الفهرس 
Acknowledgements
Nursing management for patient with cystectomy surgeriesOnly 14 pages are availabe for public view
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Abstract
Summary
The aim of the present study were in 3 folds; assess nurses knowledge and practice for nurses working with the patients cystectomy surgeries, design a teaching protocol for nurses working with patients cystectomy surgeries and evaluate the effect of implementing designed nursing teaching protocol on nurse’s knowledge and practices as well as on patient’s outcome.* patient’s outcome refers to the reduction/ prevention of post-operative radical cystectomy complications.
To fulfill the aim of the study, the following research hypotheses were formulated:
1. The post-mean knowledge scores of nurses who will be exposed to a designed teaching protocol will be higher than their pre mean knowledge scores.
2. The post mean practice scores of nurses who will be exposed to a designed teaching protocol will be higher than their pre mean practice scores.
3. The incidence of post-operative radical cystectomy complications for patient cared by nurses after protocol implementation will be lesser than that developed pre-protocol implementation.
4. A positive relationship will exist between knowledge and practice score obtained by nurses receiving the designed teaching protocol.
The study was conducted at the surgical oncology departments and outpatient clinics at South Egypt Cancer Institute, in the period of one year (March, 2017 to February, 2018). To accomplish the purpose of this study, data were collected from all nurses working in surgical oncology departments (60) in addition to all patients admitted for radical cystectomy surgeries for at least 6| months after implementing of the designed nursing teaching protocol.
The following tools were utilized for data collection:
Tool (I): pre/post test questionnaire sheet for nurses consists of two parts:
Part (1) Demographic data for nurses such as: name, age, sex, marital status, occupation, level of education……etc.
Part (2) Pre/post-test questionnaire sheet for the nurses: to assess their knowledge about care of patient undergoing radical cystectomy Surgeries.
Tool (II): Observation checklist sheet for the nurses:
It was designed based on reviewed of essential literature to assess patient’s performance toward caring. It included the following items: Care of the stoma, care of the skin, care of appliance catheter care, assessment, planning, implementation, evaluation; reporting, recording and instruction.
Tool (III): Designed nursing teaching protocol: was developed by the researcher based on the review of relevant literatures according to nurse’s knowledge and practice that can help nurses in provision of a safe and effective care for cystectomy patients. It was includes anatomy and physiology of urinary system, definition, causes, signs and symptoms, diagnosis, treatments of bladder cancer, definition and complications of cystectomy surgeries.
Tool (IV): Patient’s assessment sheet to assess post operative cystectomy complications that night develop.
Part (I): Demographic data and medical data about the patients such as: age, sex, occupation, marital status, level of education, duration of disease, address, family participation, smoking, and family history of disease.
Part (II): Physical assessment: this includes; vital signs, dietary habit, and presenting patient general symptoms/ signs.
Part (III): patient assessment for stoma: this includes; assessment of the stoma, abnormalities of skin around the stoma, and characteristics of urine.
Part (IV): patient complications after radical cystectomy surgeries: this includes; early complications as; acidosis, leaking urine or stool, bowel obstruction and kidney infection and late complications as; obstruction of ureters or intestines, renal failure, problems with opening (stoma) and scare tissue.
Data were tested for normality using the Anderson-Darling test and for homogeneity variances prior to further statistical analysis. Categorical variables were described by number and percent (N, %), where continuous variables described by mean and standard deviation (Mean, SD). Chi-square test and fisher exact test used to compare between categorical variables where compare between continuous variables by t-test \and ANOVA TEST.
A two-tailed p < 0.05 was considered statistically significant. We are used person Correlation to Appear the Association between scores. All analyses were performed with the IBM SPSS 20.0 software.
Main findings of the present study were the follows:
The majority of the studied nurses are female (88.3%). More than half of nurses their age ranged from 20 >30 years (53.3%) with Mean ±SD of 26.85±4.92 and had diploma of nursing (75.0%). The majority of nurses are married (81.7%) and not attended training programs (93.3 %). Less than half of nurses (40.0%) their years of experience more than 10years with Mean ±SD of 7.74±4.98.
Age of nurses was positively correlated with total and subtotal knowledge scores. Also it was positively correlated with general and specific care items all through the study period. However nurse’s experience as well as education was positively correlated with total& subtotal knowledge and practices scores all through the study period.
Highest percentage of the patient (70%) their age ranged between 55 to 65years with mean of (55.50±8. 31).The majority of patients were male, living in rural area, married, and have farmer in percentages of (80%, 73.3%, 100%, and 70% respectively).More than half of the patients have illiterate (60%).
The first hypothesis was supported as a sharp improvement in the mean knowledge scores after the application of the teaching protocol (5.73±0.84, 0.95±0.22, 1.9±0.3, 10.37±1.75, 18.95±2.55 respectively). A significant statistical difference was found between nurses knowledge in relation to total and subtotal mean knowledge scores. All nurses (88.3%) were in unsatisfactory knowledge level pre implementing of the nursing teaching protocol, however post implementing of the nursing teaching protocol majority of them were in good level (98.3%).
The second hypothesis was supported as a sharp improvement in the mean practice scores after the implementing of the nursing teaching protocol (14±0, 33.97±0.18, 41.85±0.48, 39.97±0.18, 79.95±0.29, 209.73±0.63 respectively). A significant statistical difference was found between nurses practice in relation to total and subtotal mean practice scores. Highest percentage of nurses (86.7%) were in unsatisfactory practice level pre implementing of nursing teaching protocol, however post implementing nursing teaching protocol majority of them were in good level(100%).
The third hypothesis was supported as the highest percentage of the studied patients with mean (20.03±4.93) was developed complication of stoma. However; stoma complications as a major surgical outcome was improved with mean (7.7±4.87) during the study period.
The fourth hypothesis was supported as a positive correlation between nurse’s knowledge and practice scores after implementing of the nursing teaching protocol with p-values <0.01.
A significant relationship was found between assessment of stoma and other late complications and early complications with (p- value = <0.001, p = 0.001) respectively. After implementing of nursing teaching protocol.