الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 115 |  |  |
| | | from | 115 | | |
Abstract
such as fatigue and poor sleep quality. Progressive muscle relaxation (PMR)
is a technique that aims to provide emotional equilibrium and relaxation of the mind by
concentrating on muscle activity. Pediatric nurse has multi-dimensional roles in a strategic
position to assess dialysis-related fatigue and poor sleep quality and to develop strategies for
managing their effects. Moreover, maximize the benefits of PMR by empowering those
children to comply to it.
The aim of the current study was to investigate the effect of progressive muscle
relaxation on fatigue and sleep quality in children undergoing hemodialysis.
Materials and method
The study was conducted in the hemodialysis unit at Smouha Children’s University
Hospital in Alexandria. A convenient sample of 30 children having end-stage renal disease
(ESRD) undergoing HD who fulfill the following criteria was included: their age ranged
from7-15 years, undergoing HD for at least six months and free from other diseases such as
neurological diseases, cerebrovascular accident or mental illness. The one group pre-testpost-
test was done for the study subjects who received PMR.
Tools of the study: three tools were used to collect the necessary data.
Tool I: Socio-demographic, Physiological Parameters and Medical
History of Children Undergoing Hemodialysis Structured
Interview Schedule
This tool was developed by the researcher after reviewing related literature (Sayed &
Younis, 2016; Murtadho et al., 2019). This tool was used to assess socio-demographic,
physiological parameters and medical data of children undergoing HD.
Tool II: Pediatric Quality of Life Inventory (PedsQL) Multidimensional
Fatigue Scale:
This tool was developed initially by Smets et al. (1995) and translated into Arabic
Version by Haggag and Soliman (1997) and the researcher used the translated version
to assess fatigue for the subject.
The scale comprises 18 items and 3 subscales: General Fatigue, Sleep/Rest Fatigue
and Cognitive Fatigue.
Tool III: Pittsburgh Sleep Quality Index (PSQI) Scale:
This tool was developed initially by Buysse et al. (1989) and translated into Arabic
Version by Suleiman et al. (2010) and the researcher used the translated version to
assess sleep quality for the subject.
It includes nineteen individual items generate seven “component” scores: subjective sleep
quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of
sleeping medication and daytime dysfunction.
The ethics committee of the nursing faculty approved the study. Approval for the study
was received from the hospital’s responsible authority after an explanation of the study’s
purpose and reception of an official letter from the Faculty of Nursing.
Method
1. At initial contact, the participating children’s demographic data, physiological parameters
and medical history were assessed using tool I.
2. The child’s fatigue was assessed by the PedsQL Multidimensional Fatigue Scale using
tool II before the application of PMR.
3. The child’s sleep quality was assessed by the PSQI Scale using tool III before the
application of PMR.
4. Progressive muscle relaxation was performed every day for 10 minutes for three
weeks. The researcher interviewed each child and his/ her parent and demonstrated
PMR while the child and his/ her parent were watching. Then the child was asked to
redemonstrate it.
5. Evaluation of the effectiveness of PMR by tool I part 2, Tool II and Tool III after three
weeks of application of PMR.
The main results of the present study were as following:
Regarding the age, 46.7% of the participating children aged from 10 to 13 years. Nearly
three-quarters (73.3 %) of the participating children were females. Two-thirds (66.7 %) were
enrolled in primary school. Two-thirds of the participating children were from rural areas
(66.7 %).
Regarding physiological parameters, the difference in the pulse before and after
application of PMR was statistically significant (p= 0.006*). Regarding the participating
children’s blood pressure, the difference between before and after application of PMR was
statistically insignificant either (systolic or diastolic, p= 0.100 and 0.755 respectively).
It was noted that, the effect of PMR on overall PedsQL Multidimensional Fatigue Scale
among of the participating children, it was found that the difference between before and after
application of PMR was statistically significant (p= <0.001*). After application of PMR, the
participating children felt less fatigue and these results reflect a high effect of PMR on fatigue
among the participating children.
In relation to the effect of PMR on the overall PSQI Scale among the participating
children, it was found the difference between before and after application of PMR was
statistically significant (p= <0.001*). After PMR, the participant children’s sleep quality was
improved and these results reflected a moderate effect of PMR on improvement of sleep
quality among them. The relationship between participating children’s score averages obtained from overall PedsQL Multidimensional Fatigue Scale and overall PSQI Scale
before and after application of PMR. The results revealed positive, statistically significant
relationship between fatigue and sleep quality before and after application of PMR (p= 0.009*
and <0.022* respectively).
It can conclude that PMR has significantly improved the overall mean and percent score of
the PedsQL Multidimensional Fatigue Scale and subscales. Progressive muscle relaxation has
also significantly improved the overall mean and percent score of the PSQI Scale and
subscales.
Recommendation
Pediatric nurses in Hemodialysis Unit should integrate PMR to nursing practice for
better children’s outcomes.
Encourage children to regularly use PMR and provision of regular training to integrate
PMR into patient’s daily lives is beneficial.
A multi-center research proposal should be conducted on larger study samples in this
area.