الفهرس 
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Abstract
Heart diseases in pediatric patients are life threatening event; that affects the child’s health and family. Heart diseases are acquired or congenital. Congenital heart defects (CHDs) are structural problems with the heart present at birth and result when a problem occurs during heart development soon after conception; usually occurs during the first 8 to 12 weeks of gestation (James et al., 2014).
Aim of study
This study aims to assess nurses‟ performance in care of children with critical cardiac conditions.
Research questions:
1. What is the nurses’ level of knowledge in car e of
pediatric patient with critical cardiac conditions
2. What is the nurses’ practice in care of pediatric patient
with critical cardiac conditions
3. What is the nurses’ attitude in care of pediatric patient
with critical cardiac conditions
Research technical design
1- Research design:
A descriptive design was utilized for conducting this study.
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2- Research Settings:
This study was conducted at the Pediatric Intensive Care Unit (This study was conducted at the Pediatric Intensive Care Unit (PICUs) at:
Cardiothoracic and Vascular Academy affiliated to Ain Shams University Hospitals.
Bahteem Hospital for Specialist Surgeries affiliated to the General Authority for Health Insurance.
Study subjects:
A convenience sample that composed of 59 nurses was included in the study from the previously mentioned settings. 30 nurses from Ain Shams University Hospitals (Cardiothoracic and Vascular Academy) and 29 nurses from Bahteem Hospital for Specialist Surgeries. The study included nurses from both genders, with different age groups, educational levels and years of experience.
3- Tools of data collection:
Three tools were used for data collection:-
Tool I: Nurses’ pre-designed interview questionnaire form: (Appendix III):-
It was designed by the researcher in simple Arabic language to suit the understanding level of the studied nurses after reviewing the recent and relevant literature (Srisomboon, (2010), Aziz & Yonis, (2013), Tibbles et al., (2013), Van et al., (2017). It consisted of the following parts:
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Part I:
This part was concerned with the characteristics of the study subject including:
characteristics of the studied nurses such as age, gender, level of education, years of experience and previous training courses.
characteristics of the studied children, such as age, gender, medical diagnosis and duration of hospitalization.
Part II: This part was concerned with nurses‟ knowledge regarding care of children with critical cardiac conditions and included 83 questions (anatomy & physiology of the heart, types of pediatric congenital heart diseases, causes, clinical Picture and complication of pediatric critical heart diseases, nursing intervention at pediatric intensive care unit, cardiac drugs, concept of pain, arterial line indications & care of mechanical ventilation, oxygen therapy, nebulizer, chest tube indications and its nursing care, central venous catheter indications, signs of cardiopulmonary arrest, aim of CPR and nursing care after CPR).
Tool II: Observational checklists (Appendix IV):
The observational checklists were adopted from Trigg et al., (2010) and Pamela & Maril., (2011), and were used to
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assess nursing practices regarding the care of children with critical cardiac conditions. It consisted of nine observational checklists which related to critical cardiac conditions (namely; respiratory hygiene including performing hand washing (11steps), endotracheal tube insertions (13 steps), endotracheal tube suction (18 steps), naso-pharyngeal suction (18 steps), routine care in PICU including connecting cardiac monitor (11 steps), measuring central venous pressure (12 steps), care of arterial line (22 steps) & post-operative care including wound care (28 steps) & management of underwater seal drainage (11 steps)).
Tool III: Nurses’ attitude rating scale (Appendix V):
It was designed by the researcher after reviewing the related literature Tantawi et al., (2015), Al-Fatlawi, & Ahmed, (2016), Fath-Allah, (2017). It consisted of 24 statements to assess nurses‟ attitude regarding the care of children suffering from critical cardiac conditions. The studied nurses were asked to respond on 3-points Likert scale. The statements were divided into ’’6’’ statements to assess nurses’ attitude regarding pediatric patient with a critical cardiac conditions, ’’7’’ statements to assess nurses’ attitude regarding hospital & work colleagues, ’’6’’ statements to assess nurses’ attitude regarding pediatric patient’ family and ’’5’’ statements were stated to assess nurses’ attitude regarding routine care provided to pediatric patient with a critical cardiac conditions.
