Effectiveness of Intervention Program on Nurses` Practices about Caring of Children with Diabetic Ketoacidosis

Firas Turkey Ali and Zaid Waheed Ajil^*

^*Correspondence: Zaid Waheed Ajil, Department of Pediatric Nursing, College of Nursing, University of Baghdad, Baghdad, Iraq, Email:

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Introduction

Diabetic Keto Acidosis (DKA) is a possibly perilous metabolic confusion of type 1 diabetes mellitus. Regardless of mediations to decrease the rate of DKA, the Public Pediatric Diabetes Review for 2018 showed that in general 20.9% of all recently analysed patients in the Assembled Realm (UK) introduced in DKA, despite the fact that there is extensive local fluctuation (Schnabel, and Hedrick, 2018) [1].

DKA is described by uncontrolled hyperglycaemia, ketosis and resulting metabolic acidosis. The clinical picture can grow guilefully because of a variable star grouping of vague foundational signs and side effects, including polyuria, polydipsia, weight reduction, weakness, heaving and stomach torment, eventually prompting disarray, unconsciousness and passing, if untreated (Wolfs Dorf J, Glaser N, Sperling Mama, et al. 2006 [2].

This educational plan was produced for pediatric crisis medication (PEM) colleagues, and pediatric and crisis medication occupants, yet could be adjusted for interdisciplinary gatherings including colleagues, inhabitants, clinical understudies, attendants, high level practice suppliers, drug specialists, and respiratory advisors. In certain foundations, going to doctors might partake close by learners and subordinate staff to support their abilities or guarantee adequate members for a recreation meeting; when this happens, attending's regularly permit students to start to lead the pack in overseeing reproduced patients. The administration of pediatric DKA isn't restricted to doctors or doctor students and can be drawn nearer according to an inter professional point of view [3].

Finally, Encouraging nurses to be enrolled in training sessions to improve their knowledge and practice to keep them up to date about management of children especially in emergency situation decrease mortality and morbidity in children.

Methods

Study Design

The quasi experimental project that applied at the teaching hospitals for pediatric in the Ramadi city to ascertain the effectiveness of the interventional program on nurse's practices. Has regarded Diabetic's ketoacidosis care from 3th of March 2022 till 20 of March 2023.

Ethical Considerations

Moral endorsement was acquired from the Logical Exploration Moral Board of trustees in the School of Nursing College of Baghdad, and from clinics partaking in the review, prior to gathering the information.

Sample and Setting

The study is conducted in pediatric and maternity teaching hospitals at al Ramadi city. Including emergency departments, inpatient wards, intensive care, and preterm infants. The sample was distributed among a group of nursing staff, according to what was mentioned in the sample study. The non-probability convenient sample was connected in this study, that comprised
(50) nurses from pediatric wards of Ramadi teaching hospitals for pediatric, likewise was alienated into the study (experimental) group. The study group included
(50) nurses non-randomly selected from the nurses are exposed to a Ramadi Teaching Hospital, as shown in Table interventional program lectures.

Instrument

The Instrument constructed based on previous literatures review that related to study purpose.

The demographic data form was developed by the researcher and used to collect demographic data including their (age, gender, marital status, position, years of graft in hospital, years of practice in emergency department, training courses).

Nurses Practices regarding management of children during DKA care used to assess the nurses practice regarding care of children during DKA care a questionnaire composed of items that constructed main nurses practices the answer were scored according to Likert Scale (Never, Sometimes, Always).

The tool validity usually discusses the qualification which it is measures and supposed to measure, that communal to usage a panel of experts to reflect the new contains the tool [4]. The questionnaire and interventional program lectures was tested by (25) experts in changed medical and nursing fields. The professionals remained requested to review the tools' contents and lectures content of interventional program for relevancy, clarity, and adequacy. Their responses were betrothed into positive changes, and considerations were done to same of the items, also changes were made according to their recommendations, suggestions, and valuable comments [5].

Data Collection of Procedures

Data Collection

Nurses' practice measures are assessment needs through open–ended question. Data is mainly collected before the start of an interventional program, immediately after the completion of the program and pilot study.

After this implementing the current interventional program, nurses' practice from a list of items study group. Then the questions parts were used as post-test 1 that was applied upon the completion of an interventional program for each of the study group that obtained the program. The post-test, the information collected is selected by conducted of the study group that obtained the program. Information was collected from selected teaching hospitals in the Children's Ward of AL-Ramadi City. They are staying at Ramadi Educational Hospital from May 10 to September 20, 2022 [6].

