الفهرس 
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Abstract
Summary
Acute lymphoblastic leukemia (ALL) is the most common type of cancer in children. Early treatment can result in a good chance for cure (Hoffman, 2012). The ALL is a primary malignancy of the bone marrow in which normal bone marrow is replaced by malignant blast cells. Oral mucositis (OM) is one of the worst side effects that can appear while treating children with ALL (Sharon, 2008).
The OM is a condition in which an individual develops painful lesions of the mucus membranes of the mouth. It is a side effect of cancer treatment and usually increases in severity as the dose of chemotherapy or radiotherapy increases. Mucositis can have a devastating effect on a person’s nutritional status, because the oral pain associated with the condition often prevents individuals from eating solid food (Balaban, 2011).
This study aimed to:
- Assess the mothers’ knowledge and practice in caring for their children suffering from oral mucositis related to acute lymphoblastic leukemia.
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Research question:
- Is there a relation between mothers’ knowledge in caring for their children suffering from oral mucositis related to acute lymphoblastic leukemia and their practice?
Subjects and Methods
I. Research design
A descriptive design was utilized in the current study.
Research settings
This study was conducted at both outpatient and inpatient pediatric departments. In the outpatient setting, the child received chemotherapy from 6 to 12 hours. Many bathrooms for hand washing in addition to places and time to perform oral care were available. Moreover, within the in-patient pediatric departments, the child was hospitalized from 15 to 21 days. The research setting was affiliated to Children’s Cancer Hospital (57357), as the hospital is being with highest admission rate of children suffering from oral mucositis (OM) related to Acute Lymphoblastic Leukemia (ALL).
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Sample size and characteristics:
A purposive sample that composed of 100 children with OM related to ALL and attending the previously mentioned setting was used. The inclusion criteria of the study involved children with confirmed diagnosis of all grades of OM related to ALL, receiving chemotherapy from both gender, aged from 1 day up to 18 years and all the mothers were accompanying their children regardless of their characteristics.
Tools and technique of data collection:
Data was collected through the following tools:
3.1. A pre-designed questionnaire format (Appendix II):
A questionnaire was designed by the researcher after reviewing the related literatures. It was written in simple Arabic language to suit the understanding level of the studied mothers and their children. It was consisted of two parts:
It was designed by the researcher after reviewing the related literatures. It was written in simple Arabic language to suit the understanding level of the studied mothers and their children. It consisted of two parts:
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Part 1: characteristics of the studied sample:
A. characteristics of the studied children including; age, gender, place of residence, level of education, child ranking in the family, reason and place of admission.
B. characteristics of the studied mothers including; age, level of education, occupation, consanguinity, positive family history of ALL and maternal exposure to risk factors during pregnancy. Part 2: Concerning mothers’ knowledge regarding care of their children suffering from OM related to ALL, covered the following:
A. Mothers’ knowledge regarding ALL (definition, causes, signs, symptoms, complications, and diagnosis).
B. Mothers’ knowledge regarding chemotherapy (goal, route of administration and complications).
C. Mothers’ knowledge regarding OM (definition, causes, degree, signs of each degree, complications and oral care).
3.2. Observational checklists (Appendix III):
The observational checklists were adopted from (Cairns, 2010 and Gaylene et al., 2010 and the policy and procedure of the Children’s Cancer Hospital, 57357). They were used to assess the mothers’ actual
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practice regarding care of their children suffering from OM related to ALL. Two observational checklists were used including; hand washing, and mouth care.
II. Operational design
The operational design of the study entailed three main phases:
A- Preparatory phase:
Review of the past and current national and international related literatures using articles, internet, journals, scientific periodicals and text books to be acquainted with the various aspects of the research problem.
B- Pilot study:
A pilot study was carried out from January 2014, involving 10% of the expected total sample size, (10 of mothers and accompanying children). It was conducted to test the clarity and applicability of the study tools and the time required to fill each tool.
C- Field work:
The actual field work was carried out over 6 months from the first week of April 2014 up to the first week of October 2014. The researcher was available in the study
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setting five days / week at the morning shift (9am to 4pm) from Sunday to Thursday. The actual work started by interviewing each mother and her child individually at the morning shift.
III. Administrative design
An official permission to carry out the study was obtained from administrators of the Children’s Cancer Hospital in Egypt (57357). It has been approved by Internal Reviser Board (IRB) through an issued letter from the Dean of Faculty of Nursing/Ain Shams University.
Ethical considerations:
Mothers’ agreement was a prerequisite to be included in the study subject. Before carrying out the study, the researcher clarified the aim of the study and its expected outcomes. The study subjects were ensured that all the gathered data was confidential and used for the research purpose only. The study subjects had the right to withdraw from the study whenever they wanted. When possible, the study subjects were provided with feedback about the research outcomes.
