الفهرس 
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Abstract
Decubitus ulcers are a common and highly pertinent professional care issues in hospitals and associated with psychological and physical suffering, increased morbidity and mortality rate and higher costs for health care worldwide (Mcinnes et al., 2015).
While the problem of decubitus ulcers received a great deal of attention, far less is known about decubitus ulcers in children and neonates. Recent studies have indicated that decubitus ulcers are common in the pediatric population, there is greater awareness that pediatric patients in certain health care settings are also at high risk of developing decubitus ulcer. Children were most frequently repositioned in the neonatal units because infants are not able to reposition themselves so rolling over is a developmental task achieved during the first year of life (Yang, et al., 2017).
Aim of the study
This study aims to assess nurse’s performance in caring of children at risk and having decubitus ulcer.
1- Technical Design:
The technical design includes research design, setting, subjects and tools of the data collection.
Research design:
A descriptive study used to conduct this study.
Research Setting:
This study was conducted at Pediatric ICU, Orthopedic department and Burn unit of children hospital and El Demerdash hospital affiliated to Ain Shams University and at Pediatric ICU of children hospital Mansoura University and Orthopedic department and Burn unit of Mansoura University hospital.
Subjects:
A convenient sample consisted of 97 nurses who deal with children at risk or having decubitus ulcer at the previously mentioned settings and 16 child at risk and 81 child with decubitus ulcer under the following inclusion criteria pediatrics aged from one month up to 19 years old, had serious diseases and long term make them at risk for developing decubitus ulcers and pediatrics with acute and chronic illness and exclusion criteria terminal ill children from previous sittings.
Tools for data collection:
Data were collected through using the following tools:
1- Pre-designed questionnaire sheet:
This tool was designed by the researcher after reviewing the relevant literature. It was written in a simple Arabic language to assess nurse’s knowledge about children at risk or having decubitus ulcers and include the following:
Part I Concerned with the characterisitics of the study subjects:
a- Personal characteristics of the studied nurse age, gender, marital status, place of work, qualifications, years of experience, residence, previous exposure to training program, seminar or work shop about decubitus ulcer.
b- Characteristics of the studied children age, gender, ranking, hospital unit name, educational level, residence, diagnosis, history of the diseases, duration of hospital stay/day and stage number.
Part II:
It concerned with nurses’ knowledge regarding decubitus ulcer as defination, risk factors, causes, stages, signs and symptoms, complication, diagnosis, preventive measures, medical and surgical management, follow up, nursing interventions and wound care.
Scoring system: Each knowledge item with a correct response will scored 1 and the incorrect will scored zero, the scores of the items were summed-up and the total divided by the number of the items, giving amean score for the part. These scores were converted into percent scores. Knowledge was considered satisfactory if the percent score was 75% or more and unsatisfactory if less than 75%.
II Attitude scale: It was adopted from Dilie et al. (2015), to assess nurses’ attitude towards caring of children at high risk and having decubitus ulcer.
It was used to measure nurses’ feelings, beliefs and behaviors concerning their interactions with children at risk and having decubitus ulcer. It is modified by the researcher to simplify steps of the procedure, it is consist of 25 statement, scored by 1 = strongly disagree, 2 = disagree, 3 = Undecided, 4 = agree, 5 = strongly agree). Sum scores were calculated to obtain the total attitude score. Total nurse’s attitude was divided into positive 60% and more and negative less than 60%.
III Observation check list: It was adopted from Awal et al. (2014) and modified by the researcher to assess nurses’ practices regarding care of children at risk or having decubitus ulcer as the following:
- Checklist to assess children at risk for developing decubitus ulcer.
- Checklist for prevention and caring of decubitus ulcer.
Regarding the scoring system for practicing of the studied nurses, a check list was assigned to score according to its number of sub item. The total nurses responses are categorized into done competent ≥85% done incompetent or not done <85%.
IV Pain rating scale: The Wong-Baker faces pain scale combines pictures and numbers for pain ratings. It can be used in children over the age of 3 and in adults. Numerical rating scale is designed to be used by those over age 9 by usinge numbers to rate pain. It was adapted from Twomy (2015), to assess nurses during pain assessment, pain scale measures a patient’s pain intensity. Pain scales are based on self-report, observational (behavioral) or physiological data. Pain measurements help determine the severity, type, and duration of the pain, and are used to make an accurate diagnosis, determine a treatment plan.
Scoring system: Regarding the scoring system for practicing of the studied nurses, a check list was assigned to score according to its number of sub item. The answer was represented as it is reported in the answer sheet done competent score (2), done incompetent score (1) and (zero) score if not done.
II- Operational Design:
The operational design includes preparatory phase, content validity & reliability and Pilot study.
