الفهرس 
Aim of the StudyOnly 14 pages are availabe for public view
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Abstract
Radiotherapy is a cornerstone in the management of cancer in children. This can be used as a primary therapy or in combination with surgery and/or chemotherapy. Radiotherapy can cause early and late side effects. Early or acute side effects occur during, immediately after, or soon after within weeks of radiotherapy treatment. Early side effects are often reversible when the dose is limited and tissue turnover is high, such as in the oral mucosa and gut, or partly reversible, such as in lungs (pneumonitis), skin, and brain (memory loss and fatigue). Children are much more sensitive and vulnerable to radiotherapy than adults because the tissues of children contain more water content, they absorb radiation more. So, parents have important role in providing immediate care for their children. When parents gave correct and competent care, preventing complication and decrease mortality (O’Connor & Halkett, 2019, Barazzuol & van Luijk, 2020).
Pediatric oncology nursing‘s roles have spread to a wide range from protection to the provision of healthcare to the child in the last period of life. Among the roles and responsibilities of pediatric oncology nurses are ensuring the safety of children, expertise, and evidence based practice, direct pediatric patient care, education, advocacy, counseling, research, management and lifelong learning (Cho et al., 2021).
The aim of the present study was to evaluate the effect of instruction guideline for parents regarding care of children receiving radiotherapy. Therefore, this study was undertaken to assess parents’ knowledge, practice, child health needs, problems and child health status, design and implement instruction guideline for parents having children receiving radiotherapy and evaluate the effectiveness of the instruction guideline on parents care who having children receiving radiotherapy.
Research design:
A quasi-experimental design (one group pre and post-test) was used to carrying out this study.
This study was conducted at Out-Patient Clinic in Radiotherapy Department affiliated to Nasser Institute Hospital. where the hospital is being with the highest admission rate of children who received radiotherapy and consider the largest center of radiotherapy in Egypt for children. All Children with confirmed diagnosis with any types of cancer and receiving external radiotherapy from both genders, aged from 6 years up to 18 years and their Parents (the total number of parents are 90), throughout 6 months from the beginning of September 2021 to the end of February 2022.
Tools of data collection:
Two tools were used to collect the data: (Appendix II):
Tool (I): A Structured Interviewing Questionnaire instruction guideline: It was designed by the researcher under supervision of supervisors based on reviewing pertinent literature and expert opinion and it was written in the simple Arabic language. Which cover the following four parts:-
The first part: It was designed to assess socio demographic characteristics of children and their parents which included 6 items (age, sex, ranking in the family, level of education, residence and diagnosis) in addition to parents characteristics which included 8 items (mothers’ age, mothers’ level of education, mothers’ job, fathers’ age, fathers’ level of education, fathers’ job, type of family and family income).
The second part: It was designed to assess children needs and problems as the following: A- concerned with child health problems which included 6 items (signs & symptoms of oral mucositis, signs & symptoms of diarrhea, signs & symptoms of constipation, signs & symptoms of genitourinary system’s inflammation, signs & symptoms of neutropenia and infection and sings& symptoms that should be notified immediately or attendance of the hospital.
B- Concerned with child health needs which included 3 items (The skin care after radiotherapy session, the suitable food for your child during the period of radiotherapy, appropriate daily activities of a child during the period of giving radiotherapy.
The third part: It was concerned with parents’ knowledge about radiotherapy as the following: A- Concerned with parents’ knowledge regarding Radiotherapy which included 8 items ( meaning of radiotherapy, Aim of radiotherapy, ways of giving radiotherapy, uses of radiotherapy, the degree of pain during giving the radiotherapy session, How many sessions will to be given to your child, the procedures that to be followed before starting radiotherapy for child and the procedures that to be followed after radiotherapy session for child.
B- Concerned with parents’ Knowledge regarding early and late side effects of radiotherapy which included 10 items (Digestive system’ side effects, Musculoskeletal system ’side effects, Genitourinary system’s side effects, Skin side effects, Respiratory system’ side effects, cardiovascular system’s side effects, Nervous system’s side effects, the short term side effects of radiotherapy are happen, the late side effects of radiotherapy and the long term side effects of radiotherapy are happen.
C- Concerned with parents’ Knowledge regarding care of their children receiving radiotherapy which included 15 items (to avoid infection during food preparation, Home preparations before bringing the child to radiotherapy Sessions, The procedures Before hair loss for child, The procedures in case of your child is feeling tired and exhausted and lack of activity, The procedures in the case of changes in the skin, The procedures in the case of oral mucositis of your child, The procedures in case of your child refused to eat, to avoid nausea and vomiting, The procedures in case of vomiting, The procedures in the case of diarrhea, the procedures in the case of constipation, The procedures in the cases of infection in genitourinary system, The procedures in the case of neutropenia, The procedures after hair loss and What is the source of your information.
The fourth part: It was concerned with Parents’ reported practice regarding care of their children receiving radiotherapy which included:-
1. General practice: Included 1 item: to assess parents’ practice to avoid infection during food preparation which include 5 steps.
2. Practices before receiving radiotherapy: Included 2 items: to assess home preparations before bringing the child to radiotherapy sessions and include 7 steps and parents’ practices before hair loss for child and includes 6 steps.
