الفهرس 
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Abstract
The specialty of orthopedics disorders management in children involves prevention, diagnostics non-operative pharmacological and surgical treatments and rehabilitation such as inflammatory, infectious, metabolic and neoplastic pathologies, as well as the management of musculoskeletal trauma and its post-traumatic consequences. Spine surgery, sports injure orthopedic oncology, foot and ankle deformity surgery. Furthermore it encompasses contributions to the multidisciplinary management of congenital and acquired deformities (Tachdjian, 2015).
Nurses are working in orthopedic wards must have adequate knowledge of basic principles about orthopedic problems and complications prevention to be applied in clinical practice because the nursing care of pediatric patients with orthopedic problems depends on understanding the scientific principles of this issues (Mersal and Fathia, 2014).
The present study was aimed to assess nurses’ knowledge and practices regarding care of pediatric patients with orthopedic problems, design, implement & evaluate effect an intervention educational program on nurses’ knowledge and practices regarding care of pediatric patients with orthopedic problems.
Subject and Method:
Study design
A Quasi -experimental design.
Settings
The study was carried out in orthopedic departments of the following hospitals:
1. Ain-Shams University Hospital.
2. Benha University Hospital.
3. Benha Educational Hospital.
Research subjects
A convenient sample of nurses (N=45 nurse) who cared for pediatric patients with orthopedic problems in the previously mentioned settings regardless of their age, educational qualification, years of experience and attendance of previous training program related to the orthopedic problems there are (15) nurses, Benha University Hospital there are (15) nurses and Benha Educational Hospital (15) nurses.
Tools of data collection
1- A predesigned questionnaire sheet: (pre/ post/ and follow up) It was developed by the researcher after review of the related literature and guidance of the supervisors, it was three parts:
1. Include the following:
A. Characteristic of nurses such as age, level of education, years of experience, and attendance of previous training program related to orthopedic problems among pediatrics patients.
B. Nurses’ knowledge regarding to acquired orthopedic problems such as fracture, joint inflammation, rickets, bone tumor and congenital orthopedic problems such as club foot, hip displays, vertebral Colum malformation and care of children with orthopedic problems, include definition, causes, types, and complications. Also nurses’ knowledge about cast care, traction care, and prevention of infection to paediatric patients with orthopaedic problems.
C. Characteristics of pediatric patients with orthopedic problems, as regards to the age, gender and medical diagnosis.
2- Observational checklist sheets: (pre, post, and follow up)
Developed by the researcher and reviewing from the researcher supervisors to assess the actual nurses’ practices regarding to care of pediatric patients with orthopedic problems. It was consisted of eleven main procedures as consisted of:
Care of cast,
Traction care,
Skin care,
Wound care and assessment with applying infection control measures,
Neurovascular state monitoring,
Fracture assessment,
Skin assessment,
Pain assessment,
Leg exercise,
Breathing exercise.
Content Validity & Reliability: Tools were revised by three expertises in the field of pediatric. Alpha Cronbach test was used to measure the internal consistency of all the tools used in the study.
Statistical design:
The data collected were organized, tabulated and presented using descriptive statistics in the form of frequencies and percentage for qualitative variables. Chi- square test was used for comparing the frequency and percentages of qualitative variables, independent t-test were used for founding the relation between one or two variable. The threshold of significance test was used (P-value) where:
P > 0.05, no statistically significant difference.
P < 0.01, highly statistically significant difference.
Operational design:
Pilot study:
A pilot study was conducted on 10% to of study subjects which constitute (5 nurses) to evaluate the clarity and applicability of the study tools and estimate the time consumed to apply the tool. According to the results obtained from the pilot study, the necessary modifications were done.
Field work
The actual field work was carried out from November 2018 up to November 2019 for data collection. The researcher explained the aim of the study for studied nurses to gain their cooperation, and then written agreement to participate in the study was taken. The researcher was available at morning and afternoon shifts by rotation 3days weekly in the study settings. Each nurse individually assessed using the questionnaire and their practices assessed by using observational checklists during their actual practices, the different teaching strategies used to achieve the aimed of the study. According to the assessment needs of the nurses, the educational program was implemented of sessions by using teaching methods and media used. Evaluation was done immediately the program intervention and after three months of implement the program by using same tools.
