الفهرس 
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Abstract
C
hemotherapy-induced nausea and vomiting (CINV) is one of the most serious side effects and a major concern in children with cancer, occurring in 70% of children under chemotherapy in spite of using best antiemetic drugs, may still cause vomiting. Chemotherapy-induced nausea and vomiting disrupt the daily activities of children undergoing chemotherapy and negatively affect the quality of their lives. It may also cause depression and anxiety in children. Nausea and vomiting can cause electrolyte disturbances and dehydration. In addition, emotional distress due to these side effects can affect treatment protocols, and may even discourage children from continuing the treatment (Farhangi et al., 2022).
Using of non-pharmacological approaches are attractive given the possibility for decreasing the side effects of chemotherapy without interacting with the many other medications. Acupressure technique is one of non-pharmacological approaches that control nausea and vomiting among children with cancer and undergoing chemotherapy as well as it is safe with no side effects, feasible, and children can learn it easily, well tolerated and acupressure can be performed by health care providers, by family members, or by patient’s themselves (Gaber et al., 2018).
The aim of the current study was to evaluate the effect of training program intervention about acupressure technique for pediatric nurses working with children undergoing chemotherapy, the sample is a purposive type composed of forty-five children undergoing chemotherapy and complain from CINV and thirty-six nurses; 27 staff in NCI (12 staff in free side and 15 in insurance side) and 9 staff in Dar ElSalam Hospital (Harmel), both of its affiliated to Cairo university Hospitals.
A quasi-experimental research design was done at National Cancer Institute and Dar Es Salam Hospital (Harmel) affiliated to Cairo University Hospitals.
Tools were designed by the researcher in an Arabic language after reviewing the related literature and after reviewing from the researcher’ supervisors, was consisted of:
Tool one: A structured questionnaire format
This tool was developed by the researcher based on the review of the literature and revised by the supervisors, the required data related to nurses and children were collected as the following:
- Part I:
This part was concerned with the characteristics of nurses which included; age, gender, level of education, years of experience in the pediatric oncology department, and attendance training program about complementary therapy.
Children’s characteristics as child’s age, gender, and medical history of the disease.
Part II (Pre, posttest & follow-up):
It consisted of 45 questions in the form of true and false, multiple choice questions, and essay questions to assess nurses’ knowledge related to:-
o Side effects of chemotherapy, different types of CINV, and management of CINV (Al Qadire & Alkhalaileh, (2019) & Sherani et al., (2019).
o Nurses’ knowledge about acupressure technique as the definition of acupressure, advantages of using acupressure technique, and uses of acupressure (Gaber et al., (2018) & Najjari et al., (2019).
Scoring system:
Nurses’ answers were checked with a model answer and each nurse toke ”2” marks for the correct and complete answer and zero for incorrect knowledge. The total marks of the questionnaire were 90 marks, the nurses’ scores were summed up and converted to a percentage, then nurses’ total level of knowledge was categorized as:
Good knowledge (Score< 60%).
Poor knowledge (Score≥ 60%).
Tool two: Observational Checklist (Pre, posttest & follow-up):
This tool adopted to assess nurses’ practices regarding application of acupressure technique. It contained 7 steps as preparatory phase, using proper finger; press on proper point, proper way of pressure and proper time application of acupressure technique (Gaber et al., 2018).
Scoring system:
The score of each item rated as following: score 1 assigned if the procedure was performed correctly and score 0 if the nurse performed it incorrectly or did not perform it at all. Total score of checklist were 7 grades.
Competent if all procedure performed correctly 100% by nurses.
Tool three: Baxter Animated Retching Faces scale BARF/ 2011 (Pre, post and follow-up intervention of acupressure technique)
The researcher was adapted this tool for assessing the severity of acute nausea at first 12 hours hours and second 12 hours from administrating of chemotherapy, as well as for assessing the severity of delayed nausea from second day till fifth day from administrating of chemotherapy. It included six faces, each face determine the severity of nausea in which a neutral face as the zero no nausea, 1-3 mild nausea, 4-6 moderate nausea and 7-10 severe nausea
Frequency of acute nausea assessed by asking the pediatric patient about times at first 12 hours and second 12 hours from administrating of chemotherapy. Also, assessing the pediatric patient for frequency of delayed nausea from second day till fifth day from administrating of chemotherapy.
