الفهرس 
Purpose of the StudyOnly 14 pages are availabe for public view
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Abstract
Meningitis is a devastating disease with many deaths and significant longterm sequelae in survivors and remains a major global public-health challenge. Soperforming lumbar puncture procedure to draw cerebrospinal fluid was used for diagnostic purpose of acterial meningitis Therefore nurses are the key element in
children with meningitis care and take the big responsibility in observing the early signs and symptoms of infections. Nurses play an active role in control and management of meningitis through early observation, helping in diagnosis and by following the universal precauation (Chauhan et al., 2020). Therefore, Instructional module supports professional practice of nursing and delivery of a safe and high quality of care for children. Continuing nursing education and training are vital components to provide children with best possible care. The purpose of the present study was to: Evaluate the effect of instructional module for minimizing nursing pitfalls of lumbar puncture for children with meningitis through: Assess nurses’ knowledge and practices about meningitis and lumber puncture procedure. Design and implement an instructional module for nurses’ based on nurses’needs regarding lumber puncture for children with meningitis. Evaluate the outcomes of instructional module for nursing pitfalls during lumbar puncture.Research Hypotheses Nurses who receive instructional module will expect to higher level of knowledge regarding their pitfalls on lumbar puncture for children with meningitis on post- test than pre- test. Nurses who receive instructional module will expect to higher level of nurses ’performance regarding their pitfalls on lumbar puncture for children with meningitis on post- test than pre- test.
Children health condition will improve after instructional module for nurses regarding their pitfalls on lumbar puncture for children with meningitis on post- test than pre- test. This section describes research design, setting, sampling technique, data collection instruments, pilot study, data collection procedure, and data analysis Research Design: A quasi-experimental (pre/post/ follow- up tests) research design was
utilized for the present study.Research setting:The present study was conducted at Shebin El- Kom Fever Hospital Menoufia Governorate in Egypt. Affliated to the Ministary of Healthh and Population.Sampling:
A convenient sample of 70 nurses employed at the previously mentioned setting. All hospitalized children with meningitis who exposed to lumbar puncture procedure throughout the period of data collection were included in the study Inclusion criteria for children: Children who had more than one lumbar puncture
during data collection period, and their age from one year to eighteen year.Data Collection Instruments:
Data was collected through using two instruments:Instrument I: A Structured interviewing questionnaire To assess nurse’s knowledge related to meningitis, lumbar puncture and nursing care for children with meningitis undergoing lumbar puncture, it was developed by the researcher. It consists of three parts as the following: Part I: characteristics of Nurses: It includes age, education level, gender,years of experience and attendance of previous training related meningitis inchildren. Part II: characteristics of Children: Such as age, gender, residence,season of admission, obligatory vaccination, duration of illness, and clinical picture at admission. Part III: Nurses’ Knowledge about a. Meningitis: It includes thirteen open end questions about meningitis.b. Lumbar Puncture Procedure: It contains ten open end questions about
lumbar puncture procedure.c. Nursing Performance for Children with Meningitis and lumbar puncture:
It includes ten open end questions Instrument II: Observational Checklist: consists from two parts
Part 1: Children Health Assessment:To evaluate nurses’ practices given to children with meningitis for Lumbar puncture procedure. It was adopted from Vicky and Cindy, (2018), It includes observation about:- measuring vital signs (included assessment axillary temperature includes ten steps, pulse includes seven steps, respiration includes steps (child position before, during and after lumbar puncture); fluid intake
consists from three steps (before, during, after lumbar puncture); and pain
assessment consists from three steps (e before, during, and after lumbar puncture).Part II: Nursing Practice Checklist:To assess nurse’s practices before, during, and after lumbar puncture procedure. It developed by the researchers guided by Celik, Ooal& Apliliogullari, (2019). It includes:A. Nurses’ practice before lumbar puncture: It consists of:1. Nurses’ practices at preparatory phase includes thirteen steps.
2. Nurses’ practices about general guidelines for diagnostic tests includes ten steps.3. Nurses’ practices about tray set up, includes five steps.B. Nurses’ practice during Lumbar Puncture: consists of ten steps.C. Nurses’ practice after Lumbar Puncture: consists of thirteen steps.The main results of the study showed that: According to characteristics of studied nurses. Regards mean and standard deviation of nurse’s age, it was found that approximately two third of studied nurses (27.914.21) mean aged form 20 to 30 years old. Also more than half of them (58.6%) had technical nursing institute, regards years of experience,it is clear that (44.2%) had experience in pediatric nursing for 3 to less than 5 years. Approximately all of studied children (95.7%) had admission to hospital in winter. Regards children vaccination, it was found that all of them had vaccinations. Regards duration of symptoms before admission, it was found
that 47.1% of them had symptoms for 3 to 7 days, and 40% of them had for 1 to 2 days. It was found that there were highly statistically significant differences between pre, post and follow up tests regarding total mean score and standardn deviation of nurses’ knowledge about meningitis, lumbar puncture, nursing
care about lumbar puncture, and total score of nurses’ knowledge as P value(<0.01). Regarding total mean scores and standard deviation of vital signs nurse s’assessment on pre, post and follow-up Tests, it was noted, that there were highly statistically significant differences between pre, post and follow-up
tests regarding total mean and standard deviation of vital signs nurses’assessment as P value (<0.001). Regarding total mean scores of nurses’ performance of children health assessment on pre, post and follow-up tests, it was revealed that the studied nurses had the highest total mean score and standard deviation assessment ofchildren health on post-test. Therefore, there were highly statistically significant differences between pre, post and follow- up tests as P value(<0.01). Concering total mean score and standard deviation of nurses’ performance of lumbar puncture on pre, post and follow- up tests. It was obvious, that there were highly statistically significant differences between total mean andstandard deviation of nurses’ practice on pre, post and follow -up tests as Pvalue (<0.01). Regards total mean score and standard deviation of pitfalls of nurses’performance before, during and after lumbar puncture on pre, post- test and follow- up tests. It was revealed that there were highly statistically significant
differences between pitfalls nurses’ performance on pre, post and follow up tests as P value (<0.01). Regarding Pearson correlation between total score of nurses’ knowledge and total performance, it was showed that there was highly statistically significant positive correlation between total knowledge and total practice as P value(<0.01). Concering Pearson correlation between total score of children health status,
total score of nurses’ knowledge and performance, it was showed that there were highly statistically significant positive correlation between total knowledge and total practice as P value (<0.01). Also there was highly statistically significant positive correlation between total knowledge and total score of child status as P value (<0.01).The study concluded that: Nurses who receive instructional module had higher level of knowledge as well as nursing performance regarding lumbar puncture for children with meningitis on post –test than pre- test. Also, they had fewer nursing pitfalls related to lumbar puncture procedure. Furthermore, children health condition improved on post-test than pre-test.Based on the result of the study, it was recommended that: Recommendation for Nursing Practice Continuous job training programs must be provided for nurses regarding management of meningitis in children. Pediatric nurses should update their knowledge and performance through continued nursing education, training, and frequently attending seminars and conferences based on their needs assessment to prevent any pifalls. Recommendation for Education Providing educational guidelines, posters, pamphlets and manuals about meningitis should be available at each nursing station in wards and encourage nurses to get use of them. Encourage the nurses to participate in training courses, online workshops and conferences held by specialists in meningitis and lumbar puncture procedure to update their knowledge. Recommendation for Research: Further research is needed to assess the impact of application of educational module on the quality of nurses’ intervention provided to children during lumbar puncture. Further studies are recommended on large sample and different setting to permit more generalization of the study’s’ results. four steps , and blood pressure includes six steps); position consists from three