الفهرس 
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Abstract
Childhood blood disorders are a heterogeneous group of diseases with wide range of etiology, severity, treatment, and prognoses. This is due in great part to the complex structure and function of blood and to the independent functions of each of its components. The constituents of blood are so vital to homeostasis that severe disorders or deficiencies may be incompatible with life, and even mild dysfunctions have systemic effects. Nursing care of children with blood disorders requires a sound knowledge of normal blood anatomy and physiology as well as an understanding of the nutrition, and, as in all pediatric disorders, growth and development.
Alteration of the respiratory system is the most common cause of illness in the infant and the child. Infants and children under age three years are at increased risk to develop respiratory infections due to their immature immune system, smaller upper and lower airways, and underdeveloped supporting cartilage. Although most respiratory infections are self-limiting, infants and young children can quickly experience respiratory distress as mucus and edema obstruct their small airways. Parents should be taught preventive measures, which include adequate rest, good nutrition, and good hygiene with emphasis on hand washing. Even with the most careful hygiene and preventive measures, most children will experience some type of respiratory infection each year.
When caring for children with blood disorders, the nurse is challenged in the areas of preventive, acute, and chronic care, depending on the disorder and the condition of the child admitted to hospital for diagnosis and stabilization, and returned home for maintenance. The nurse plays a very important role in the care of the child with a chronic respiratory disease. Beyond given acute care to the hospitalized child, the nurse must nurse coordinate and facilitate the child’s long- term care. Because of the advances being made in the treatment of chronic pediatric respiratory conditions, the treatment and care of children affected by these disorders is constantly changing and improving.
The aim of the present study was to assess the quality of care given by nurses in the hematology and emergency units in pediatric department in Assiut University Hospital, and to plan, implement and evaluate an educational and training program given to nurses based on their needs, the results of this study was included in the study results.
A total of 38 pediatric nurses, who serve in the hematology unit as well as in the Emergency unit were recruited in the study. An interview questionnaire sheet was designed to measure the level of knowledge of nurses (pre-test) about hematology and emergency care. It consisted of parts for demographic characteristics, nurses’ knowledge about blood and respiratory diseases, and care given to the child in the hematology and emergency units. The second tool was an observation checklist designed by the researcher to evaluate nurses’ practice as regards the care given to the child in the hematology and emergency units. A pilot study was implemented on eight nurses to test the tools.
The in-service training program was prepared by the researcher based on the knowledge and skills needs previously identified during assessment of nurses’ knowledge and the observation of their practice as well as reviewing relevant literature. Implementation of the program took six weeks in the form of scheduled sessions and teaching during official working hours. There were a total of six sessions, which were repeated ten times, once for each subgroup of 3-4 nurses. The whole educational contents were covered within six days. Evaluation of both knowledge and performance was conducted immediately after ending the educational program (post-test) and three months later (follow-up test).
Data were collected in the period from June till August 2005 for pre-test. Then, the educational and training program was given from September till November 2005. Lastly, the post-test was done from March 2006 till June 2006.
The results, revealed that nurses’ score of knowledge and performance about different subjects related to caring of children with hematological and respiratory disorders were generally low prior to application of the educational program. Statistically significant associations were revealed between nurses’ knowledge and their age (p=0.03), total experience years (p=0.02), and current experience years (p=0.005), with knowledge scores increasing with older age and longer experience years.
Immediately after the application of the program, knowledge scores were observed to improve, with statistically significant differences. Also, nurses’ performance has demonstrated sharp and statistically significant improvements. However, three months later, at the follow-up stage, there were some declines in nurses’ knowledge and performance scores, but the scores remained always higher than the pre-test level.
In conclusion, most studied nurses had unsatisfactory knowledge and inadequate practice in the pre-test before program implementation. Deficiency in nurses’ knowledge and performance were significantly corrected and improved through implementation of the educational program.
It is recommended to implement the developed program. Pediatric nurses should update their knowledge and performance through continued nursing education and training and frequently attending seminars and conferences. Continuing evaluation and education for nurses caring of children with hematology and respiratory disease is needed, as they may lose knowledge and skills in the course of time. Further research is needed to assess the effect and impact of application of such training programs on the quality of service provided, treatment outcome, and patient satisfaction.