Administrative design:
An official written approval letter clarifying the purpose of the study was obtain from the Dean of Faculty of Nursing Ain-Shams University to collect data from the pre-mentioned study setting. Also, written approval was submitted to collect data from pre-mentioned study subjects.
Ethical consideration:
Ethical approval granted from the Scientific Research Ethical Committee of the Faculty of Nursing at Ain Shams University before starting the study. Clarifying the objectives and aim of the study to the studied nurses and obtaining a written informed consent from each. They were assured about confidentiality of data collected that were used for the purpose of the study only. They were informed that they have the rights to withdraw from the study at any time without giving any reason.
The results of the study showed that:
More than one third of the studied nurses (37.8%) age were ranged from 20-< 30 years old with a mean age 30.91±5.87 years.
More than two thirds of the nurses (68.9%) were having diplom (Secondary School) degree in nurses and only 11.1% of them having bachelor degree.
More than one third (37.8%) of studied nurses had years of experience (1- 5) years, while 11.1% of them had nursing experience from ˂1year.
All nurses (100%) did not attend previous program related to pediatric orthopedic problems.
More than half (53.3% and 55.6%) of the studied nurses had un satisfactory knowledge about types and causes of congenital orthopedic problems respectively pre intervention, while (91.1% and 84.4%) of them had satisfactory knowledge in the same items immediately post intervention respectively.
A high statistically significant difference was observed pre/post and follow up intervention regarding nurses’ knowledge about types and causes of acquired orthopedic problems in pediatric, where (P- value 0.001).
More than one third (42.2%) of the studied nurses satisfactory knowledge about fracture pre intervention, while (82.2% and 86.7%) of them had satisfactory knowledge related the items of immediately post program intervention respectively.
The results of the current study clarified that, 55.6%, 48.9%, and 28.9%, of the studied nurses had satisfactory knowledge about definition, manifestation, etiology and complications of hip dysplasia, respectively pre intervention, while the same items improved by, 73.3, %75.6%, 73.3%, and 65.6% immediately post intervention regarding the same items respectively.
There was a high statistically significant difference was observed pre/post intervention regarding nurses’ knowledge about pediatric club foot, where (P- value 0.017). While, there was no statistically significant was observed between post and follow up where (P-value 0.803).
There was a high statistically significant difference was observed pre/post intervention regarding nurses’ knowledge about scoliosis where (X2= 9.360 and P- value 0.002). While there was no statistically significant was observed between post and follow up (X2=0.0 62 and P- value 0.803).
Regarding nurses’ knowledge about flat foot in pediatric pre/post program intervention 35.6% and 37.8% of the studied nurses satisfactory knowledge regarding types and causes pre intervention, while more than two thirds 77.8% and 80.0% immediately post intervention related the items respectively.
The results of the current study clarified that, a high statistically significant difference was observed between their total level of knowledge pre/ post intervention where (X2=9.202 and P 0.002). While there was no statistical was observed between post and follow up (P- value 0.796).
There was a high statistically significant difference was observed pre/ post intervention regarding nurses’ knowledge about bone tumor, where (X2 =13.658 and p<0.001). While there was no statistically significant was observed between post and follow up (P- value 0. 000).
There was a high statistically significant difference was observed pre/post program intervention, regarding total nurses̓ knowledge about the joint inflammatory, where (X2 =17.532 and P-value < 0.001). While there was no statistically significant was observed between post and at follow up (X2 =0.080 and p- value 0.777).
There was a high statistically significant difference was observed pre/post program intervention regarding total nurses̓ knowledge about cast care, where (X2=14.006 and P<0.001). While there was no statistically was observed between post and follow up (P- value 0.764).
There was a high statistically significant difference was observed pre/ post intervention regarding total nurses’ knowledge about traction care where (X2=9.053and p-0.003) While there was no statistically was observed between post and follow up (P- value 0.796).
