الفهرس 
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Abstract
SUMMARY
Life expectancy has increased tremendously owing partly to improved health care services, nutrition and awareness of health lifestyles and disease prevention. This has led to rise in the number of older persons worldwide. Ageing process can be a major risk factor for diseases commonly seen among older adults such as FTDs. The characteristic changes in the thyroid gland due to aging contribute to its gradual decline and decrease in optimal functioning. Thus, leading to overt or covert production of its hormones. Thyroid hormones have diverse functions in the body including neuromodulation and metabolism. Therefore, any changes in the hormonal steady state can influence these functions. Older persons are more vulnerable due to the ageing process and thus this population group has a higher prevalence of FTDs. In addition, FTDs manifestations in the elderly are subtle. Hence, nurses should have appropriate competency in order to deliver quality care for geriatric patients with functional thyroid disorders.
The aim of this study was to:
Examine the effect of a training program on nurses’ competency in caring for geriatric patients with functional thyroid disorders.
Study hypothesis:
Nurses caring for geriatric patients with functional thyroid disorders who receive the proposed training program exhibit higher level of competency than those who do not.
Material and method
A. Material
Study design:
The study followed a quasi-experimental research design (one study group and one control group).
Setting:
This study was conducted in the outpatient clinics at the one-day services Centre which is an extension of the Main Alexandria University Hospital (El Amiri Hospital) affiliated to the Faculty of Medicine in Alexandria, Egypt.
Study subjects:
This study included a convenience sample of sixty (60) technical nurses and nurse specialists who had more than one year experience of working at the Alexandria University Main Teaching Hospital (El Amiri) Outpatient Department Centre. The study subjects were divided into two groups; study and control group each comprising of thirty (30) subjects.
Tools
Two main tools were used in this study:
i. Nurses’ social demographic and work-related characteristics questionnaire:
This tool was used to assess the social and demographic characteristics of the nurses. It includes questions such as; age, years of work experience, level of education, previous in-service training in geriatric care, previous in-service training in thyroid disorders, the experience they have in caring for older adults with thyroid disorders.
ii. Nurses’ competency in caring for Geriatric patient with functional thyroid disorders questionnaire:
This tool was developed by the researcher based on related literature to evaluate nurses’ competency in caring for geriatric patientwith functional thyroid disorders. This tool has three parts (tools):
1. Part 1: Hypothyroidism and hyperthyroidism nurses’ knowledge:
This part includes multiple choice questions about definition, causes, risk factors, clinical presentation, diagnosis, complications, management for each functional thyroid disorders.
2. Part 2: Nurses’ attitude toward geriatric patients with hypothyroidism and hyperthyroidism:
This part includes a total of thirteen (13) items to assess nurses’ General Attitude towards older adults five 5 items, and nurses’ attitude toward geriatric patients with functional thyroid disorders eight 8 items).
3. Part 3: Hypothyroidism and hyperthyroidism nurses’ practices:
This part includes a total of twenty-one (21) items (17 Likert scale type questions and four (4) string questions) about the different nurses’ practices related to the care of geriatric patients with FTDs such as using of the geriatric depression scale short form, Mini Mental State Examination, Medication Adherence Rating Scale, fatigue scale, skin and foot care, deep breathing exercises, precautionary measures against COVID-19 including wearing, removing gloves and masks correctly, and safe environment.
Method
The study was carried out in three phases:
I- Preparation phase:
Following necessary approval for the study, tools one and two were submitted to the jury of three experts. Their feedback led to further modification and development of the final tool. After obtaining the permission for study at the outpatient clinic in the Main Alexandria University teaching hospital, a pilot study was carried out and reliability of the tool II was tested using Cronbach’s Alpha then the final tool was produced. The proposed training program intervention was prepared by the researcher accordingly.
II- Implementation phase:
Preparation of the study setting was done by the researcher in order to ensure a quiet, non-disturbing with adequate lighting, well arranged and comfortable place to deliver the proposed sessions to the study subjects. However, due to the nature and activities in the outpatient clinic the sessions were carried out in different rooms as space became available. These included clinic rooms where the nurses work from and nurse supervisors’ office as well as staffroom. Majority of the sessions took place in the clinic room after attending to patients.
The nurses who fulfilled the inclusion criteria were included after explanation of the aim of the study and obtaining informed consent. Pre-test was done using tool I and II for all the study subjects. The researcher conducted the sessions based on those present and available to attend because the hospital schedule was flexible which means those present today most of them are unlikely to be on duty tomorrow and so the researcher had to adopt the flexible training schedule (FTS). This (FTS) also applied to the place/room for the training. Due to the nature of the outpatient clinic, it was not visible to move the staff from their work environment to another site.
