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العنوان
Effect of Nursing Intervention on Short and Long Term Health Problems of Children Suffering from Hirschsprung’s Disease/
المؤلف
Mohamed, Fatma Mohamed.
هيئة الاعداد
باحث / Fatma Mohamed Mohamed
مشرف / Wafaa E. Ouda
مشرف / Safy S. Al-Rafay
مشرف / Salma E. Hassan
تاريخ النشر
2015.
عدد الصفحات
318 p. :
اللغة
الإنجليزية
الدرجة
الدكتوراه
التخصص
طب الأطفال
تاريخ الإجازة
1/1/2015
مكان الإجازة
جامعة عين شمس - كلية التمريض - تمريض الأطفال
الفهرس
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Abstract

Hirschsprung’s Disease is a common congenital anomaly effecting 1/5000 live birth due to absence of the ganglion cells. The definitive treatment of Hirschsprung’s Disease has started in 1948 by Swenson, since then several operations were used to improve the outcome of this anomaly. Research studies demonstrate that despite the availability of effective techniques for Hirschsprung’s Disease management in children, nursing intervention is age dependentwhere in the newborn, detection is high priority. As the child grows older, careful attention to a history of constipation and diarrhea is important. Pre operative care depends on the age and clinical condition. A child who is malnourished may not be able to withstand surgery until the physical status improve often ,this is after symptomatic treatment with enemas, a low fiber, high calorieand high proteins diet and in severe situations, the use of total parental nutrition (TPN) (Wong, 2006).
Aim of the study:
A present study aimed to investigate the effect of Nursing Intervention on Short and Long Term Health Problems of Children Suffering from Hirschsprung’s Disease. This aim was attained through the following objectives:
- Assess nurses’ knowledge and practice regarding short and long term health problems of children suffering from Hirshsprung’s Disease.
- Design, implement and evaluate the effectiveness of the nursing intervention regarding short and long term health problems of children suffering from Hirshsprung’s Disease.
Research hypothesis
Nursing intervention will affect nurse’s knowledge and practice in relation to children suffering from Hirschsprung’s Disease.
Subjects and Methods:
I. Technical design:
The technical design for the study includes research design, setting of the study, subjects and tools for data collection.
1) Research design:
A quasi-experimental designwas used.
2) Setting:
This study was conducted at the pediatric surgical unit/ Pediatric Children Hospital affiliated to Ain Shams University Hospitals.
) Subjects:
A purposive sample consisted of 30 nurses, who employed in the study setting and were responsible for direct and indirect care for children suffering from HSD pre operatively and post operatively regardless their characteristics. The study sample involved also all the available children in the study setting suffering from Hirshsprung’s Disease regardless their age, gender and residence. Nurses were assessed twice before/ after nursing interventions using same tools.
4) Tools for data collection involved:
1. Child assessment sheet.
2. Questionnaire sheet for assessment of nurses’ knowledge.
3. Check lists for ”pre operative care, post operative care, colostomy care, child weight, infant weight, child height, child length, enema preparation, administration and care.
4. Booklet for nursing intervention program for nurses caring of children suffering from Hirschsprung’s Disease.
1) Child assessment sheet:
Child assessment sheet was designed and written in simple Arabic language by the researcher after reviewing related literatures. Each study subject was individually interviewed and their parent when necessary; it comprised three parts as follows:
a. Socio demographic characteristics of children with Hirschsprung’s Disease such as age, gender, level of education.
b. Characteristics of children’s family such as age of parents, their level of education, family size, job, income and residence.
c. Family history of HSD, type of treatment, complication.
2) Questionnaire sheet for assessment of nurse’s knowledge pre and post nursing intervention: It composed of two parts:
Part I: concerned with nurses’ age, level of education, marital status, years of experience and attendance of training programs related to pediatric surgical.
Part II: concerned with Nurses’ knowledge about:
• Definition of Hirschsprung’s Disease, incidence, causes, signs and symptoms, short and long term health problems, treatment and complications of the disease.
• Colostomy: definition of colostomy, its types, shapes and complications.
• Infection control in care of children suffering from Hirschsprung’s Disease pre operatively and post operatively (Def, principles … etc).
- Scoring system;
- nurse knowledge about HSD and its complications, Consisted of 50 question as open and close ended questions.the total score for the sheet was 100 score, that was distributed according to the importance of the items.
- Satisfactory score for knowledge <50%.
- Unsatisfactory score for knowledge>50%.
1) Observation check lists to assess the nurses’ practice in ”pre operative and post operative care for children suffering from Hirschsprung’s Disease. It was adopted from Ashwill and Droske 2001) to assess nurses’ practice related to pre operative and post operative care.