There was a highly statistically significant difference was observed between pre/ post program intervention regarding total nurses’ knowledge about prevention of infection, where (X2=9.202 and P=0.002). While there was no statistically significant was observed between post and follow up.
The results of the current study clarified that, a high statistically significant difference was observed between pre/ post intervention where (X2=16.878 and p<0.001) While there was no statistically significant was observed between post and follow up (p-value 0.379).
The results of the current study clarified that, a high statistically significant difference was observed between pre/post intervention where (X2=12.256 and p<0.001) While there was no statistical significant was observed between post and follow up (p-0.695).
There was a highly statistical significant difference was observed between pre/ post program intervention regarding total nurses’ practices about neurovascular check where (X2=13.141 and p<0.001) While there was no statistically significant was observed between post and at follow up (X2 =2.357and p-0.502).
The results of the current study clarified that, a high statistically significant difference was observed between pre/ post intervention where (X2=10.161and p<0.001) While no there was statistically significant was observed between post and at follow up (X2 =2.021 and p-0.732).
The results of the current study clarified that, a highly statistically significant difference was observed between pre/ post intervention where (X2=11.905 and p<0.001). While there was no statistically significant was observed between post and at follow up (X2 =5.054 and p-0.537).
There was a high statistically significant difference was observed between their practices related pain assessment pre/ post intervention where (X2=16.800 and p<0.001). While there was no statistically significant was observed between post and at follow up (X2 =0.058 and p-0.809).
There was a highly statistically significant difference was observed between their practices related wound assessment pre/ post intervention, more than one third (35.6%, 44.4%, and 48.9%) of the studied nurses had competent practices regarding assess the appearance of the surrounding tissue, review the medical orders nursing care plain related to wound care pre intervention, while majority (82.2%, 91.1%, and 84.4%) of them had competent knowledge post intervention. While there was no statistical significant was observed between post and at follow up (X2 =3.761 and p-.584).
More than one third (44.4%, 46.7%, and 48.9%) of the studied nurses had competent practices regarding palpate skin to assess temperature, inspect the skin for lesions, and note any problems to in your documentation pre intervention respectively, while almost of them had competent knowledge regarding the items post intervention respectively. While there was no statistical significant was observed between post and follow up (X2 =2.797 and p-0.592).
More than one third (35.6%,, 42.2 %, 44.4%, and 48.9%) of the studied nurses had competent practices regarding check vascular injury, nerve palsy injury, assess configuration of Spiral / oblique / transverse / butterfly / comminuted /Greenstick / torus / plastic deformation, assess subcutaneous tissue swelling and documenting the procedure with time and signature pre intervention, while this items improved by) 95.6%, 84.4%, 80.0%, and 86.7%) post intervention respectively. While there was no statistically significant was observed between post and follow up (X2 =4.503and p-0. 479).
In relation to nurses’ practices related leg exercise pre/post and follow up, was found a high statistically significant difference was observed between their practices where (X2 =49.702and p-<0.001), while there was no statistically significant was observed between post and at follow up (X2 =1.673 and p-0. 796).
Regarding nurses’ practices related birthing exercise pre, post and follow up, was found a high statistically significant difference between their observation checklist where (X2 =65.319 and p<0.001), while there was no statistically significant was observed between post and at follow up found (X2 =2.352 and p- 0. 799).
The results of the present study clarified that, the highest mean of score was found among nurses with their education bachelor degree where, ±SD=3.923, where P =0.012 and years of experience 1-<5 years ±SD =5.735 where P<0.001 post program intervention.
The results of the present study clarified that, the highest mean of score was found among nurses with their education bachelor degree where, ±SD= 4.265, where P =0.035 and years of experience 1-<5 years ±SD =5.070 where (P<0.001) post program intervention.
There was a high statistically significant relation was observed regarding nurses’ level of knowledge and practices about implementing pre, post program intervention and at follow up where, (P- value < 0.001).
Positive correlation and significant between nurses’ level of knowledge and practices in pre, post program intervention and at follow up where (p-value <0