الفهرس 
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Abstract
The IMCI program is an integrated approach to children’s health that focused on the well-being of the whole under five children. It incorporates a broad range of age groups in which the occurrence of most common diseases take place as; pneumonia, diarrhea, measles, malnutrition, and anemia. The major aim of this program is to help countries to achieve millennium goals in decreasing both morbidity and mortality rates among those children. Particular attention was given to the most common childhood illnesses in developing countries, particularly ARI as; pneumonia, cough and difficult breathing, sore throat, and ear problem. According to the WHO, there is a significant reduction in the mortality rate of the under five children with pneumonia from 18% in 2004 to 16% in 2015 after the supported efforts from the WHO to commit to such program.
The pediatric nurse plays a crucial role in the management of children with ARI. Appropriate nursing management, proper follow-up, and counseling are the cornerstone of improving the health of the under five children and preventing complications. It is important for pediatric nurses to be aware and commit to such recent IMCI program to ensure high-quality of care.
Aim of the study
The aim of the current study was to assess nurses’ commitment to the IMCI program in the management of children with ARI.
Setting of the study
The study was conducted in all health care centers and units in both urban and rural PHC settings in Damanhour city, El-Behira governorate.
Sample of the study
The sample comprised of all pediatric trained IMCI nurses working in the previously mentioned settings. Their number was 100 nurses.
Tool of the study
One tool was used to collect necessary data: An observational checklist that was developed by the researcher based on the IMCI program to assess nurses’ commitment to this program in the management of children with ARI. This tool also included socio-demographic characteristics of nurses. Every nurse was observed three times at the morning shift while committed to the IMCI program in the management of children with ARI.
The main results of the present study revealed the following:
• It was obvious that the age of 50% of the studied nurses was 40 years old and more. While, only 9 % of them aged from 20 to less than 30 years old.
• It was clear that 89 % of nurses had a diploma in nursing, 8% had a technical institute certificate in nursing. While, only 3.0 % of them had a bachelor in nursing.
• All nurses attended training about IMCI program.
• Almost two thirds (66%) of nurses had from five to less than 10 years of experience in the IMCI program. Meanwhile, 13 % of them had from one to less than five years of experience.
• It was clear that 69% of nurses are working in FHUs. While, the minority of them are working in FHCs and MCHs (21%, and 10% respectively).
• The highest percentages of the observations reflected that nurses completely committed to ask the mother about the children’s age and sex (100%, and 97.7% respectively).
• Around 85% of the observations indicated that nurses completely committed to measure the children’s weight and 60% of them revealed that nurses completely committed to plot the measured weight on the growth chart.
• Almost all (98%) observations revealed that nurses completely committed to measure body temperature and 88% of them revealed that nurses completely committed to record it in the children’s sheet.
• The nurses’ practices score in commitment to greet the mother varied between fair and poor (46%, and 54% respectively).
• More than half of the observations reflected that nurses completely committed to ask either about if the children able to drink or breastfeed or if he vomits (57%, and 60.7% respectively).
• The nurses’ practices score in commitment to check for general danger signs of any disease was good (16%), fair (20%) and poor (64%).
• Two-thirds of the observations illustrated that nurses completely committed to either ask about if the children have a cough or difficult breathing or listen for wheezes (65.3%, and 66.7% respectively).
• The highest percentages of the observations highlighted that nurses not committed to assess the children for fast breathing, chest indrawing or listen for stridor (98.3%, 97%, and 94% respectively).
• More than half of the observations showed that nurses completely committed to ask if the children have a sore throat and an agonizing ear pain (51.3% , and 51.7% respectively).
• All nurses not committed to palpate either for enlarged lymph nodes on the front of the neck or tender swelling behind the ear.
• The nurses’ practices score in commitment to assess the children for the main symptoms of ARI was poor for 95 % of nurses.
• Sixty percent of the observations indicated that nurses completely committed to determine if the children’s weight is appropriate for his age by using growth chart.
