lingard, 2008), wound dressing (Beiltz, 2005), cast care
(Altizerr, 2004), drug administration (Polovich et al., 2005),
sponge count sheet check list, surgical pause and instrument
preparation checklist (WHO, 2013). For every procedure, there
were 10 minutes for each to explanation.
Scoring system:
Scoring system of nurse’s practices for each procedure
was classified into:
• Score 85% < 100% : Competent level of practice.
• Score 0% < 85% : Incompetent level of practice.
Then the total scores of practice for nurses were classified
into competent or incompetent.
Construction of nursing intervention program:
Actual need assessment was done and accordingly, the
program was provided. A guiding booklet was designed by the
researcher after reviewing the related literature; it was designed
in Arabic language. The guiding booklet was evaluated for its
content validity and clarity by a panel of expert professionals in
the field of the study including the supervisors of this work. In
the light of their comments, the necessary modifications were
carried out and the final form of the guiding booklet was stated.
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107
A variety of teaching strategies were used in implementation of
nursing intervention program.
The educational program consumed months and was
divided into four theoretical and five practical sessions, a
checklist consumed 1 hour for every procedure. The first
session centered on identifying the program and its objectives,
definition of osteosarcoma, causes, signs, symptoms and risk
factor of osteosarcoma in addition to diagnosis, staging and
complications of osteosarcoma. The time allotted for this
session was 1 hour.
The second session was about the definition of the preoperative
stage, general pre-operative care, pre-operative care
specific for orthopedic surgery and open discussion about preoperative
care in details, it took 1 hour also.
The third sessions contained the definition of the intraoperative
stage and the four stages of surgical pause,
instruments needed for prosthesis operation, microsurgery set,
fixation set and the special equipment for orthopedic surgery, it
took also 1 hour.
The fourth session included the definition the postoperative
stage, identification of the peripheral circulation and
explanation about the importance of measuring the peripheral
pulse post operatively.
The fifth session demonstrated the cast care and wound
care, and the time allotted for this session was 1 hour.
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The sixth session centered on the wound dressing and
took 1 hour.
The seventh session centered on the drug administration
and also took 1 hour.
The eighth session centered on demonstrating the sheet
and sponge count and also took 1 hour.
Finally the ninth session centered on demonstrating the
special instruments for orthopedic cases. Different teaching
media were used to clarify the sessions such as posters,
handouts and checklists.
III. Operational Design:
1- Preparatory phase
A review of the past and current related literature
covering various aspects of the research problem was done by
using available articles, periodicals, magazines, and books to be
acquainted with the research problem to develop the study tools
and content.
2- Exploratory phase
A pilot study was carried out involving 10% of the
expected study sample to test the validity and reliability of the
study tools, time needed to fill in, study tools applicability and
feasibility. Modifications were done as revealed from the pilot
study by adding or omitting some items, the nurses involved in
the pilot study were excluded later from the study.
Summary
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3- Field Work:
The actual field work was carried out of data which was
collected 2 days per week from 8 am to 2 pm o’clock. The
researcher individually interviewed the nurses to collect data
related to their care of children with osteosarcoma. The
researcher explained the aim and the nature of the study. The
educational program consumed six months and was divided into
four theoretical and five practical sessions, the checklist lasted 1
hour for every procedure. Finally, the researcher disseminated
an Arabic handout to the nurses about care for children with
osteosarcoma. Different teaching strategies were used such as
modified lectures, small group discussions, role-playing,
demonstration and redemonstration using real objects. Suitable
teaching aids were prepared especially for the program, these
included a booklet, colored posters and modules.
Evaluation:
Upon the completion of the intervention nursing
program. The post test was done for nurses to evaluate the out
comes of the nursing intervention program using the same pre
program tools.
4. Administrative Design:
An official permission to conduct the study was obtained
from the dean of faculty of nursing (Ain Shams University)
submitted for administrators of the previously mentioned
setting concerning the title objective, study technique and tools
(seeking for their co-operation).
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5. Ethical consideration:
Verbal approval was obtained from the studied nurses and
their nursing administration. Before inclusion in the study, a clear
and simple explanation was given according to their level of
education. They were assured that all the gathered data were
treated confidentially and used for research purpose only and
nurses have the right to withdraw from the study at any time
without giving any reason.
IV. Statistical Design:
Data collected from the studied sample was revised, coded
and entered using computer. Data entry and statistical analysis
was fulfilled using the statistical package for social sciences
(SPSS). Data was presented using descriptive statistics in the form
of frequencies, percentages. Chi-square test (X2) was used for
comparisons between qualitative variables, and spearman
correlation analysis was used for assessment of the interrelationships
among quantitative variables. Statistical
significance was considered at p-value <0.001.
10. Results:
The most important findings that were obtained from the
present study can be summarized as the follows:
There was statistical significant difference between nurses’
knowledge and their ages (P < 0.001).
There was statistically significant difference between nurses’
level of knowledge and their level of practice (P < 0.001).
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There was a highly statistical significant difference between
nurses’ total knowledge and their education diploma,
specialty and working state (P<0.001).
There was statistical significant difference between nurses’
practice and their age (P < 0.001).
There was statistically significant difference between
nurse’s total level of knowledge and their total level of
practice (P < 0.001).
There was statistical significant difference between nurses’
knowledge and their years of experience (P < 0.001).
11. Conclusion:
The findings of this study can be concluded as following:
Half of the studied nurses had average knowledge,
incompetent practice and their nursing role was incompetent pre
program. On the other hand, most nurses’ knowledge and practice
were improved post program implementation and follow up, it also
reflected statistically significant difference.
Moreover, there was a positive correlation between
nurses’ characteristics and their knowledge at age 20<25 years;
and a highly statistical significant differences between nurses’
knowledge, their level of education and years of experience for
diploma nurses and specialty under 5 years experience.
Educational program about osteosarcoma had positive
effect on nurses’ knowledge and practice. Real materials and
tools assisted nurses to upgrade their knowledge and to achieve
competent practices.
Summary
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Respecting the nurses’ opinions, attitudes, hopes as well
permitted them to express their feelings, beside their spiritual
states.
12. Recommendations:
Based upon the results of the current study, the following
recommendations were suggested:
Additional educational program for nurses regarding
osteosarcoma to keep them in touch with advances in
health education about care of children suffering from
osteosarcoma and their families.
Motivate nurses in oncology hospital to acquire updated
knowledge and practice through workshops and training
by national, regional and international
agencies/associations.
Development and dissemination of a guideline leaflet,
Arabic handout and colored posters for nurses about care
of children with osteosarcoma.
Designing and carrying out programs to support the
children with osteosarcoma and their families to cope
with the disease.
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Apply several nursing approaches as evidence based
nursing practice to improve nurses’ knowledge, practice
and periopertive care; and to evaluate the effects of those
approaches among children receiving osteosarcoma
management.
Regular assessment and monitoring of factors hindering
compliance of children with osteosarcoma and their
families during follow up of post surgical operation.
Continuous nurses’ evaluation and monitoring their
knowledge and practice for the children with
osteosarcoma perioperatively