الفهرس 
Introduction and Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
Nasolacrimal duct obstruction is a common condition among infants. The main cause of the occlusion is an imperforate membrane at the distal end of the nasolacrimal duct (Valve of Hasner). It was found in up to 30% of infants at birth, but nearly 6% has symptoms of nasolacrimal duct obstruction, unilateral or bilateral affection. Symptomatic congenital nasolacrimal duct obstruction is characterized by epiphora and/or mucopurulent discharge in the first few weeks after birth. The blockage of the lacrimal system causes excessive tearing. The eye lids can become red and swollen with yellowish green discharge that result in conjunctivitis or reach to dacryocystitis. The following conservative treatment may be recommended in persistent obstruction of the lacrimal duct in the form of tear duct massage with topical antibiotic eye drops. The conservative treatment is the best option until the first year of age and many infants with lacrimal duct obstruction respond to conservative treatment. Surgical procedure is usually accompanied with risk hazards especially during the first year of life. Tear duct massage is simple technique for mothers and can be performed at home to help the tear duct open. A primary care nurses can demonstrate it to help infants gain its benefits. The present study was aimed to evaluate the effect of educational training program on mothers’ knowledge and practice and clinical outcomes for infants with congenital nasolacrimal duct obstruction. Aquasi-experimental research design was used in the present study. The study was conducted atOut-patient clinic at Ophthalmology Department of Main Tanta University Hospital and Out-patient clinic of Ophthalmology Hospital of Tanta City which Affiliated to Ministry of Health. Convenience samples of 80 mothers and their infants that diagnosed with congenital nasolacrimal duct obstruction. Tools of data collection: Three tools were used to collect the necessary data. Tool (I): Structured questionnaire schedule. It was developed by the researcher after reviewing the related literature: Mothers’ knowledge and socio -demographic characteristics. Part (1): Socio -demographic data of mothers as: age, level of education, occupation, period of pregnancy and residence. Part (2): Infants characteristic such as: age, birth order, sex, weight of infant, laterality of the obstruction, Age of the infant at the appearance of symptoms and symptoms appear on the infant. Part (3): Mothers’ knowledge: it was developed by the researcher to assess mothers’ knowledge related to their infants with congenital nasolacrimal duct obstruction such as definition, causes, signs and symptoms, treatment, complication, importance of care of the eye in the prognosis of the obstruction and frequency of nasolacrimal massage. Tool (II): Mothers’ practices by using observational check list: it was developed by the researcher after reviewing the related literature (127) which includes 5 steps that represent technique of the massage steps such as cutting the nails, washing hands, using lubricant, place the index finger, the number of times to perform that technique and care of their infants such as: care of infant in home in case of nasolacrimal duct obstruction, benefits and correct area of nasolacrimal duct massage, steps for eye care and how to make eye compression , dangerous signs when appear should report doctor and how to care infant when temperature increased. Tool (III): Clinical outcomes for infants: it was developed by the researcher after reviewing the related literature (133, 134) to determine the effects of educational training program for mothers on their knowledge and practice related to their infants with congenital nasolacrimal duct obstruction - Symptoms worse or not improved or slightly improved or improved such as (epiphora, eyelid swollen, eyeball redness, inflammation of eyelid and discharge of eye) The mothers were divided into ten groups, each group consisting of 8 mothers, and five educational sessions were conducted on how to care for children with congenital obstruction of the nasolacrimal duct for three weeks, three consecutive days per week, two sessions on some days and one on other days in the outpatient clinic of the ophthalmology department of the hospital Tanta Main University and the outpatient clinic of Ophthalmology Hospital in Tanta, affiliated to the Ministry of Health, and the time specified for each session was 30-45 minutes. The mothers’ information and practices were evaluated immediately after the sessions and also after a month. The main results of the study showed that: - It was found that less than half of the mothers (45%) their age were between 25-<30. It was noticed that more than 58.7% of mothers completed their secondary education. Regarding their occupation, more than two thirds (71.3%) of mothers were house wives. - The results showed that slightly two thirds (66.2%) of mothers were from urban areas. Concerning pregnancy duration majority of mothers (85 %) have completed pregnancy period. - It was noticed that, more than one third of children (35%) aged less than 3moths and from 3 to 5 months. Males were presented by 57.5% of the studied sample and (50%) of them were in the first birth order. In addition, slightly less than three quarter (72.5%) of the studied infants was born with cesarean section and more than three quarter (78.7%) of them born with normal birth weight. - Concerning symptoms appear on the infant all of them (100 %) have symptoms of congenital nasolacrimal duct obstruction and almost (83.7%) of the studied infants have less than or equal 6months of age when symptoms appear. In addition, more than three quarters (77.5%) of the studied infants had unilateral obstruction. - It was noticed that there was a significant difference between total mother’s knowledge about congenital nasolacrimal duct obstruction