The training program was delivered in three (3) sessions as follows:
The training program was carried out two to three times per week for five weeks during official working days, each session lasted for a maximum 45 minutes.
• The first session
During this session, the researcher gave an overview about the thyroid gland, its function, normal age-related changes, some related terms, pharmacological and non-pharmacological management of functional thyroid disorders including the nursing role at the outpatient clinics and patient education regarding prevention of complication, nutrition, adherence with medication and effective way of taking thyroid medications, coping with signs and symptoms associated with FTDs such as constipation and depressed mood.
• The second session
This session included training about the use of valid tools to screen for the different manifestations that accompany the FTDs among geriatric patients namely training the nurses about screening for depression among geriatric patients using different tools such as patient health questionnaire-2 and geriatric depression scale short form, the use of Mini-Cog., Mini Mental State Examination to screen for cognitive impairment among geriatric patients, and training on the use of the Fatigue Scale. As well as, the use of Medication Adherence Rating Scale to screen Medication non adherence among geriatric patients. Arabic version of all these tools (4) was provided to the participants who were encouraged to use them among their geriatric patients and report their experience in using these tools.
• The third session
This session included teaching nurses about skin and foot care, deep breathing exercises, and maintaining a safe environment for geriatric patients, precautionary measures against COVID-19 including wearing and removing gloves and masks correctly as geriatric patients especially those with functional thyroid disorders are more liable to be infected with COVID-19 and other communicable diseases.
III- Evaluation phase:
The assessment of the nurses’ competency for both groups; study group and control group were done immediately (pre-test) before the training interventions for the study group using tool I and II. The post test was done for both groups using tool II after the implementation of the training interventions for the study group. Follow-up after intervention for the study group was done after 4 weeks post intervention. However, due to public holidays and clinic scheduled activities such as (inspection), follow-up post-test was extended by three weeks.
The main results obtained from this study are as follows:
• The mean age of the study subjects was 47.5±9.4166. the study subjects in the study group had a mean age was 49.9±6.87 while those in control group had a mean age of 45.5±10.91
• Majority of the study subjects in both groups were married (93.3 and 80%) for study and control group respectively.
• Regarding the study subjects’ level of education, majority (93.3%) had technical level training and only one specialist nurse (1.7%) in each group.
• Majority (≥73.4%) had between 16-35 years of work experience whereas a minimal number of respondents indicated less than 6 years of work experience (16.6%) in both study and control group.
• Of the nurse in the study group, 23.3% indicated that they had attended previous in-service geriatric training compared to 33.3% of the control group. Of those who attended, 57.1% and 60% had the training within <6 months ago in the study and control group respectively.
• Concerning care for older adults, more than two third of the study subjects in both study and control group (≥86.6%) had not cared for older adults while (≤13.3%) said that they had cared for older adults.
• Majority of the nurses in the control group indicated that they had no preference for group of care whereas majority of the study group indicated that they prefer to care for older adults.
• There was a significant increase in mean score for knowledge (P<0.001), attitude towards geriatric patients with FTDs (P<0.001) and practice (P<0.001) for nurses in the study group.
• There was a statistically significant increase in practice after follow up (study group) (P<0.001) with a mean difference of 18.47±17.37.
• The results show a positive correlation between knowledge and practice (P<0.006).
• There was a statistically significant increase in total mean scores of nurses’ competency levels regarding FTDs in the study group compared to the control group, immediately post-implementation of the proposed training intervention from novice to competent (94±19.348, 62±19.66294).
• The effect of the training program intervention for knowledge and practice was very large with Cohen’s d at 1.393 and 1.493 respectively while attitude towards geriatric patients with functional thyroid disorders was large Cohen’s d at 1.000.
Conclusion
Based on the results of the present study, it can be concluded that the proposed and implemented training program may improve FTDs competency among nurses caring for geriatric patients with FTDs.
Recommendations
• The outpatient clinic nurse managers plan for a regular and flexible in-service training program on geriatric FTDs competency should be developed and implemented for all outpatient clinic nurses who give care for geriatric patients.
• Outpatient clinic nurse managers plan and conduct regular geriatric FTDs competency training program utilizing the booklet ‘Nursing Interventions for Geriatric Patients with FTDs’ and brochures as well as use of goal tracking and action plan. Also provide the booklet to all nurses at the outpatient clinic.
• Nurse managers provide varied geriatric assessment tools to be used by nurses when caring for geriatric patients with FTDs.
• Self-evaluation and use of action plan and goal tracking by individual staff nurse should be done consistently to enhance geriatric FTDs competency.
Recommendation for future research
Replication of the study in other similar settings as well as for nurses caring for geriatric patients in the in-patient and long-term care facilities to assess the effect of the training intervention for wider generalization of the findings.