الفهرس 
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Abstract
Pediatric respiratory disorders constitute a significant health problem, with prevalence standing at 23%. At least 50% of children fewer than 6 years of age have experienced wheezing episodes in their lives. Asthma attacks are considered one of the main medical emergencies in pediatrics and account for about 5% of the reasons for emergency department visits (Diagnosisn and Therapeuticn Protocols in Pediatric Emergencies, 2022).
Nursing care for pediatric patients is an important line like medical treatment because nursing care maintains the link between medical treatment and intervention for patient’s problems. But nursing care may be influencing by some factors (Howley et al., 2022).
Nurses’ performance means the actual conduct of activities to meet responsibilities according to standards. It is an indication of what is done and how well it is done and focusing attention on the total behavior of nurses and the use of specialized knowledge and skills that acquired through training as well as integration of practice (Ayed et al., 2016).
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The factors that influence the nursing performance in caring of pediatric patients with respiratory disorders include; environmental factors, organizational factors, coordination and communication factors and patient`s information factors. Also, it includes the consistency of caregivers, nurse- patient relationship and sufficient time, personal attributes, personality, attitude, caring with empathy and compassion technical skills (Shah et al., 2018).
Aim of Study:
This study aimed to assess the factors influencing nurses` performance towards caring of pediatric patients with respiratory disorders.
Research Questions:
What is the level of nurses` knowledge about the care of pediatric with respiratory disorders?
What is the level of nurses` practices regarding the care of pediatric patients with respiratory disorders?
What are the factors that influencing nurses` performance towards caring of pediatric patients with respiratory disorders?
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The subject and methods of the study was portrayed under the following four designs.
I-Technical design
II-Operational design
III-Administrative design
IV-Statistical design
I-Technical Design:
Technical design for the study was included research design, study setting, subjects and tools of data collection.
Research Design:
Descriptive design was used to achieve the aim of this study.
Study Setting:
This study was carried out at Emergency Department, Pediatric Department and Pediatric Intensive Care unit in Pediatric Hospital that affiliated to Ain Shaim University Hospitals and Damanhur University Hospital.
Subjects:
Purposive sample was consisted of 151 nurses; 68 nurses from Pediatric Hospital that affiliated to Ain Shaim
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University and 83 nurses from Damanhur University Hospital were recruited under the following criteria.
The inclusion criteria
Full time nurses, provide direct care for pediatric patient with respiratory disorders and have one year of experience and more.
The Exclusion Criteria
Part timer nurses and newly employed nurses in previously mentioned setting.
Tools of Data Collection:
Data was collected through using the following tools
I- A predesigned questionnaire sheet
It was designed by the researcher after reviewing the related National and International literature, it was written in simple Arabic language to suit nurses` level of understanding, it was consisted of the following three parts.
Part I: It was concerned with the characteristics of study subjects study subjects including age, level of education, years of experience and their attainment pervious training, it was consisted of (7 questions).
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Part II: It was related to nurses` knowledge about pediatric respiratory disorders, definition, types, causes, risk factors, oxygen therapy, nublizer amd mechanical ventilator; it was consisted of (40 questions).
Part III: It was related to nurses` knowledge nursing care for pediatric patients with respiratory disorders; it was consisted of (45questions).
Scoring system:
A scoring system was followed to assess nurses` knowledge about pediatric respiratory disorders and nursing care for pediatric patients with respiratory disorders. The correct answer was scored 1 grade and the incorrect answer was scored zero. These scores were summed and were converted into a percent score and accordingly the nurses` total knowledge was classified into three categories.
-Score <60% considered poor knowledge.
-Score from 60% to 75% considered average knowledge.
- Score ≥ 75% considered good knowledge.
Part IV: It was related to nurses` knowledge about the factors influence nurses` performance regarding care of
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pediatric patients with respiratory disorders includes environmental factors (7 items), organizational factors (9 items), communication with patients’ information factors (6 items) and Evaluation and developing methods skills factors (7 items).