Scoring system:
According to mothers’ actual practices, each step was scored as ”1” if the step was done correctly, and scored
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”Zero” if the step was not done or done incorrectly. The total scores ranged from ”0-26”, according to the mothers’ actual practice, they were being classified into:
− Satisfactory level of practice (more than 75%).
− Unsatisfactory level of practice (less than 75%).
Results:
Finding of the current study can be summarized as the following:
1. More than half of the studied children (52%) were males, while 48% of them were females. Also, more than one third of them (37%) were in the age group of 9<12 year with mean age 8.8+ 5.0.
2. More than half of the studied children (56%) were living at rural areas, and more than half of them (53%) were ranked as second children.
3. More than half of the studied children (56%) had duration of the disease from 1<3 years.
4. More than one third the studied mothers (35%) had middle educational levels, and more than half (56%) of them were working mothers.
5. Three quarters of the studied mothers (75%) reported complete correct answers of the definition of leukemia.
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6. More than half of the studied mothers (60%) reported complete correct answers about symptoms of ALL, and more than half of them (58%) reported complete correct answers about complications of leukemia.
7. More than half of the studied mothers (58%) reported complete correct answers about the goal of chemotherapy, while near three quarters of them (74%) reported complete correct answers about types of emergency situations.
8. Near two thirds of the studied mothers (63%) reported complete correct answers about the type of received medication. Also, more than half of them (80%) reported complete correct answers about route of chemotherapy administration, while more than half of them (67%) reported complete correct answers about chemotherapy complications.
9. More than half of the studied mothers (72%) reported complete correct answers about definition of oral care, and less than half of them (48%) reported complete correct answers about OM, while more than two thirds of them (70%) reported incorrect answers about OM classification.
10. Regarding mother’s knowledge about signs of OM, it was found that more than half of the studied mothers
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(53%) reported incorrect answers about 1st degree of OM, and more than half of them (57%) reported complete correct answers about 2nd degree OM, while near three quarters of them (73%) reported incorrect answers about 3rd degree OM. Also, more than half of them (62%) reported incorrect answers about 4th degree OM.
11. Less than half of the studied mothers (47%) reported complete correct answers about OM complications.
12. The majority of the studied mothers (98%) reported incomplete correct answers about importance of oral care, and more than three quarters of them (77%) reported complete correct answers about oral care techniques. Also, more than half of them (70%) reported complete correct answers about oral care protocol.
13. More than half of the studied mothers (62%) reported complete correct answers about using mouth wash and mouth gel, while less than half of them (46%) reported complete correct answers about using antifungal agents.
14. More than half of the studied children (53%) were affected psychologically and more than half of them (59%) were affected socially, while less than half of them (39%) had affected school achievements due to OM.
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15. More than half of the studied mothers (62%) had fair knowledge about ALL, and more than half of them (60%) had good knowledge about chemotherapy. Also, less than half of them (40%) had poor knowledge about care of their children suffering from OM.
16.There were high statistically significant differences between mother’s total knowledge and their level of education (p<0.01). While there were no statistically significant differences between mother’s total knowledge and their work state (p>0.01).
17. More than half (58%) of the studied mothers did not perform effective techniques in the following steps of hand washing; wetting hands with water (99%) and rubbing hands palm to palm (64%).
18. More than half of the studied mothers (68%) did not do hand washing before performing mouth care, and more than half of them (63%) did not observe for any signs of inflammation of the child’s gum.
19. No statistically significant differences between mothers’ total levels of knowledge and their total actual practice (p > 0.01) were found.
Conclusion
The current study concluded that most of the studied mothers had average knowledge and satisfactory practice
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regarding care of their children suffering from oral mucositis related to acute lymphoblastic leukemia.
Recommendations
In the light of the study findings, the following recommendations were suggested:
- Developing an educational program for mothers regarding prevention and care of their children suffering from oral mucositis.
- Development of a guideline leaflet for mothers based on their actual need assessment for children with oral mucositis to guide them in care of their children.
- Regular assessment and monitoring of factors affecting the mothers’ compliance during care of their children with oral mucositis.
- Optimizing oral health before start chemotherapy, by evaluation of dental professional to eliminate/reduce oral infections.
- Findings of the study should be transferred to the mothers and children through mass media programs for prevention of oral mucositis. Moreover, the radio and television with their wide distribution and popularity can be very essential media tools.
- Further research should be conducted to assess mother’s knowledge and practices about oral mucositis
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prevention, warning signs and symptoms, control and management.