Scoring system;
The checklist for pre operative care of child consisted of 21 items which were checked correct, incorrect or not done the total score were (42 degree) as the following;
• Correctly done =2 score.
• Incorrectly done =1score.
• Not done=zero.
The sum of scores of each of the previous items as:
• Competent=more than 85%
• Incompetent=less than 85%
The checklist for post operative care of child ren consisted of 17 items which were answered correct, incorrect or not done the total score were (34 degree) as the following;
• Correctly done =2 score.
• Incorrectly done =1score.
• Not done=zero.
The sum of scores of each of the previous items as:
• Competent=more than 85%
• In Competent=less than 85%
2) Colostomy care: it was modified from Ashwill, and Droske, (2001), to assess the nurses’ practice related to care of stoma site and it was composed of 17 items.
Scoring system:
- The colostomy observation checklist consisted of 17 items which were checked either either correct or incorrect or not done .the total score was 34 degree as the following;
• Correctly done =2 score.
• Incorrectly done =1score.
• Not done=zero.
The sum of scores was categorized as:
• Competent= more than 85%
• Incompetent= less than 85%
3) Child’s measurements including:
- A- Child and infant weight; adopted from Coran et al., (2004). To assess nurses’ child and infant weight pre and post nursing interventionthatthat contains 6 items for child weight and 7items for infant weight,
3-b- Child height and length; adopted from Lister and Irving, (2005) that contains 4 items for child height and 7 items for infant length
4) Enema care procedure consisted of 25 items which were assessed as correct, in corrector, not done; the total score was 50 degree as the following;
• Correctly done =2 score.
• Incorrectly done =1score.
• Not done=zero.
The sum of scores of each of the previous items as:
• Competent= more than 85%
• Incompetent= less than 85%
5) Nursing intervention program:
It was designed by the researcher according to actual needs assessment of the studied nurses providing care to children suffering from Hirschsprung’s Disease and their parent. It was designed as a program guided by booklet in simple Arabic language by the researcher.The booklet was appendix (V) given for both nurses and parent s”as well.
II. Operational design:
The operational design consists of the preparatory phase, pilot study, field work, operational definitions and limitation of the study.
2) Preparatory phase:
A review of current and past, local and international related literature on various aspects related to the assessment of nurses’ knowledge and practice regarding short and long term problems of children suffering from Hirschsprung’s Disease using articles, books ,periodicals, magazines and internet, to develop the study tools for data collection and the content of the nursing intervention.
(2) Pilot study:
The pilot study was carried out including a group of five nurses to test the clarity and arrangement of the items and time The operational design consists of the preparatory phase, pilot study, field work, operational definitions and limitation of the study.
2) Preparatory phase:
A review of current and past, local and international related literature on various aspects related to the assessment of nurses’ knowledge and practice regarding short and long term problems of children suffering from Hirschsprung’s Disease using articles, books ,periodicals, magazines and internet, to develop the study tools for data collection and the content of the nursing intervention.
(2) Pilot study:
The pilot study was carried out including a group of five nurses to test the clarity and arrangement of the items and time • Subjects are allowed to choose to participate or to quit at any time without penalty.
(4) Field of work:
• Data collection for this study was carried out in the period from December 2011 until April 2012.
• The programe consisted of (10) session with one session for formative assessment (pre nursing intervention assessment).
• The researcher collected the data during the morning and after-noon shifts from study setting over two days /week (Monday and Wednesday) to assess nurses’ knowledge and actual practice.
• The child assessment sheet was filled by the researcher based on child condition.
• Child assessment sheet was filled by parents for illiterate parent; data were filled by the researcher through interview, within 20-30 minutes.
• Nursing intervention on form of program guided by booklet was given to the nurses on individual or groups that included up to 5 nurses. The researcher explained the purpose of the study for every nurse/ group.Different teaching methodology was used for theory and practice.
• The study tools were assessed by jury of 5 experts in the field prior its actual use in data gathering phase to confirm its validity.
(5)Limitation of the study:
• Inconvenience of the setting for data collection, as there was difficulty to find the setting appropriately ready for delivering the program or interviewing the nurses.
III. Administrate design:
An official permission was obtained from the medical director of the study setting through a formal letter that was issued from the Dean of Faculty of Nursing, Ain Shams University.
An oral approval to carry out the study was taken from each child and his/her accompanying parents as well and oral approval from nurses as well.
IV. Statistical Design:
The collected data were organized, tabulated, categorized and analyzed by the computer program ”SPSS”. Data were presented in tables using number and percentage.
*significance of the results:
Not significant if P<0.05
Significant if P>0.05
Highly significant if P >0.01