before program was (10%) had good knowledge compared to (77.5%) immediate post program and (66.3%) after one month program implementation. - It was found that there was a significant difference between mother’ total practice (83.2%) had unsatisfactory practice before program compared to more than three quarter (78.8%) immediate post program and (77.5%) after one month program implementation had satisfactory practice. - The study also showed that there was a significant difference improvement of infants’ clinical outcomes that follow up program a (P= .000) regarding of infants’ signs and symptoms of congenital nasolacrimal duct obstruction immediate post program and after one month program implementation than before program. - The study revealed that all infants (100%) had symptoms of congenital nasolacrimal duct obstruction before program compared to more than half (56.3%) had cured immediate and (87.5%) of them after one month program implementation. - The study showed a statistically significant positive correlation between total knowledge of the studied mothers and their total practices regarding congenital nasolacrimal duct obstruction before, immediate and after one month program implementation P <0.05. - It was observed that (60.3%) of the studied infants had cured of mothers had satisfactory practices compare to more than (58.8%) of the studied infants not cured of mothers had unsatisfactory practices immediate post program while most (90.3%) of the infants had cured of mothers had satisfactory practices after one month program implementation. Conclusion and recommendations Conclusion: Based on the findings of the present study, it can be concluded that, there were improvement in mother’s knowledge and practice after educational training program implementation and there was statistic significant difference between total mothers knowledge and practice before, immediate and after one month from educational training program implementation and subsequently lead to high rates improvement of infants’ clinical outcomes and resolution of congenital nasolacrimal duct obstruction. Chapter VII Su mmary - 92 - Summary Nasolacrimal duct obstruction is a common condition among infants. The main cause of the occlusion is an imperforate membrane at the distal end of the nasolacrimal duct (Valve of Hasner). It was found in up to 30% of infants at birth, but nearly 6% has symptoms of nasolacrimal duct obstruction, unilateral or bilateral affection. Symptomatic congenital nasolacrimal duct obstruction is characterized by epiphora and/or mucopurulent discharge in the first few weeks after birth. The blockage of the lacrimal system causes excessive tearing. The eye lids can become red and swollen with yellowish green discharge that result in conjunctivitis or reach to dacryocystitis. The following conservative treatment may be recommended in persistent obstruction of the lacrimal duct in the form of tear duct massage with topical antibiotic eye drops. The conservative treatment is the best option until the first year of age and many infants with lacrimal duct obstruction respond to conservative treatment. Surgical procedure is usually accompanied with risk hazards especially during the first year of life. Tear duct massage is simple technique for mothers and can be performed at home to help the tear duct open. A primary care nurses can demonstrate it to help infants gain its benefits. The present study was aimed to evaluate the effect of educational training program on mothers’ knowledge and practice and clinical outcomes for infants with congenital nasolacrimal duct obstruction. Aquasi-experimental research design was used in the present study. The study was conducted atOut-patient clinic at Ophthalmology Department of Main Tanta University Hospital and Out-patient clinic of Ophthalmology Hospital of Tanta City which Affiliated to Ministry of Chapter VII Su mmary - 93 - Health. Convenience samples of 80 mothers and their infants that diagnosed with congenital nasolacrimal duct obstruction. Tools of data collection: Three tools were used to collect the necessary data. Tool (I): Structured questionnaire schedule. It was developed by the researcher after reviewing the related literature: Mothers’ knowledge and socio -demographic characteristics. Part (1): Socio -demographic data of mothers as: age, level of education, occupation, period of pregnancy and residence. Part (2): Infants characteristic such as: age, birth order, sex, weight of infant, laterality of the obstruction, Age of the infant at the appearance of symptoms and symptoms appear on the infant. Part (3): Mothers’ knowledge: it was developed by the researcher to assess mothers’ knowledge related to their infants with congenital nasolacrimal duct obstruction such as definition, causes, signs and symptoms, treatment, complication, importance of care of the eye in the prognosis of the obstruction and frequency of nasolacrimal massage. Tool (II): Mothers’ practices by using observational check list: it was developed by the researcher after reviewing the related literature (127) which includes 5 steps that represent technique of the massage steps such as cutting the nails, washing hands, using lubricant, place the index finger, the number of times to perform that technique and care of their infants such as: care of infant in home in case of nasolacrimal duct obstruction, benefits and correct area of nasolacrimal duct massage, steps for eye care and how to make eye compression , dangerous signs when Chapter VII Su mmary - 94 - appear should report doctor and how to care infant when temperature increased. Tool (III): Clinical outcomes for infants: it was developed by the researcher after reviewing the related literature (133, 134) to determine the effects of educational training program for mothers on their knowledge and practice related to their infants with congenital nasolacrimal duct obstruction - Symptoms worse or