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The total studied nurses’ performance was calculated by summation of the total knowledge score, total practice score and total attitude score. These scores were converted into a percent score. The total nurses’ performance score was ’’351’’ grades, the total nurses’ performance was classified into:
Score ≥ 60 % (≥ 211 grade) referred to adequate performance.
Score < 60% (< 211 grade) referred to inadequate performance.
3) Operational Design:
The operational design includes preparatory phase, content validity, pilot study and field work.
A. Preparatory phase:
It included reviewing of related literature using textbooks, journals, scientific periodicals and web-sites was conducted to develop the study tools and to get acquainted with the various aspects of the research problem.
B. Pilot Study:
A Pilot study involved six nurses (10% of the total sample size) to test the clarity, applicability, feasibility & relevance of the tools used and to determine the needed time for data collection by using the study tools. After analyzing results of a pilot study, the necessary modifications were done. Finally the nurses involved in the pilot study were excluded from the study sample later.
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C. Field work: The actual fieldwork was carried out over a period of six months starting from the first of May to the end of October 2019. At the beginning, the researcher introduced herself to the studied nurses and explained the purpose of the study to gain their cooperation and to assure the studied nurse about the anonymity of their answers and that the information will be used for scientific research only and was being strictly confidential. The data collected through interview and observation of the nurses individually to identify background information and evaluate their performance. The collection of data was conducted three days per week. The researcher was available two days/week (Sunday and Monday) at Cardiothoracic and Vascular Academy and one day weekly (Wednesday) at Bahteem hospital for specialist surgeries in throughout morning and afternoon shifts during providing direct care to the pediatric patients. The average time required to complete each questionnaire and attitude sheet was 30 minutes. The studied nurses were observed and evaluated for the actual care provided to the children suffering from critical cardiac conditions by the observation checklists which filled by the researcher.
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Results:
The findings of the current study can be summarized as the following:
More than half (56%) of the studied nurses were in the age group of 25 < 30 years (±SD 29.18±5.22 years). The majority (86.4%) of them were females. Also, nearly three quarters (72.9%) of them were technical nursing institute diploma graduates, it was found that two thirds (66.1%) of them their years of experience were less than 5 years and less than two thirds (61%) of them were married.
Less than two thirds (63%) of the studied nurses had not previous training courses about care of the children with critical cardiac conditions.
More than one third (35.6%) of the studied children were in the age group of 1 to < 5 years (±SD 4. 53±1. 77 years). In relation to their gender, more than half (52.5%) of them were females. Also, diagnosis of 50.8 % of them was post-operative cardiac surgery and more than half (54.2%) their duration of hospitalization ranged between 1 to < 5 days (±SD 3.52±1.63 days).
Only more than a quarter (28.8%) of the studied nurses had a satisfactory level of knowledge regarding the care of pediatric patients with critical cardiac conditions and
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less than three quarters (71.2%) of them had an unsatisfactory level of knowledge.
Only less than two fifths (37.3%) of the studied nurses had satisfactory total practices regarding the care of pediatric patients suffering from critical cardiac conditions and less than two thirds (62.7 %) of them had unsatisfactory total practices.
Only more than sixth (16.9%) of the studied nurses had a positive attitude regarding the care of pediatric patients with critical cardiac conditions, while nearly half (49.2%) of them had an indifferent attitude and about a third (33.9%) had a negative attitude.
More than half (54.2%) of the studied nurses had an adequate total performance regarding the care of pediatric patients with critical cardiac conditions, and 45.8% of them had an inadequate total performance.
There was significant statistical difference between the nurses’ total performance and nurses’ qualifications at p-value of 0.046.
There was positive correlation and highly statistically significance difference between nurses‟ performance and their knowledge, practice & attitude at p-value 0.000, 0.000, 0.000 respectively.