• The majority (86.3%) of the observations showed that nurses completely committed to take the children’s immunization history and 74.4% of them reflected that nurses completely committed to instruct the mother about the next date for an immunization.
• No nurse committed to give the children either immunization or vitamin A supplementation according to schedule.
• No nurse committed to give an identified treatment for the children as pediatrician ordered.
• Three-quarters of the observations reflected that nurses completely committed to counsel the mother to return immediately when the children become sicker. In addition, nearly two thirds of them indicated that nurses completely committed to counsel her to return immediately if the children develop a fever or if he not able to drink or breastfeed (66.7%, and 61.7% respectively).
• The nurses’ practices score in commitment to identify treatment if no urgent referral is needed and counsel mother about when to return immediately was poor for 97% of nurses.
• No nurse committed to give either first dose of oral antibiotic or antipyretic in the treatment of pneumonia, sore throat or ear infection. Meanwhile, almost three-quarters (73.1%) of the observations illustrated that nurses completely committed to give an inhaled bronchodilator if wheezing present in the treatment of pneumonia.
• Two-thirds of the observations showed that nurses completely committed to instruct the mother to come for follow-up in two days for pneumonia. Moreover, more than half of them showed that nurses completely committed to instruct her to come back for a follow-up in five days for a sore throat and ear infection (57.3%, and 56.2% respectively).
• Around two-thirds of the observations revealed that nurses not committed to demonstrate the rolling of clean soft strong tissue paper into a wick or placing it in the children’s ear (67.2%, and 65.6% respectively).
• It was found that 65.7 % of the observations showed that nurses completely committed to tell the mother about giving her child safe remedy as breast milk, tea with lemon and honey, tileo, and chicken soup.
• The nurses’ practices score in commitment to treat sick child and teach the mother about how to treat local infection varied between fair (17%) and poor (83%).
• It was revealed that 91.1% of the observations showed that nurses completely committed to assess the child’s feeding.
• Nearly three-quarters of the observations showed that nurses completely committed to ask the mother about if she breastfeeds her child, and if her child takes any other food or fluids (74%, and 74.3% respectively).
• More than half of the observations highlighted that nurses completely committed to ask about if the child feeds too small amounts of food and if he is not feeding well during illness (53.8%, and 52.3% respectively).
• Approximately three-quarters (71%) of the observations revealed that nurses not committed to counsel the mother about clearing blocked nose if it interferes with feeding.
• Almost all (99.3%) observations showed that nurses completely committed to ask and listen to the mother. In contrast, 73.3% of them indicated that nurses not committed to check if she understands or needs further explanation.
• The nurses’ practices score in commitment to assess, identify and counsel the mother about the child’s feeding problems was poor for 95% of nurses.
• The total score of nurses’ practices in commitment to the IMCI program in the management of children with ARI varied between (79%) poor, (18%) fair, and (3%) good.
• Nurses with young age demonstrated better practices score in their commitment to the IMCI program than older nurses and the differences were statistically significant in the areas of checking for general danger signs, treating of a sick child as well as in assessing, identifying and counseling the mother about child’s feeding problems.
• Nurses with a bachelor in nursing had better practices score in their commitment to this program than those who had either technical institute certificate or diploma in nursing and the differences were statistically significant in the areas of checking for general danger signs, assessing for the main symptoms of ARI, identifying the treatment if no urgent referral is needed, treating of sick child as well as total practices score.
• Nurses with shorter years of experience exhibited better practices score in commitment to such program than those with long years of experience. There were statistical significant differences in the areas of checking for general danger signs and the total practices score.
• There was statistical significant relation evident between nurses’ practices score in commitment to the IMCI program and their residence. Where, nurses from urban areas demonstrated better practices score than those from rural ones.
• There was no statistical significant relation detected between nurses’ practices score in commitment to this program and their place of work in the area of assessing the child for the main symptoms of ARI.