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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:- Summary 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. Summary 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. Summary 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. Summary 108 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 109 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). Summary 110 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). Summary 111 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 112 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. Summary 113 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 |