الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
Pain is a usual occurrence that is considered as one of the most municipal and opposing stimuli to humans at any stage of life. Most of the times, it could be as a result of nociceptive feelings, injury, surgery, or illness which cause children to seek health- care services. Pain is a subjective data that are personally experienced and reported by the child whom makes it difficult for others to assess, evaluate, and manage (Freudenrich, 2015).
It is important for nurses to possess a good mastery and a positive disposition regarding pain management because they spend the bulk of time with the children. Therefore, pain management is a prerequisite knowledge for nurses to acquire (Issa et al., 2017). Nurses focus mainly on how to tackle the disease that resulted in pain rather than the cause of the pain itself, despite their knowledge in managing children with pain. Pharmacological intervention and analgesic prescriptions are preferred due to the time consumed in the evaluation and assessment of pain and considering the large number of children that need health-care attention in the unit (Omran et al., 2014).
Perception is defined as the ability to see, hear, or become aware of something through the sense. Perception of pain is highly complex. The notion of perception as a driver of health care makes this conception important to nurses to
improve health outcomes. Pain perception is composed of highly interactive, emotional, cognitive, as well as sensory components (Collis, 2016).
Subject and Methods
This study was aimed to assess pediatric nurses’ perception of pain among pre-school age hospitalized children.
Research Question:
1- What is pediatric nurses’ perception of pain among pre-school hospitalized children?
The subject and methods of the current study were discussed under the following four (4) designs:
I. Research Design
II. Operational Design
III. Administrative Design
IV. Statistical Design
Research Design
A descriptive design was used to conduct this study.
Setting:
The study was conducted at Children’s Hospital affiliated to Ain-Shams University Hospitals in Pediatric Intensive Care Unit, Surgical Wards, Emergency Departments, Hemodialysis and Oncology Units because it is large hospital that receives pediatric patients from rural and urban area and has adequate number of pediatric nurses. Also, children suffer from many types of pain.
Subject:
A purposive sample of ( n=80) pediatric nurses with high and middle education and with more than 1 year of experience and exclusion of nurses had nursing deplome with less than 1 year of experience. A purposive sample of (n=80) pre-school hospitalized children (3-6) years of age with acute pain in pediatric department and Pediatric Intensive Care Unit with exclusion of comatose patients and children with terminal illness and children with mental disabilities.
Tools of data collection
Data were collected through used the following tools:
(Tool I): A Structured Questionnaire format:
It was developed by the researcher based on scientific updated literature review and will be written in simple Arabic language to suite level of nurses. It assesses nurses perception of pain among pre- school hospitalized children and includes the following parts:
First part : Concerning personal demographic characteristics of nurses as regard age, sex, level of education years of experience, field of specialty, number of training programs they exposed to in the field of pain education, residence, marital status, number of children and income ).
Second part: Concerning pre-school demographic characteristics as regard age, gender, ranking, number of brothers, date of admission and diagnosis).
Third part: knowledge assessment sheet it used to assess nurses’ perception regarding pain management among pre-school children. It was a dopted from (Smart, 2005) modified and translated in to Arabic language by the researcher.
(Tool II): perception assessment sheet modified and translated to Arabic language from Salantera (2002) ”nurse’ perceptions about children pain” and Margolius et al. (2000) ”assess nurse’ beliefs and perception about pain in children.
Scoring system will be used to present the following options: (strongly agree, agree, uncertain dis agree and strongly disagree). The scoring system from 5 to1 score according to strongly agree has score 5, agree has score 4, uncertain has score 3, disagree has score 2 and strongly disagree has score 1.
(Tool III): Wong-Baker faces scale:
Wong-Baker faces scale (Hockenberry, 2005) it was used to assess pain score in pre-school hospitalized children. from (0-10) 0 no hurt, 2 hurts little bit, 4 hurts little more, 6 hurts even more, 8hurts whole, 10 hurts worst.
Operational Design
The operational design for this study consisted of three phases, namely, preparatory phase, pilot study, and fieldwork.
Preparatory phase:
A review of past and current literature covering the various aspect of research problem. It done by using the available articles, periodicals, journals and text books to be acquainted with the research problem. During this phase, the researcher also visited the selected places to get acquainted with the personnel and the study settings. Development of the tools was under supervisors‟ guidance and experts‟ opinions were considered.
Pilot study:
Pilot study was carried out on 10% (n=8 nurses) of the studied nurses and pre-school children at the previously mentioned settings in order to test the applicability of the constructed tools and its clarity and validity. The pilot has also served to estimate the time needed for each subject to fill in the questions. According to the results of the pilot, no corrections and omissions of items were performed. The pilot participants were included in the main study sample.Content Validity and Reliability:
Content Validity Tools was exposed to jurying committee of pediatric nursing and medicine to gain their experiences and opinion’s regarding the tools contents and modification was done accordingly.