Scoring system:
A scoring system was followed to assess factors influencing nurses` performance towards caring of pediatric patient with respiratory disorders. The influencing factors were scored 1 grade and the non-influencing factors was scored zero. These scores were summed and were converted into a percent score and accordingly the nurses` total knowledge was classified into two categories:
- Score <60% considered non- influencing factors.
- Score ≥ 60% considered influencing factors.
II-Observational checklists:
It was adapted from Aylott, (2013) and Cameron et al., (2015), to assess nurses` practice to words caring of pediatric patients with respiratory disorders. It was consisted of 7 procedures (115 steps), include oxygen therapy (16 steps), nebulizer therapy (11 steps), care of endotracheal tube (16 steps), oral hygiene (17 steps),
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suction (nasopharyngeal suction and endotracheal tube suction) (31 steps), and breathing exercise (9 steps).
Scoring system:
A scoring system was followed to assess nurses` practices; each step was done correctly was scored one grade, while each step done incorrectly or not done was scored zero. The score of steps was summed-up and divided by the number of the steps, giving a mean score. These scores were converted into a percent score and classified as the following:-
- Incompetent: score < 80%
- Competent: score ≥80%
Results:
- 41.7% of the studied nurses were in the age group 20 :< 30 years old with mean age 26.96± 8.613 year.
- 66.9% of the studied nurses had poor level of total knowledge regarding respiratory disorders in pediatrics; meanwhile, 18.5% and 14.6% of them had average and good level of knowledge.
- 66.2% of the studied nurses mentioned that environmental factors influencing their performance
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towards caring of pediatric patients with respiratory disorders.
- 83.4% of the studied nurses mentioned that organizational factors influence their performance towards caring of pediatric patients with respiratory disorders.
- 86.1% of the studied nurses mentioned that communication with patient’s information influences their performance towards caring of pediatric patients with respiratory disorders.
- 6.9% of the studied nurses mentioned that evaluation and training of nurses’ performance influence their performance towards caring of pediatric patients with respiratory disorders.
- 67.5% of the studied nurses had competent total level of practice regarding O2 therapy administration.
- 64.2% of the studied nurses had competent total level of practice regarding nebulizer administration.
- 66.9% of the studied nurses had competent total level of practice regarding endotracheal tube care.
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- 64.9% of the studied nurses had competent total level of practice regarding oral hygiene.
- 68 % of the studied nurses had competent total level of practice regarding suction.
- 84.8% of the studied nurses had competent total level of practice regarding breathing exercise procedure.
- 67.5% of studied nurses had a competent total level of practice regarding caring for pediatric patients with respiratory disorders.
- There was statistically significant difference between studied nurses’ total level of knowledge and their characteristics (p-value ≤0.05) except for age and years of experience, there are highly statistically significant difference (p-value ≤ 0.001).
- There was statistically significant difference between studied nurses’ total level of practices and their characteristics (p-value ≤0.05*) except for years of experience, there are a highly statistically significant difference (p-value ≤ 0.0001**).
- There is positive correlation between total level of knowledge and total level of practice among the studied
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nurses towards caring of pediatric patients with respiratory disorders.
- There is positive correlation between total level of knowledge and factors influencing nurses` performance towards caring of pediatric patients with respiratory disorders.
- There is positive correlation between total level of practices and factors influencing nurses` performance towards caring of pediatric patients with respiratory disorders.
Conclusion
Based on the present study findings it can be concluded that, almost two thirds of studied nurses had poor level of knowledge regarding respiratory disorders in pediatric patients, more than two thirds of studied nurses were competent level of practices regarding caring for pediatric patients with respiratory disorders.The environmental factors were mentioned by two thirds of studied nurses that influencing their performance. Moreover, the organizational factors and the communication with patient’s factors were mentioned by the majority of studied nurses. Also, two thirds of studied