Tool four: Vomiting Assessment Sheet: Pre, post and follow-up intervention of acupressure technique
The researcher was adopted from American Academy of Pediatrics (AAP) (2014) tool, this tool used for assessing the severity of acute and delayed vomiting according to AAP classification while the frequency of vomiting episodes, 1-2 episodes/day is considered mild, 3-7 episodes/day is considered moderate and 8 or more episodes/day is considered severe vomiting. Acute vomiting assessed at first 12 hours and second 12 hours from administrating of chemotherapy as well as the severity of delayed vomiting was assessed from second day till fifth day from administrating of chemotherapy.
Frequency of acute vomiting was assessed by asking the pediatric patient about the times at first 12 hours and second 12 hours from administrating of chemotherapy. Also, the pediatric patient was assessed for the frequency of delayed vomiting from second day till fifth day from administrating of chemotherapy.
Field work:
• The researcher planed and implemented training program based on assessment of actual need for the studied sample (nurses), it covered the theoretical knowledge and practical procedures.
• Training program was distributed to each study subject.
• Each nurse was assessed pre and post implementation of training program as well as at follow-up after three months of intervention using the previously mentioned tools.
The results of the study can be summarized as follows:
1. The majority of the studied nurses (88.9%) were graduated from technical institute of nursing.
2. Nearly half of studied nurses (47.2%) were ages between 20 to less than 30 years old with mean ± SD age 29.7± 8.4 years.
3. Almost three quarters of studied nurses (72.2%) were males.
4. Nearly half of studied nurses (47.2%) had 5 to less than 10 years of experience in oncology department with mean ± SD experience 2.13± .93 years.
5. More than one third of studied children (40.0%) ages were between 14 to 18 years old with mean ± SD 11.7± 4.41 years.
6. More than half of studied children (53.3%) were females in primary level of education.
7. More than half (55.6%) of studied children were from rural area.
8. The highest percentage of studied children (48.9%) suffered from Acute Lymphocytic Leukemia.
9. All of studied children (100%) received highly ematogenicity chemotherapy.
10. The vast majority (94.4%) and majority (88.9%) of the studied nurses had a good level of knowledge regarding to application of acupressure technique and CINV after training program intervention and at follow-up respectively, compared to one quarter (25%) of them before training program intervention with a highly statistically significant difference (p<0.01).
11. The vast majority (91.70%) and majority (88.9%) of the studied nurses had a competent level of practice regarding to application of acupressure technique after training program and at follow-up respectively, compared to incompetent (0%) of them before training program intervention with a highly statistically significant difference (p<0.01).
12. There was a highly statistically significant difference regarding severity and frequency of acute nausea among the studied children with a statistically significant difference was found between post training program intervention and follow-up phases (p<0.05).
13. There was a highly statistically significant differences (p<0.01) between pre, post phases of training program intervention and follow-up regarding severity and frequency of delayed nausea among studied children.
14. Highly statistically significant differences was found between pre, post phases of training program intervention and follow-up regarding the severity and frequency of acute vomiting among studied children.
15. A highly statistically significant difference was found between pre and post training program regarding severity and frequency of delayed vomiting among studied children, also between posttest and follow-up.
16. There were a highly statistically significant relations between the studied nurses’ total level of knowledge about CINV and the application of acupressure with their qualifications post phases of training program intervention and follow-up with (p<0.01), also with their years of experience in oncology department of the training program intervention with (p<0.01). As regard their age, a statistically significant relation was found at post phases and follow-up with (p<0.05). In addition their job title, a statistically significant relation was found at follow-up with (p<0.05)
17. There were a highly statistically significant relations between the studied nurses total level of practice and their ages at post and follow-up phases of training program intervention with (p<0.01). Regarding their years of experience in oncology department, a highly statistically significant relation exists at post intervention with (p<0.01) and a statistically significant relation is found at follow-up (p<0.05). Concerning their qualifications, a statistically significant relation was found at post phases and follow-up with (p<0.05). As regard their gender, a statistically significant relation is found at post intervention with (p<0.05).
18. There was a highly statistically significant positive correlation between total level of knowledge of the studied nurses and their total level of practice at post and follow-up of training program with (r=0.501, p<0.000**), (r=0.467, p<0.000**) and (r=0.577, p<0.000**) respectively.