الفهرس 
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Abstract
Cancer is a chronic, long-term illness that affects not only the child but also the family and the community as a whole. Caring for a child with cancer brings an enormous physical, psychological, social stressors and financial burden upon the family. Nurses must be keenly aware of the ongoing responses, needs, stressors and coping patterns of the child suffering from cancer and his/her mother. A nurse can support the family by respecting them and serve as a support by making referrals, providing information through continuous health education about the illness and its management and allowing emotional expression by all family members. Education and psychosocial support by nurses and other health care team lead to coping positively with this chronic illness and its related consequences (Hinds, 2010).
The aim of this study was to study the effect of nursing intervention on stressors and coping patterns of children suffering from cancer and their accompanying mothers through assessment of their stressors and coping patterns, design and implement nursing intervention and study the effect of the implemented nursing intervention on the studied subjects’ stressors and coping patterns. This study was conducted at both Inpatient Medical Department and Outpatient Oncology Clinics of Pediatrics Hospital affiliated to Ain Shams University Hospitals. The studied subjects composed of one hundred and fifty children suffering from cancer and their accompanying mothers, from both sexes, with age group 6-18.The studied subjects randomly divided into two equal groups (study and control) that entail 75 children and their accompanying mothers in each group.
Data obtained through an interview with the children suffering from cancer and their accompanying mothers through using the following tools:
1- Structured questionnaire sheet:
That was designed by the researcher and written in simple Arabic language to gather data in relation to:
a. Socio-demographic characteristics of children suffering from cancer including age, sex, rank, educational level and residence.
b. Socio-demographic characteristics of the children’s accompanying mothers including age, educational level and occupation.
c. Characteristics of the studied subjects’ surrounding environment including: kind of residence, type of residence, number of indoor rooms, presence of safety water supply, presence of sewage disposal, good ventilation, availability of transportation to the health care service settings and availability of health care settings suitable to the children’s condition.
d. Data regarding the studied children’s history of illness including: family history of illness, early discovery of illness and causes of hospital admission.
e. Data regarding the studied subjects’ knowledge about cancer that includes: concept of cancer, its causes, signs and symptoms, treatment, and complications.
f. Data regarding the studied subjects’ knowledge about stressors that include: concept of stressors, its types, sources and factors that affect stressors.
g. Data regarding the studied subjects’ knowledge about coping that include: concept of coping, factors that affect coping and positive and negative coping patterns.
2- Stressors’ scale by Miles and Brunsser (1998):
That was used to assess the physical, psychological, social and financial stressors experienced by the studied subjects. The studied subjects will answer either Yes (for presence of the stressors) or No (for absences of the stressors). The studied subjects will be given (2) point for presence of the stressors and (1) point for absence of the stressors. The scales consist of 79 statements divided into 4 kinds of stressors (physical, psychological, social and financial).
3-Coping patterns scale by Jalowiec and Powers (1991):
It was used to assess children and mothers coping patterns towards the chronic disease. It is a three point scale according to the degree of positive coping, the numerical values allotted to each response was as; always, sometimes and never. Where, (3) points were given for always able to cope, (2) point was given for sometimes able to cope and (1) point for never able to cope. Coping patterns scale for the mothers contains (33) statements while the coping patterns scale for the children contains (28) statements.
A pilot study was carried out to test the study tools. The necessary modifications were done as revealed from the pilot study. Children and their accompanying mothers who share in the pilot study were excluded from the study sample. The pilot study also helped in estimating the time necessary for each child and his accompanying mother to implement the nursing intervention.
Field of the work
The actual field work was carried out from the first of October 2013 to the end March 2014 for data collection and implementation of nursing intervention. The researcher was available 3 days /week from 8 o’clock a.m to1 p.m. The total number of session was 9 sessions, the time for each session was about 30 to 45 minutes. Methods of teaching were through modified lectures, group discussion, demonstration and redemonstration. Learning activities were done in the Inpatients Department and in the Outpatient Oncology Clinics affiliated to Ain Shams University Hospitals.
The main findings of the study can be summarized as the following:
As regards characteristics of the studied children it was found that, the mean age of the studied children was (10.98+2.87) years for the study group and (10.18+3.06) years for the control group. More than half (58.7%) of the studied children were equally females and males in both study and control groups respectively. It was clear that (56%) were ranked as the first and the second child in both study and control group respectively. while 60% of the studied children in both study and control groups were in the stage of basic education.
In relation to the studied mothers characteristics it was found that, the mean ages of the studied mothers in the study group was (39.92+6.53) years and (37.65+7.68) years in the control group. In relation to mothers education it was found that, 30.7% of them were in primary education in the study group and more than quarter 28.1% of them were in preparatory education in the control group. As regards mothers’ work it was clear that 73.3% and 76% of the studied mothers in both study and control groups was housewives.