not improved or slightly improved or improved such as (epiphora, eyelid swollen, eyeball redness, inflammation of eyelid and discharge of eye) The mothers were divided into ten groups, each group consisting of 8 mothers, and five educational sessions were conducted on how to care for children with congenital obstruction of the nasolacrimal duct for three weeks, three consecutive days per week, two sessions on some days and one on other days in the outpatient clinic of the ophthalmology department of the hospital Tanta Main University and the outpatient clinic of Ophthalmology Hospital in Tanta, affiliated to the Ministry of Health, and the time specified for each session was 30-45 minutes. The mothers’ information and practices were evaluated immediately after the sessions and also after a month. The main results of the study showed that: - It was found that less than half of the mothers (45%) their age were between 25-<30. It was noticed that more than 58.7% of mothers completed their secondary education. Regarding their occupation, more than two thirds (71.3%) of mothers were house wives. - The results showed that slightly two thirds (66.2%) of mothers were from urban areas. Concerning pregnancy duration majority of mothers (85 %) have completed pregnancy period. Chapter VII Su mmary - 95 - - It was noticed that, more than one third of children (35%) aged less than 3moths and from 3 to 5 months. Males were presented by 57.5% of the studied sample and (50%) of them were in the first birth order. In addition, slightly less than three quarter (72.5%) of the studied infants was born with cesarean section and more than three quarter (78.7%) of them born with normal birth weight. - Concerning symptoms appear on the infant all of them (100 %) have symptoms of congenital nasolacrimal duct obstruction and almost (83.7%) of the studied infants have less than or equal 6months of age when symptoms appear. In addition, more than three quarters (77.5%) of the studied infants had unilateral obstruction. - It was noticed that there was a significant difference between total mother’s knowledge about congenital nasolacrimal duct obstruction before program was (10%) had good knowledge compared to (77.5%) immediate post program and (66.3%) after one month program implementation. - It was found that there was a significant difference between mother’ total practice (83.2%) had unsatisfactory practice before program compared to more than three quarter (78.8%) immediate post program and (77.5%) after one month program implementation had satisfactory practice. - The study also showed that there was a significant difference improvement of infants’ clinical outcomes that follow up program a (P= .000) regarding of infants’ signs and symptoms of congenital nasolacrimal duct obstruction immediate post program and after one month program implementation than before program. Chapter VII Su mmary - 96 - - The study revealed that all infants (100%) had symptoms of congenital nasolacrimal duct obstruction before program compared to more than half (56.3%) had cured immediate and (87.5%) of them after one month program implementation. - The study showed a statistically significant positive correlation between total knowledge of the studied mothers and their total practices regarding congenital nasolacrimal duct obstruction before, immediate and after one month program implementation P <0.05. - It was observed that (60.3%) of the studied infants had cured of mothers had satisfactory practices compare to more than (58.8%) of the studied infants not cured of mothers had unsatisfactory practices immediate post program while most (90.3%) of the infants had cured of mothers had satisfactory practices after one month program implementation. Conclusion and recommendations Conclusion: Based on the findings of the present study, it can be concluded that, there were improvement in mother’s knowledge and practice after educational training program implementation and there was statistic significant difference between total mothers knowledge and practice before, immediate and after one month from educational training program implementation and subsequently lead to high rates improvement of infants’ clinical outcomes and resolution of congenital nasolacrimal duct obstruction. Chapter VII Su mmary - 97 - Recommendations: The study showed that the following recommendations. 1. Nasolacrimal massage should be utilized for all infants who suffer from nasolacrimal duct obstruction. 2. Follow up program of the infants with congenital nasolacrimal duct obstruction should be applied and organized in the hospitals, for the proper conservative treatment application, ensure that mothers follow correct practices , reliving of the signs and symptoms and prognosis of congenital nasolacrimal duct obstruction on the infants, 3. More researches are needed for training of pediatric nurses and mothers about the proper care of congenital nasolacrimal duct obstruction, nasolacrimal massage and improving mothers’ knowledge and practices about the nature of the disease, different forms of management, complications and its prognosis. Recommendations: The study showed that the following recommendations. 1. Nasolacrimal massage should be utilized for all infants who suffer from nasolacrimal duct obstruction. 2. Follow up program of the infants with congenital nasolacrimal duct obstruction should be applied and organized in the hospitals, for the proper conservative treatment application, ensure that mothers follow correct practices , reliving of the signs and symptoms and prognosis of congenital nasolacrimal duct obstruction on the infants, 3. More researches are needed for training of pediatric nurses and mothers about the proper care of congenital nasolacrimal duct obstruction, nasolacrimal massage and improving mothers’ knowledge and practices about the nature of the disease, different forms of management, complications and its prognosis.