الفهرس 
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Abstract
Nurses in various areas of practice settings encounter patients with altered neurologic function. Disorders of the nervous system can occur at any time during life span and can vary from mild, self-limiting symptoms to devastating, life-threatening disorders.
Brain disorders are among the most serious health problems facing the adults, causing human suffering and enormous economic costs. They are also among the most mysterious of all diseases, and ignorance of the underlying disease mechanisms is a major obstacle to the development of better treatments
The economic costs of brain disorders are correspondingly large. These include not only the cost of treatment, but also the lost productivity of patients and their caregivers, for whom looking after chronically disabled family members can represent an enormous source of emotional, practical, and financial burden
Brain disorders account for one –third of all chronic illnesses. More than one million adults in the U.S. are diagnosed annually with a chronic brain disease. According to Alexandria Main University Hospitals (AMUH) Statistical Medical Annual Records 2016, it was found that 300 patients were scheduled for brain surgery in the year 2016 .Brain surgery is a critical and complicated process. The type of brain surgery done depends highly on the condition being treated.
Brain surgery is done to correct physical abnormalities in the brain. These can be due to birth defect, disease, injurys and other problems. Brain surgery means various surgical procedures that involve repairing structural problems in the brain or any surgery performed inside the skull or cranium to treat problems in the brain and surrounding structures. One of the most critical surgeries performed on the human body is brain surgery
The postoperative period for brain surgery’s patient is the weakest and the most vulnerable phase of a patient’s life, so the neurosurgery nurse has a double responsibility towards patients undergoing brain surgery, especially because their family members may experience difficulty adjusting to a loved one’s diagnosis and are unprepared for the caregiver role. It is the task of the multidisciplinary team not only to recommend appropriate treatment modalities, but also to acknowledge the time when comfort measures are warranted to establish a better quality of life
Aim of the study
The aim of this study was to determine the impact of a nursing educational program on the expected post operative outcomes of patients undergoing brain surgeries.
Setting: The present study was carried out at the Neuro-surgery Inpatient and Out Patient Clinics including oncology clinics related to Alex Main University Hospital
Subjects: Subjects of the study comprised two groups:
A) Patients
A convenience sample of 70 adult male and female patients undergoing brain surgery was included in the study according to the following criteria
1. Adults from 21 < 65 years.
2. Able to communicate verbally, alert and able to follow instructions.
3. Free of associating illnesses, that would affect post surgery prognosis
4. Admitted at least one day prior to surgery
5. Willing to participate
B) Nurses: All nurses providing direct care for patients undergoing brain surgeries throughout the study period of data collection at the above mentioned setting were enrolled in the study. Their number was a total of 24 nurses.
Tools of the study:
Five tools were used for this study, as follows
A) Patients’ tools: These tools i.e 1-2 were used to collect necessary data from patients.
Tool I: Brain Surgery Patients’ Assessment Sheet: This tool was developed a thorough review of related literature, to assess the brain surgery patients’ health status. It consists of five parts as follows:
Part 1: Socio-demographic characteristics of patients: II: Patients’ clinical data
Part III. Neurological assessment.
Part IV. Laboratory investigations
Part V. Brain surgeries patients’ headache assessment.
Tool II: Postoperative Brain Surgery Patients’ Expected Outcomes: This tool contained two parts:
Part I: Assessment of the postoperative brain surgeries patients’ expected outcomes. This part included an It included a group of expected outcomes to be checked by the investigator
Part II: Postoperative brain surgery patients’ satisfaction toward the provided nursing interventions. This part was developed and modified from Chunlaka (2011) to measure patient’s satisfaction toward nursing interventions after implementation of the nursing educational program.
B-Nurses tools
Tool III: Nurses Knowledge Assessment Questionnaire: This tool was developed, after reviewing related literature to assess nurse’s knowledge about the care of patients undergoing brain surgery.
Tool VI: Nurses’ Performance Observation Checklist For Patients Undergoing Brain Surgeries.
This tool was developed after reviewing related literature. It was used to assess the nurses’ performance for patients undergoing brain surgeries.
Tool V: The Nursing Educational Program For Patients Undergoing Brain Surgeries.
Program contents covered the following areas:
- Brief anatomy of the brain structure.
- Definition and indications for brain surgery.
- Various diagnostic procedures and patient preparation.
- Benefits of surgical management and types of brain surgeries.
- Neurological assessment
- Systemic and neurosurgical postoperative complications after brain surgery.
- Informations about how to reduce or prevent postoperative complications
The study was carried out in four phases as follows:
Sample size
Based on Epi info 7program, a convenience sample of seventy adult patients undergoing brain surgery were recruited according to the previously mentioned inclusion criteria and assigned into two sequential equal groups as follows:
group (I): Study subjects who receiving hospital care after implementation of the nursing educational program (n=35).
group (II): Control subjects who receiving routine hospital care (n=35).
Also, all nurses providing direct care for patients undergoing brain. Their number was a total of 24 nurses and assigned into two sequential equal groups as follows:
I-Nurses were providing nursing care for the study subjects (n=12).
II-Nurses were providing nursing care for the control subjects (n=12).
I. Assessment phase:
a) Initial assessment
Patients initial assessment was carried out 24 hrs preoperatively by the investigator using tools I, tool II for both group subjects to collect base line data and nurses initial assessment was carried out to the enrolled nurse participants for their knowledge and performances regarding brain surgery patients’ routine care, using tools III and IV before application of the nursing educational
b-Subsequent assessment
Patients: Subsequent assessment was carried out on disharge, one and three months postoperatively in order to evaluate the impact of the developeds nursing educational program on post operative outcomes.
Nurses: The enrolled nurses were reassessed for knowledge using tool III and watched for their performances and clinical skills regarding brain surgery patients’ care, using tools IV in the first day after discharge from ICU, after application of the nursing educational program and finally on the discharge day , as the third observation
II. Planning phase: The nursing educational program contents was developed based on a review of related literature as well the assessment phase findings. Audiovisual materials (in the form of the program booklet) as well as audiovisual powerpoint were provided for the enrolled nurses
III. Implementation phase: The developed educational program contents were initially introduced individually for every nurse and the teaching sessions for both theory and practice were scheduled and introduced .These nurses were divided,there after into small groups, 4 to 5 nurses, each.
The first session: This seesion involved an introduction objectives of the program, informations about the brain anatomy and surgical procedures as well as medical treatment
The second session: This session comprised routine preoperative care and neurological assessment.
The Third session included: This session was mainly on postoperative care
The fourth session: This session included nursing care of the surgical wound drain as well as pain management techniques.
The fifth session: This session comprised infection control measures
The sixth session: This session included exercises, medication compliance as well as follow up after discharge.
IV. Evaluation phase: This phase was carried out using study tools as follows:
Immediate evaluation: This phase included patients re assessment using tools I and II.
Late evaluation This phase included patients re assessment one and three months post discharge using tools I and II ,also nurses were evaluated for knowledge one and three months post patient discharge using tools III and for performances first day after patient discharge from ICU and on the discharge day using tool IV . Data collection:
Data was collected for a period from February 2017 to January 2018.