Regarding number of family members the present study revealed that, the majority 93.3% and 96% of the studied subjects in both study and control groups were 4 ≤ 8. less than three quarters and more than half 72% and 52% of the studied subjects in both study and control groups had no consanguinity between their parents.
Less than three quarters and more than half 70.7% and 54.7% of the studied subjects in both study and control groups were living in urban areas. The majority 98.6% and 92% of the studied subject’s monthly income in both study and control groups were ranged from 600≤ 1200/LE.
Regarding family history of cancer this study cleared that, the majority 92% and 82.7% of the studied children were having negative family history of cancer in both study and control groups. While the majority 98.7% and 97.3% of both study and control groups were discovered the child’s cancer by coincidence.
Findings of the current study revealed that, 100% and 97.3% of the studied children was previously admitted to hospital. While 100% and (90.7%) was admitted for taking medications and more than two thirds 66.7% and 69.3% was admitted because of complications in both study and control groups respectively.
More than one third 40% and more than three quarters (82.7%) of the studied subjects were having knowledge deficit and cannot clarify the concept of cancer (as hereditary, controllable and curable disease) pre implementation of the nursing intervention but after implementation of the nursing intervention the majority 94.7% and 80% and 100% of studied subjects in the study group can identify the concept of cancer regarding the previously mentioned items compared to the control group.
In the light of the current study, it was clarified that, there was a clear improvement in the studied subjects’ knowledge regarding all items related to causes of cancer in the study group post intervention compared to the control group.
Concerning the studied subjects’ knowledge regarding signs and symptoms and treatment of cancer. Findings of the current study revealed that, there was a clear improvement in the studied subjects’ knowledge regarding signs and symptoms of all items of treatment of cancer in the study group post intervention compared to the control group.
Findings of the current study showed that, there was a clear improvement in knowledge among the studied subjects of the study group post intervention regarding physical & psychological complications of cancer compared to knowledge of the studied subjects in the control group.
The current study proved that, there was an improvement in the studied subjects’ knowledge in the study group post intervention regarding all items of effect of cancer on social and financial condition of the child and family compared to the control group.
There was an improvement in the studied subjects’ knowledge regarding meaning of stressors in the study group post intervention compared to the control group.
The present study clarified that, the majority 98.6% and the most 86.6% of the studied subjects in the study group had improved knowledge regarding all items of sources of stressors post intervention compared to 42.6%,44%,32%,80% and 73.3% in the control group.
All 100% the studied subjects in the study group had improved knowledge post intervention regarding factors affecting stressors in the form of financial stability and information about the illness compared with 94.7% and less than one third 29.3% in the control group respectively.
There was a clear improvement of knowledge in the study group post intervention regarding all items of concept of coping as observed in 77.3%, 85.3%, 69.3% and 92% compared to 25.3%, 24%, 9.3% and 4% in the control group.
On investigating the studied subjects’ total level of knowledge regarding cancer, stressors and coping the current study proved that, the majority 97.3% of the studied subjects in the study group had good knowledge regarding cancer, stressors and coping post intervention compared to the minority 13.3% in the control group had average knowledge.
Regarding to the studied children physical stressors the current study revealed that, all 100% of the studied children in the study group had mild physical stressors post intervention compared to the minority 4% of the studied children in the control group who had moderate physical stressors.
In relation to the studied mothers’ physical stressors it was observed from the current study that, less than three quarters 74.6% of the studied mothers in the study group had mild physical stressors post intervention compared to more than half 54.7% of the studied mothers who had moderate physical stressors in the control group.
The current study showed that, all 100% of the studied children in the study group had mild psychological stressors post intervention compared to less than two thirds 64% of the studied children in the control group who had moderate psychological stressors.
The most 90.7% of the studied mothers in the study group had mild psychological stressors post intervention compared to less than two thirds 66.3% of the studied mothers had severe psychological stressors in the control group.
The most 92% of the studied subjects (children and mothers) in the study group had mild social stressors post intervention compared to more than half 57.3% and the minority 11% of the studied subjects in the control group who had moderate to severe social stressors respectively.
Less than two thirds 64% of the studied mothers in the control group had severe financial stressors compared to less than three quarters 72% of the studied mothers in the study group had moderate financial stressors post intervention.
More than three quarters 82.7% and 89.3% of both children and mothers in the study group were able to cope positively post intervention compared to more than half 56% and less than two thirds 65.3% of the studied subjects in the control group respectively.
The present study revealed that, there was no statistical significant difference between total level of stressors and coping patterns of the studied subjects and mean score of their monthly income in the study group post intervention.
There was a statistical significant difference (P˂0.001) between the studied subjects’ total level of knowledge and their total level of stressors and coping patterns in the study group post intervention.
There was a statistical significant difference (P<0.001) between both mothers and children physical stressors in both groups of the study pre and post nursing intervention.
There was a statistical significant difference (P<0.001) between both mothers and children psychological stressors in both groups of the study pre and post nursing intervention.