الفهرس 
THE RESPIRATORY SYSTEM - DEVELOPMENT
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Abstract
Bronchial asthma is the most frequent chronic disease in
children. Epidemiological data suggest that in some
countries the frequency and severity of its course, especially
in children, has been increasing. Asthma, like any other
chronic disease contributes to the deterioration of quality of
life and may impair child’s development.
Bronchial asthma is related to a high morbidity rate,
leading to an increased frequency of emergency room visits,
hospital admissions, and poor scholastic performance in
addition to the physical, psychological, and social impact.
BA mortality and morbidity are still unacceptably high due to
lack of knowledge, perception, and skills of mothers who
provide care for their children. Management of asthma
requires open communication and cooperation between child,
family and all health team who provide care for this child, so,
the child can lead a relatively normal life.
The present study was aiming to assess effect of
discharge plan on school aged children having bronchial
asthma. This aim was achieved through assessing the
common physical and psychological and social problems
perceived by the children having asthma, Constructing and
implementing a discharge plan for children having asthma and evaluating the effect of discharge plan on children
having asthma.
The subjects and methods of the current study are discussed
under the following designs:
V- Technical design
VI- Operational design
VII- Administrative design
VIII- Statistical design
I-Technical design:
Technical design includes; the research design, setting,
subjects and tools for data collection.
Research Design:
A quasi-experimental study design was utilized in
carrying out this study.
Settings:
The study was conducted at Emergency Department
and Outpatient Clinic in Children Hospital affiliated to Ain
Shams University Hospitals.
Subjects:
A purposive sample was compromised of (86) school
aged children were attending with their mothers to the previously mentioned settings. Under the following inclusion
criteria:
Age from 6-12years.
Both genders.
Confirmed diagnosis of being bronchial asthma.
Exclusive Criteria:
Children with cystic fibrosis and other chest
diseases.
Tools of data collection
Data were collected through the following tools.
1- An Interviewing Questionnaire: (Appendix I)
It was designed by the researcher after reviewing
related literatures and it was translated into Arabic Language.
It was comprised from three parts:
Part one:
It was concerned with children and their mothers’
demographic characteristics such as age, sex, education,
residence, mother characteristics.
Part two:
It was concerned with children health history such as
duration of asthma, previous hospitalization and family
history related to bronchial asthma.Part three:
It was concerned with children and their mothers’
knowledge regarding to definition of bronchial asthma, signs
symptoms, causes, trigger factors, complications, and
management.
Scoring System:
The questions about children and their mothers’
knowledge were given scored two marks for the correct
answer, one mark for the incomplete answer and Zero for the
incorrect answer.
According to children and their mothers’ answer, their
knowledge was categorized into unsatisfactory knowledge <
75% and satisfactory knowledge ≥ 75%.
2- Quality of life (QOL) Scale: (Appendix II)
It was adopted from Varni et al., (2008) and modified
and by researcher to assess children QOL.
Scoring System:
This part deal with assessment of the children QOL, it
consisted of five aspects of QOL. The statement of each
aspect checked as ―always‖, almost, ―sometimes‖, rarer or
―never‖. An always go zero score, almost go one score,
sometimes go two score, rarer go three score and never go four score. The total score for this part was twenty four
marks vided as the following;
- Physical aspect: five statements 20 marks.
- Psychological aspect: six statements 24 marks.
- Emotional aspect: seven statements 28 marks.
- Social aspect: four statements 16 marks.
- School aspect: six statements 24 marks.
- According to the children answer, their quality of life
(QOL) was categorized into good quality of life < 75% and
≥ 75% a poor quality of life.
3- An Observation Checklist (Appendix III)
It was adopted from El- Hawashy et al., (1997) and it
was used to assess self-care practices. It included hygiene
care, safety measure, regular outpatient clinic follow up and
training for treatment regimen. Children practices classified
into dependent <75% and independent ≥ 75%.
4- Discharge Planning: (Appendix x)
The discharge planning constructed by the researcher
according to needs assessment of the children having
bronchial asthma. It was designed as a booklet in simple
Arabic Language to suit the children and their mothers and
guided by illustrated pictures and figures. It was included
knowledge about management plan which should befollowed regularly and the practices for drugs dosage
calculation and usage of nebulizer.
