الفهرس 
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Abstract
Sleeping disorders are a group of syndromes characterized by disturbance in the child’s amount of sleep, quality or timing of sleep, or in behaviors or physiological conditions associated with sleep. Sleep disorders are common in childhood; they are serious enough to interfere with normal physical, mental, social and emotional functioning (Johans, 2018), Childhood bronchial asthma is a chronic inflammatory disease of the airways characterized by reversible airflow obstruction, bronchospasm, wheezing, coughing, chest tightness, shortness of breath and trouble sleeping (Wilson and Hockenberry, 2019). Childhood asthma can cause daily symptoms that interfere with child’s play, sports, school attendance and sleep pattern (Bjornsdottir et al., 2018).
The nurse has a key role to help children and their parents, to cope with the sleeping disorders through providing them guidelines as develop consistent and age appropriate sleep and wake schedules including limiting naps for older children, establish consistent routines around bedtime (American Academy bof Sleep Medicine, 2019), Mother play pivotal role in the children adjustment to the illness, especially children who suffer from severe episodic manifestations of asthma have been found to experience increased amounts of stress and anxiety over their illness and have difficulty in maintaining a sense of well-being (Banjari et al., 2018).
Aim of the study:
To assess mothers and their children’s level of knowledge among children suffering from bronchial asthma.
The subject and methods of the current study discussed under the following four (4) designs:
I. Technical Design
II. Operational Design
III. Administrative Design
IV. Statistical Design
I. Technical Design
Technical design included the research design, study setting, subjects and tools of data collection.
Research Design
Descriptive exploratory design was used to conduct this study.
Study Settings
The study was conducted at the Pediatric departments and Out-Patients clinics Department in Pediatric Hospital affiliated to Ain Shams University and Benha University Hospital. As it located in a vital place, covering large area of the country and receiving the largest number of sick children. Ain Shams University included two settings which were the old building: contained the NICU, PICU, surgical PICUand wards.The new bulding contains dialysis, oncology and NICU. Benha University Hospital included one setting which contained the NICU, PICU, dialysis and wards.
Subject
A purposive sample composed of 100 children with bronchial asthma and accompanying mothers regardless their characteristic according to power analysis equation:
While;
P= 0.5
N= Total population
Z= Z value “1.96”
D= Standard Error
n= sample size
Inclusion criteria
Children with bronchial asthma aged from 6- 19 years old and free from other physical or psychological diseases.
Data collection tools
Data for this study collected through using the following tools:-
I. First Tool
Structured Interviewing Questionnaire (AppendixI):
It was designed and developed by the researcher in Arabic language after reviewing the related literature it covered the following parts:
Part (1): concerned with characteristics of the studied subject:
A. Characteristics of the children include, age, gender, level of education, child rank, child present health status,residence and place of management chest in outpatients, duration of outpatient hospital stay.
B. Characteristics of studied mothers include, age, level of education, marital status, residence, occupation.
Part (2): Mothers’ knowledge regarding sleep disorders among their children suffering from bronchial asthma (12 Multiple Choose Questions).
Defintion, factores, types, symptoms, problems, meaning of sleep apnea, causes of sleep apnea, symptoms of sleep apnea during the day, handling sleep apnea, health Instructions, treatment of sleep disorders and care child with sleep disorders.
Part (3): Mothers’ knowledge regarding bronchial asthma (25 Multiple Choose Questions).
Scoring system:
A scoring system was followed to assess mothers’ knowledge regarding sleep disorders among their children suffering from bronchial asthma. The total score for the questionnaire was 74 grades, each question was scored as: A complete correct answer response was scored 2, incomplete correct answer response was scored 1and incorrect/don’t know zero for each area of knowledge. Then the answers were checked with a key answer and accordingly the study sample knowledge was classified into two levels; satisfactory (≥60%), and unsatisfactory (<60%).
II. Second Tool:
Quality of life inventory Scale(Appendix II): It was adapted from Varnia (2003), it was used to determine quality of life inventory Scale for asthmatic children with sleeping problems, and some modifications was done to be adapted to nature of the present study. Quality of life inventory Scale consists of ten items (55 statements).