3. Health Practice in case of side effects of radiotherapy: Included 11 items: parents’ practice in case of child is feeling tired and exhausted and lack of activity and include 5 steps, parents practice in the case of changes in the skin and include 6 steps, parents practice in the case of oral mucositis and include 6 steps, parents practice in case of child refused to eat and include 6 steps, parents practice to avoid nausea and vomiting and include 6 steps, parents practice in case of vomiting and include 6 steps, parents practice in the case of diarrhea and include 6 steps, parents practice in the case of constipation and include 6 steps, parents practice in the cases of infection in genitourinary system and include 6 steps, parents practice in the case of neutropenia and infection and include 6 steps and parents practice after hair loss and include 5 steps .
Tool II: Radiotherapy assessment sheet was utilized in Nasser Institute Hospital (Radiotherapy Department) was used to evaluate child health status. It contained 23 items divided into 5 parts, the first part was measuring vital signs (4 items), the second part was measuring level of consciousness (6 degrees), the third part was measuring level of child distress (4 levels), the fourth part was assessing skin color (5 characters), the fifth part was measuring level of child activity tolerance (4 levels).
The main findings of this study were summarized as follows:
• Regarding to personal demographic characteristics of studied children, 32.2% of studied children their aged from 6 to less than 12 years old, with mean age was 11.58±3.11 years, 54.4% of them were females. 27.8% of them were the second child in their family, 38.9% were enrolled in primary schools and 55% lived in rural area and 24.4% of them had the diagnosis of brain tumor.
• Regarding to personal demographic characteristics of studied parents, 43.3% of studied mothers their age ranged between 20≤30 years with mean age 34±9.95 and 45.6% of them were secondary school level. Meanwhile 48.9% of studied fathers their age ranged between 30≤ 40 years with mean age 37.67±8.84 and 35.6% of them were secondary school level. Regarding to parents’ job 53.3% of studied fathers were free business. While 62.2% of studied mothers were doesn’t work and 68.9% of studied parents were extended family.
• Regarding to children health problems, 61.1% of the studied children always had signs & symptoms of genitourinary system’s inflammation, compared to 12.2% in post instruction guideline implementation. 58.9% of the studied children always had signs & symptoms of constipation, pre instruction guideline implementation compared to 25.6% in post instruction guideline implementation. 57.8% of the studied children always had signs & symptoms of oral mucositis, pre instruction guideline implementation compared to 23.3% in post instruction guideline implementation. There were highly statistically significant differences between all items of studied children regarding their health problems pre and post instruction guideline implementation, (p=<0.000**).
• Regarding to child’s health needs, 30.0% of the studied children had highly needs regarding skin care after radiotherapy session pre instruction guideline implementation compared to 67.8% in post instruction guideline implementation. 12.2% of the studied children had highly needs regarding suitable food during the period of receiving radiotherapy pre instruction guideline implementation compared to 46.7% in post instruction guideline implementation. 21.1% of studied children had highly needs regarding appropriate daily activities during the period of receiving radiotherapy pre instruction guideline implementation compared to 46.7% in post instruction guideline implementation. There were highly statistically significant differences between all items of studied children regarding their needs pre and post instruction guideline implementation, (p=<0.000**).
• Regarding to child health status, 100% of studied children had normal vital signs and level of consciousness. While 39%, 44% respectively of them had abnormal skin color after radiotherapy sessions. Also 53.3% of them had activity tolerance grade two.
• Regarding to total knowledge level of the studied parents with radiotherapy at pre and post instruction guideline, 20% of studied parents had good total knowledge level pre instruction guideline implementation compared to 70% of them had total good knowledge level post instruction guideline implementation.
• Concerning to total practice level of the studied parents with radiotherapy at pre and post instruction guideline, 18.9% of studied parents had satisfactory practice pre instruction guideline implementation. While 64.4% of them had satisfactory practice post instruction guideline implementation.
• There were statistically significant differences between total knowledge level of the studied parents and their age & level of education post instruction guideline implementation (p=≤0.000).
• There were statistically significant differences between total practice level of the studied parents and their age & level of education post instruction guideline implementation (p=≤0.000).
• There was a positive highly statistically significant correlation between the studied parents total knowledge level and their total practice level pre and post instruction guideline implementation (p<0.000**).
Based on the results of the present study and answering of research hypothesis, the following can be concluded:
• More than half of the studied children always had signs & symptoms of oral mucositis, pre instruction guideline implementation compared to less than one quarter in post instruction guideline implementation, more than two third of the studied children had highly needs regarding skin care after radiotherapy session post instruction guideline implementation, more than two third of the studied parents had good knowledge level post instruction guideline implementation and less than two third of them had satisfactory practices.
• There were statistical significant relations between total knowledge level of the studied parents and their demographic characteristic as age and level of education post instruction guideline implementation. There were statistical significant relations between total practices level of the studied parents and their demographic characteristic as age and level of education post instruction guideline implementation. there were a positive statistically significant correlations between the studied parents’ total knowledge level and total practice level pre and post instruction guideline implementation (p<0.000**).
Based on the findings of this study, following points are recommended:
1. Health education and continuous intervention classes should be encouraged by radiotherapy patient education team in outpatient for both parents to improve their knowledge and enhance their practice level regarding care of their children receiving radiotherapy.
2. Designing and distributing instruction guideline about radiotherapy for parents these materials are printed, online and on hospital TV channels
3. Health education about the radiotherapy must be involved in the routine nursing care for parents and their children who receiving radiotherapy.
4. Further studies are proposed to explore the effect of instruction guideline on increase parents knowledge and practice regarding care of their children on large sample of parents in different setting for the generalization of the obtained results.
5. Further studies, the Educational programs and courses for the radiotherapy nurses about radiotherapy, its side effects and needs of children should be provided to help the children and their parents to manage any problems.