Content reliability of the tool was tested to ensure that an assessment tool produces stable and consistent result over times. Reliability of the study tools was done by alpha Cronbach test (0.98).
Field work:
The actual field work of this study was carried out over 6 months period started from the beginning of August 2017 till the end of January 2018 from 9 a.m. to 2 p.m. twice per week. periodically in different sessions by rotation the previously mentioned setting shift. Each nurse/child was interviewed individually to gather the necessary data of the study. The nurses were asked to give their responses according to the study tools. The required time to collect data from each nurse about 40 -50 minutes.
Administrative design:
An official approval to carry out the study was obtained by the Dean of Faculty of Nursing Ain Shams University to general director of pediatric hospital.Ethical considerations:
Verbal approval was obtained from the child/nurses before inclusion in the study; a clear and simple explanation was given according to their level of understanding. They secured that all the gathered data was confidential and used for research purpose only.
The ethical research considerations include the following:
The research approval was obtained from the faculty ethical committee before starting the study.
The researcher was clarifying the objectives and aim of the study to nurses included in the study before starting.
The researcher was assuring maintaining anonymity and confidentiality of subjects’ data included in the study.
The nurses informed that they are allowed to choose to participate or not in the study and they have the right to withdraw from the study at any time.
Statistical analysis
Data collected from the studied sample was revised, coded and entered using computerized data entry and statistical analysis were fulfilled using the Statistical Package for Social Sciences (SPSS) version 20. Data were presented using descriptive statistics in the form of frequencies, percentages. Chi-square test(X2) was used for comparisons between qualitative variables and correlation cofficiency (Spearman’s rank test) was used to test correlation between variables. Statistical significant was considered at p-value <0.05.
Results:
It was cleared that 37.5% of the studied nurses were aged between 30<35 years old with mean 31.6± 2.2 years, 52.5% of them were married, 46.3% of them were live in family consist of 5 members, 37.5% of them had 5-10 years old experience in pediatric nursing with mean 8.1±1.6 while, 27.5% of them had less than 1 years old experience in current unit with mean 8.5±0.9 years while 58.7% of them weren‟t attended training program about pain management.
It was observed that 55.0 % of the studied nurses were Technical Institute certificates, 63.7 % of the studied nurses were live in urban.
It was illustrated that 40.0% of the studied nurses were agree with the feeling of pain may be caused by disease or injury, while 45.0% of them were disagree with the child may sleep if he suffering from pain.
It was illustrated that50.0% of the studied nurses were disagree with the effectiveness of morphine when taking I.M doesn‟t exceed 4:5 hrs., while 43.7% of them were agree with the lack of knowledge about analgesics and ways to give effects on relieving pain.It was obvious that 48.8% & 42.6% of the studied nurses were disagree with the non-pharmacological intervention such as compresses, images and play are useful in reduce mild and moderate pain but are rarely helpful in relieving acute pain & it‟s necessary to use non pharmacological methods rather than analgesics respectively.
It was cleared that 42.5% & 40.0% of the studied nurses were disagree with it‟s necessary to encourage the child to control pain before giving him analgesic & type of analgesic given to child is chosen according to pain not on child complains respectively.
It was found that 40.0% & 42.5% of the studied nurses were disagree with the increase blood co2 level & increase blood viscosity as a bio-chemical changes result from pain respectively.
It was obvious that 35.0% of studied nurses were disagree with the minimize pain during suction, while 41.3% & 42.5% of them were agree with administer pain medication before changing dressing of large burns & eliminate chronic pain such as cancer respectively.
It was found that 55.0% & 56.3% of the studied nurses were disagree with the relaxation and massage is very useful to child & play eliminate intensity of child‟s pain as anon-pharmacological pain management methods to manage pain in pre- school age children respectively
There were statistical significant differences between nurses‟ age, level of education, years of experience in pediatric nursing, years of experience in unit, attend training program of the studied nurses and their knowledge regarding to pain among pre-school hospitalized children.
There were no statistical significant differences between level of education, attend training program, residence of the studied nurses and their perception regarding to pain among pre-school hospitalized children.
There were positive correlation between nurse’s knowledge and their perception regarding to pain among pre-school hospitalized children, there are statistical significant differences between nurse’s knowledge and their perception regarding to pain among pre-school hospitalized children (r=0.82).
There was negative correlation with significant difference between nurses‟ perception and children‟ level of pain.