Preparatory phase:
It includes review of related literature and theoretical knowledge of aspects of the study using books, articles, internet and magazines was done to develop the study tools and the various aspects of the research problem.
Content validity: It was being done by jory committee include three expertises from nursing and surgical departments. Their opinions were elicited regarding the format, layout, consistency, accuracy and relevancy of the tools.
Content reliability: It was done by used Cronbach’s alpha test.
Items Cronbach’s alpha test
Nurses knowledge .752
Nurses practice .960
Nurses attitude .710
Pilot Study
The pilot study was conducted on 10% of the study sample to test the validity, feasibility and applicability of the study tools will be used and to estimate time to filling it. According to the results, the modification was done and they excluded from the study latter on.
Field work:
The researcher was explaining the aim and the nature of the study for subjects. The study was implemented during period of (6) months, two days per week by rotation (Sunday and Wednesday) during the morning shift. The questionnaire was filled in by the researcher through interview of nurses individually, children and care givers in leisure time and consumed 15 minute and observation checklist was filled in by researcher during the nurses actually caring their children at risk and having decubitus ulcer, and each checklist will be consumed 5 minutes and each step was evaluated according to its important in the care.
Results:
Findings of the current study can be summarized as the following:
Less than half (41.2%) of them were in the age group 25<30 with a mean age 31.8±2.3 years and More two thirds (69.1%) of the studied nurses were females and most 84.5% of them not attend training courses about decubitus ulcer.
More than one third (35.1%) of the studied children aged 9-<12 years with mean age 11.3±8.03 years and more than half )54.6%( of them were female and around half 50.6% of the studied children had primary education and more than three fifth )61.9%( were from urban area, respectively.
Less than two fifth (38.1%) of the studied children suffered from fractures and less than half (46.4%) of them were hospitalized more than 14 days.
Less than two fifth (39.2%) of children had grade I decubitus ulcer. Additionally more than half (56.7%) changed their position every shift repectively.
More than half (54.6%) of them had incorrect knowledge about the main causes of decubitus ulcers. While Less than three quarters (72.2%) of the studied nurses had correct knowledge about the sites of decubitus ulcers.
More than two thirds (71.1%) of the studied nurses had unsatisfactory level of total knowledge regarding to decubitus ulcer.
The majority (82.4%) of the studied nurses strongly agree about the incidence of decubitus ulcer should be 0% in the ward and slightly less than two thirds 61.9% children who is at risk for decubitus ulcer development should be assessed at the admission, respectively
About two thirds (66%) of the studied nurses had positive attitude regarding to assess occurance of decubitus ulcer.
Most (86.6%) of the studied nurses were competent practice regarding to Advice caregiver regarding decubitus ulcer preventive.
All the studied nurses were competent practice regarding to wear clean gloves. Mean while less than three fifth 56.7% of them didn’t measure length of wound, record in centimeters respectively.
Great majority )96.9%( of the studied nurses were competent practice regarding to ensure child is in a comfortable position.
Great majority (92.8%) of the studied nurses were rest the elbows, forearms and wrists on arm supports.
All the studied nurses were move child legs, hips, and trunk to side of bed.
Great majority (97.9%) of the studied nurses were wash child body using a wet washcloth with small amount of soap.
Majority (90.7%) of the studied nurses were expose fingers or toes whenever extremity is used for intravenous medication.
More than half (53.6%) of the studied nurses maked a fitted cushion, while (55.7%) of them didn’t clean the rubber mattress and leave it to dry.
The majority (80.9%) of the studied nurses were place the egg crate pad on top of the mattress with the bumps facing toward the ceiling.
More than one third (37.1%) of the studied nurses had competent level of total practice regarding care of children at risk and having decubitus ulcer. While near to two thirds of them (62.9 (% had incompetent level of practice.
More than two fifth (41.2%) of the studied nurses’ competent regarding pain assessment and less than three fifth 58.8% of them incompetent.
There were statistically significant differences between total knowledge of the studied nurses, age, gender and their years of experience, education level and attendance of training courses, while there was no statistically significant difference between total knowledge of the studied nurses and residence.
There were statistically significant differences between total attitude of the studied nurses, gender, their years of experience and education level, while there was no statistically significant difference between total attitude of the studied nurses and age and residence.
There were statistically significant differences between total practice of the studied nurses and their age, years of experience, education level and attendance of training courses, while there was no statistically significant difference between total practice of the studied nurses and residence.
There was positive correlation between studied nurses’ total knowledge and their total practices regarding to care of children at risk and having decubitus ulcer. Mean while there was negative correlation between nurses’ total knowledge and their total attitude regarding to care of children at risk and having decubitus ulcer.
There was negative correlation between studied nurses’ total practice and their total attitude regarding to care of children at risk and having decubitus ulcer.