الفهرس 
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Abstract
E
nd stage renal disease is a common worldwide problem that defined as total loss of kidney function. It occurs when a leading cause impairs kidney function that need early management. The goal of management of chronic renal failure (CRF) in children is not only to prevent complications but to fulfill the physiological and emotional needs of children to the best possible quality of life. It can be achieved through early and appropriate treatment of reversible causes of chronic renal failure (Harada et al., 2022(.
Hemodialysis is the most common method used to treat advanced and permanent kidney failure in pediatrics. However it has many complications as cardiovascular, nutritional, hepatic, complications of vascular access devices. Dysfunctional dialysis access disrupts scheduled dialysis treatment and associates with higher mortality rates. So it’s important to take care of the vascular access to prevent complications (Machaly et al., 2020).
The dialysis nurse plays a vital role in providing information, care, support for child and his family. The proper nursing management must be provided to reducing the complications of renal function and the stresses of dealing with this life threatening illness (Sobh et al., 2019).
Aim of the Study
This study aimed to assess nurses’ performance regarding prevention of vascular access complications among children undergoing hemodialysis. This aim achieved through:
- Assessing the nurses’ knowledge regarding prevention of vascular access complications among children undergoing hemodialysis.
- Assessing the nurses’ practices regarding prevention of vascular access complications among children undergoing hemodialysis.
- Assessing the nurses’ attitude regarding prevention of vascular access complications among children undergoing hemodialysis
Research Questions:
- What are the levels of nurses’ knowledge regarding prevention of vascular access complications among children undergoing hemodialysis?
- What are the levels of nurses’ practices regarding prevention of vascular access complications among children undergoing hemodialysis?
- What are the levels of nurses’ attitude regarding prevention of vascular access complications among children undergoing hemodialysis?
Subjects and Methods
Research design:
A descriptive exploratory design was utilized in this study.
Research settings:
This study was conducted at the Pediatric Hemodialysis Unit in Children Hospital affiliated to Ain Shams University Hospital and Hemodialysis Unit affiliated to Al-Ayyat General Hospital (which added because of number of in sufficient nurses at Ain Shams University).
Research subjects
This study was conducted at the Pediatric Hemodialysis Unit in Children Hospital affiliated to Ain Shams University Hospital and Hemodialysis Unit affiliated to Ministry of Health (Al-Ayyat General Hospital)
Tools for data collection:
Data was collected through using the following tools:
Tool I: A structured interviewing questionnaire: It was designed by the researcher in the light of relevant literatures and reviewed by supervisors. It was written in simple Arabic language and included two parts as the following:
Part 1: characteristics of study subjects such as: age, gender, level of education, marital status, years of experience and previous attend of training courses.
Part 2: Nurses’ knowledge regarding hemodialysis vascular access and its complications.
Tool II: Observation Checklist: It was used to assess nurses practice for vascular access & prevention of its complications it was included the following:
• Hand washing
• Personal protective equipment wearing
• Care of hemodialysis catheter
• Care of arteriovenous fistula/graft
• Care of children undergoing hemodialysis before, during and after hemodialysis session
• Care of vascular access device infection
• Care of catheter embolism
• Prevention of catheter occlusion
• Care of catheter malposition or kinking
• Central venous access device dressing change
Tool III: Nurses’ Attitude Rating Scale: It was used to assess nurses’ attitude for vascular access & prevention of its complications.
Results
The current study result showed that, half (50%) of the studied nurses were in the age group 20: <30 years old, 38.7% and 37.1% of them have <5 years of experience in pediatric hemodialysis, attained previous training program about pediatric hemodialysis and nearly three quarters (74%) of the studied nurses were female respectively.
More than one third (35.5% & 34.5%) of the studied nurses were graduated from technical health institute of nursing and held diploma respectively.
More than three quarters (79%) of the studied nurses had average knowledge about preventing vascular access complications among children undergoing hemodialysis.
Additionally, 82.3% of the studied nurses had incompetent practice toward care of children undergoing hemodialysis,
The majority (96.8%) of the studied nurses has positive attitude about care of children undergoing hemodialysis.
Conclusion
In the light of the current study findings, it can be concluded that
More than three quarters of the studied nurses had average knowledge about preventing vascular access complications among children undergoing hemodialysis, and the most of them had incompetent practice toward care of children undergoing hemodialysis. Moreover majority of the studied nurses has positive attitude about care of children undergoing hemodialysis.
Recommendations
Based on the current study finding the following recommendations were proposed:
Periodic assessment of knowledge, practice and attitude for all nurses dealing or providing care to children undergoing hemodialysis therapy.
Emphasize the importance of continuous training based on actual need assessment of nurses caring for children undergoing hemodialysis therapy.
Assess factors affecting nurses’ performance positively for better quality of care for children undergoing hemodialysis therapy.
Procedure book should be available in hemodialysis units as a reference for all nurses.
Replication of the current study on larger probability sample and various setting in Egypt to examine the effectiveness nursing intervention on prevention of vascular access complications.