الفهرس 
Introduction and Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
Childhood cancer is the second leading cause of death worldwide. It affects all age groups, causing more death among children 3 to 15 years of age than any other diseases. Childhood cancer is a general term used to describe a range of cancer types found in children. Leukemia, brain tumors and cancer in the nervous system are the most common cancers in children. Palliative care is directed toward children with advanced stage of cancer for pain and other symptoms management. The goal is not to cure, but to provide comfort and maintain the highest possible quality of life for as long as life remains. Palliative care programs also, meet psychological and spiritual needs along with the physical needs. The focus is not on death, but on compassionate specialized care for the living. Pediatric oncology nurses play a significant role in palliative care for children with cancer as assessing pain, planning pain-control regimen and evaluating the effectiveness of therapies, managing physical symptoms as nausea and vomiting , dyspnea and constipation through pharmacological and non-pharmacological interventions and providing appropriate psychological and spiritual care. They also, provide emotional support to families of children with cancer so, they must first develop a relationship of trust to be able to relate with the child and his family, promote hope for them, also maintain their dignity and self-esteem and provide spiritual care. Furthermore, support family members through providing information about home care services. The aim of the current study was to evaluate the effect of educational program on nurses’ competency regarding providing palliative care for children with advanced stage of cancer. Research design: A quasi-experimental research design was used in the present study. Setting: The present study was conducted at Pediatric Hematology and Oncology Unit at Tanta Main University Hospital and Tanta Cancer Center which Affiliated to the Ministry of Health and Population. Subjects: The subjects of the current study consisted of all nurses (45) who are working in the previously mentioned settings and divided into thirty nurses from Tanta University Hospital and fifteen nurses from Tanta Cancer Center. Tools of data collection: Two tools were used to collect data, these tools included the following: Tool I: Structured Questionnaire Schedule: It was developed by the researcher after reviewing of recent and related literature (28,31,58,61) to assess nurses ’ knowledge before, immediately and one month after the educational program implementation . It consisted of two parts: Part 1: Socio-demographic characteristics of studied nurses: Including age, sex, residence, educational level, working department, years of experience in oncology department and previous training programs. Part II: Nurses’ knowledge regarding childhood cancer and palliative care: Such as definition of cancer, common manifestation, sedation or opioid used for pain management, palliative care definition, aim, purposes and principles, best time to integrate palliative care into child line of treatment, role of pediatric palliative care nurse, nursing interventions to relieve cancer pain, nausea and vomiting and dyspnea, nursing interventions to improve psychological and spiritual health of children with advanced stage of cancer. Tool II: A palliative care competency checklist: It was developed by the researcher based on Palliative Care Competency Framework (86) and Nurse’s Core Competency in Palliative Care Scale.(87) It was used to evaluate nurses’ competency regarding palliative care before, immediately after and one month after implementing the educational program . This tool was used for nurses to self-report their nursing practice in relation to professional competency regarding palliative care. It included the following six core competency domains: 1- Principles of palliative care. 2- Communication. 3- Optimizing comfort and quality of life. 4- Care planning and collaborative practice. 5- Loss, grief and bereavement. 6- Professional and ethical practice. The main results obtained from the present study was as follows: - Regarding the age of nurses, the mean age was (40.333 ± 11.457) years. -It was clear that, about two thirds (62.2%) of the nurses had diplom in nursing , 22,2% had technical nursing institute education , while 15.6 % of them had completed their university nursing education. -Regarding experience inside Pediatric Hematology and Oncology Units, it was found that 20% and 24.4% of the studied nurses had 10- ˂ 20 and 20 - ˂ 30 years of experience respectively, while 26.7% and 28.9% had ˂ 10 and 30- ˂ 40 years of experience respectively. The mean years of experience was 19.267 ± 11.563 years. - Concerning nurses’ total knowledge, there were highly statistical significant differences before, immediately after and one month after implementing the educational program (P=0.0001). - It was found that, before the educational program 62.2 % of the studied nurses had a low level of knowledge. While, immediately and one month after the program implementation, all nurses (100%) and 91.1% had a high level of knowledge respectively. - The mean of total knowledge scores of the studied nurses were 16.533±3.64, 27.000± 1.27 and 25.111±2.01 before, immediately and one month after educational program implementation respectively. - Regarding nurses’ total competency, there were highly statistical significant differences in total nurses’ competency regarding palliative care before, immediately and one month after implementing the educational program (P=0.0001). - It was apparent that, the majority of the studied nurses (86.7%) weren’t competent in providing palliative care before the educational program. While, immediately and one month after, all of the studied nurses (100%) and 88.9% were competent in providing palliative care respectively. - It was found that, there was significant positive correlation between total competency and total knowledge before, immediately and one month after the implementation of the educational program. - It was clear that, there were significant positive correlation between nurses’ total knowledge, educational level, working unit and experience level before the program, while immediately and one month after program, all nurses’ total knowledge improved regardless educational and experience level. - There was significant positive correlation between total nurses’ competency and their age, working unit and experience level before program implementation. While immediately and one month after program implementation, there was significant positive correlation between nurses’ competency, age and experience level only. - It was clear that, all competency domains related to palliative care were positively correlated to each other before, immediately and one month after the program. Conclusion: Based on the result of the current study, it can be concluded that, there was a significant improvement in the mean scores of total level of nurses’ knowledge and competency immediately and one month after the implementation of the educational program in relation to palliative care for children with advanced stage of cancer than before implementing it. There was a positive correlation between the total knowledge scores among the studied nurses and the total competency scores of nursing intervention for children with advanced stage of cancer. Recommendations: Based on the findings of the present study, the following.