Content of booklet (Discharge Planning)
The booklet included some information about;
Theoretical background for asthma, (definition, types
of asthma, causes, healthy and unhealthy characters
for asthma).
Care of asthma (self care, safety measures, medication
administration & nebulizer).
Questions commonly asked by the children with
asthma (Doctors visited, Medication, Sports\
Exercises).
Trigger factors producing asthma.
Complication of asthma.
V. Operational Design:
Preparatory phase
A review of the past and current related literature
covering various aspects of the discharge for children having
bronchial asthma, using books, articles, periodicals, and
magazines to get acquainted with the research problem to
develop the study tools. Content Validity and Reliability
Testing validity of the proposed tools by inspecting
the items to determine whether the tools measure what
supposed to measure. The stage developed by a jury of 7
experts from different academic categories (professors and
assistant professors) of the medical –surgical nursing at the
faculty of nursing, Ain Shams University. The expertise
reviewed the tools for clarity, relevance, comprehensiveness,
simplicity and minor modification was done.
Testing reliability of the proposed tools was done
statistically by Cronbach alpha test.
Pilot study
The pilot study was carried out on 10% of total subject
size of children and their mothers to test the applicability and
to evaluate the content validity of the study tools. Results of
the pilot study helped to make modifications on the tools;
some items of questionnaire were modified and unnecessary
were omitted. It takes about one month from the end of
November 2013. The children and their mothers in the pilot
study were excluded from the study sample.
Ethical Considerations:
The ethical research considerations in this study
included the following: The research approval obtains before discharge plan
implementation.
The researcher clears the objective and aim of the study
to subjects.
The researcher maintain on anonymity and confidentiality
of subjects.
Subjects are allowed to choose to participate or not
participate, and they have right to withdraw from a
study any time without penalty.
Field work:
The actual field work for data collection for has
consumed 6 months started on January 2014 up to the end of
June 2014 for collection data and two weeks later for follow
up started after implementation of each session of the
program through: 4 sessions with one session for formative
assessment to show the children condition and one session
for filling the questionnaire before discharge and applied
individual or groups for children.
Children under study were selected on discharge and
given booklet about discharge planning only ongoing
discharge phase.The researcher collected the data during the morning
shifts in Emergency Department in El-Demerdach
Hospital, at two days each week.
The children assessment sheet was filled by the
researcher based on child condition on through personal
interview, within 30-40 minutes; the purpose of the study
was explained to them.
Child’s questionnaire sheet filled by children and their
mothers as pre/post. To identify children and their
mother’s knowledge about discharge planning after
received booklet, without refer to textbooks or another
resources, within 40- 50 minutes. For illiterate child, data
were filled by the researcher through interview.
The booklet of discharge planning was given to children
and their mothers. The researcher explained the purpose
of the study for every child, clarified each item in the
booklet, and any item needing practice was explained and
demonstrated; observation of media about (self care and
administration of medication) in the booklet and real
media (supplies of a nebulizer) in hospital, together
answered any questions related to disease or it is
complication for children and their mothers to reduce fear
and anxiety, within the schedule of program.The observation checklists for self & administration of
medication were filled by the researcher on ongoing
discharge phase within 20 -30 minute.
The QOL Scale for children having asthma was filled by
children before received program and booklet, within 30-
40 minutes. For illiterate children it was filled by the
researcher.
During follow up, the children had filled QOL Scale
again in outpatient clinic and the observation checklists
for self & administration of medication were filled by the
researcher.
VI. Administrative design:
To carry out the study, the necessary approval was
obtained from the Hospital Director and Nursing Director in
El- El-Demerdach Hospital, explaining the aim of study to
obtain the permission for data collection. A letter was issued
to them from the Faculty of Nursing affiliated to Ain Shams
University Hospitals.
VII. Statistical design:
Statistical analysis was done using the Statistical
Package for Social Sciences (SPSS), version 20. Data were
presented using descriptive statistics in the form of
frequencies and percentages for qualitative variables, means and standard deviation for quantitative variables, qualitative
variables were compared using chi-square test and
quantitative variables, qualitative variables were compared
using paired T test.
Significance of results:
Non significant (NS) if P> 0.05
Significant (S) if P< 0.05
High significant (HS) if P<0.01