Scoring system: scores are ranged from (0-4) with zero representing never has a problem, with (1) representing almost never has a problem, with (2) representing sometimes has a problem, with (3) representing often has a problem, with (4) representing almost always has a problem. The total score was 220 marks that were classified into three levels; good (75%), average (50<75%) and poor (<50%).
III. Third Tool:
The children sleeping pattern check list (Appendix III), it was adapted from Owens et al., (2000): it was used to assess sleep disorders among children suffering from bronchial asthma. It includes (32statements).
Scoring system: The total answers of data from children and their mothers regarding statement of sleeping disorders were classified into three levels: rarely, sometimes and usually. The total score was 96 marks were classified into three levels; Severe disorders (≥75%), Moderate disorders (50<75%) and Mild disorders (<50%).
Fieldwork
The actual field work was carried out over 3 months started at the beginning of November (2020) and was completed by the end of January (2021). The researcher was available at study setting by rotation, three days/week (Saturday, Monday and Thursday) during the morning from 9Am to 2 Pm and starting by introducing herself to children and their mothers then informing them about aim of the study. where each child and mother were interviewed individually. The studied tool was filled in by the researcher, it consumed frpm 45-60 minutes.
Ethical Consideration
Verbal approval obtained from the child/mother before inclusion in the study; a clear and simple explanation was given according to their level of understanding, physical and mental readiness. They secured that all the gathered data was confidential and used for research purpose only. The studied subject informed that they are allowed to choose to participate or not in the study and they had the right to withdraw from the study at any time.
VI. Statistical Analysis
Data collected from the studied sample was revised, coded and entered using Personal computer. Computerized data entry and statistical analysis was fulfilled using the statistical package for social sciences (SPSS) version 26. Data was presented using descriptive statistics in the form of frequencies, percentages. Chi-square test (X2) was used to compare between qualitative variables and correlation cofficiency to test correlation between variables. The confidence interval was set to 95% and the margin of error accepted was set to 5%. So, the p-value was considered significant as the following:
• P value ≤0.05 was considered significant.
• P value <0.001 was considered as highly significant.
• P value >0.05 was considered insignificant.
Results
The study revealed that 58 % of the studied children were males and their age ranged between 9 <12 years. Also, 40% of the studied mothers aged between 25<30 years with secondary level of education. As regarding to the studied children family history for bronchial asthma; 58% of them had positive family history. 66% of the studied mothers had unsatisfactory knowledge regarding sleep disorders of children with bronchial asthma, 59% of the studied children were dependent to perform self care activities, 39% of them had average total quality of life and 48% of them had moderate sleep disorders. 90.3% of the studied children had unsatisfactory knowledge suffering from severe sleep disorders, 80.6% of the them were dependent in self care activity suffering from severe sleep disorders and 54.8% of them had poor quality of life suffering from severe sleep disorders.
There was positive correlation between the level of total knowledge of the studied children and their self care activity, while there was a statistically significant difference between self care activity of studied children and their total quality of life, there were statistically significant differences between sleep disorders of the studied children and their age, gender. Meanwhile, there were no statistically significant differences between sleep disorders of the studied children and their and ranking in the family, level of education and quality of life.
Conclusion
Based on results of the current study, it was concluded that, slightly more than one fifths of the studied children had mild sleep disorders, and approximately half of them had moderate sleep disorders, and more than one quarter of them had severe sleep disorder.
In addition, Sleep disturbance among children with asthma reported impact on the physical, psychological and social domains of quality of life. More than half of the studied children were dependent to perform self care activities, one third of them had poor total quality of life.There were statistically significant differences between sleep disorders of the studied children and their gender, age. Meanwhile, there were no statistically significant differences between sleep disorders of the studied children and their ranking in the family and level of education.
Recommendations
The results of this study projected the following- recommendation:
Provide discharge instructional pamphlet or illustrated booklet to mothers of childrens with bronchail asthma at all emergency departments, inpatient departments, outpatient hospital clinics and health centers for children suffering from bronchial asthma and for their mothers about asthma and related sleep disorders.
Periodical follow-up for the level of health teaching for mothers having asthmatic children suffering from sleep disorder.
Further researches are required involving larger study sample of children suffering from bronchial asthma and their mothers about the effect of discharge plan at different study settings, all over Egypt, in order to generalize the results.