Data Analysis

Spellbinding measurements (implies, frequencies, standard deviation, and rates) were utilized to depict the segment information. Inferential insights were utilized to look at the mean scores of every reliant variable. The suppositions of ordinariness and homogeneity of fluctuation of the variable were tried utilizing inferential insights and checked before the proper factual examination was performed. Importance was set at a p esteem < 0.05. Investigation of Change (ANOVA), it was utilized for decide the huge contrasts and the critical relationship among medical attendant's practices with their sociodemographic qualities [7].

Results

Characteristics Data of the Participants

The analysis in table 4-1 discloses nurse is normal age of 28±7 years old in which 62% of nurses are with age group of 20 – less than 30 years. Relative to gender, 60% of Nurses are women, while 40% of them are men. The qualification in nursing refers that 56% of nurses are graduated from nursing secondary school and 34% of them are graduated with diploma in nursing [8].

Table 4-1: Circulation Nurses According To Their Own Professional Characteristics.

This table shows that the average years of experience is 7±6 years, of which 58% of nurses associated with 1-less than 6 years of experience. Regarding working in current department, the nurses show 4±3 average years of working that 78% is working for 1-less than 6 years. The hours of working are referring to 8 hours among 72% of nurses and only 28% working for 24 hours. Regarding contribution in training courses, only 24% of nurses reported they participated in training courses inside country. More of nurses have not information about care of diabetes ketoacidosis (72%) and only 28% of them reported they get their information from internet [9].

This table exhibits the overall assessment of nurses’ practices about care of children with diabetes ketoacidosis; the table indicates that nurses show poor level of practices (M±SD=31.76±19.575) among 86% of nurses during the pre-test time though through the post- test time, the nurses show increasing in level of practices during the post-test time 1(M±SD=77.04±26.293) among 56% of them and post-test time 2 (M±SD=80.98±24.416) among 54%of them, which indicates an improvement in their practices after application of interventional program [10].

Dissection

Nursing Staff Mobility by Socio-Demographic Characteristics.

The table 1.1 commitments the factors of segment by any means out the respondents' model focus on bunch, bunch at age (20-30) years 62%, but test at age (30- 40)26% and 40 years and more 12%. The model isolated to male 40 % and female 60%. The total of 50 Examples, the Nursing Capability Centre School 2%, and optional school 56%, and Recognition 34%, and Unhitched male 8%, and hard and fast 50 models. These results concur with Mahmoud and Shawq (2022). With showed that the medical caretakers test when reviewing the mean (1.33) and standard deviation (0.606) of 73.3% (22) of the sample aged (20-29) years old, mean (1.60) and standard deviation (0.498), of which 46.7% (14) were single breastfeeding males, mean (2.30) and standard deviation (0.750) of educational attainment [11].

These results must be contradictory 110 patients participated in the review; 35 males (32.8%) and 75
females (68.2%). The average age was 34.6 ± 21.757 years old, the youngest was 3 years old, and the oldest was 80 years old. 32 members under the age of 15; they completed the survey with the help of their guardians, whose age ranged from 20 to 70, with an average age of 35. 28% (28.1%) were male and 71.9% were female. Member's financial status, this result is contradictory (Abduelkarem, AR and El-Sharif 2013). Who A total of 116 healthcare workers completed the pre-task survey: 49 from the cautious unit (42.2%); 33 (28.5%) from the drug unit; 15 (12.9%) from the emergency department); (7 (6.0%) from the paediatric; 5 cases (4.3%) from
Gynaecology; 5 cases (4.3%) from Dermatology, 2 cases (1.7%) from mixed departments. Most pooled tests were females (n=103; 88.8%) among the males and of the absolute number of female medical staff, 35 (30.2%) were non-Libyan. A total of 67 (57.8%) had a bachelor's degree in nursing, 34 (29.3%) had advanced nursing skills and 15 (12.9%) excluded them skills. Nearly half of healthcare providers (n=57; 49.1%) reported a positive first-degree relative with a family history of diabetes for
31.1 ± 7.1 years (range, 20-52 years). Mean tenure was
9.2 ± 5.7 years : 73 (62.9%) healthcare workers worked ≤ 10 years, 31 (26.7%) worked > 10 years, and 12 (10.3%) participants gave their insights into the working hours. Table 1 Participant orientation, teaching level, work area, and participant work time were summarized throughout the review period.

These results differ from information reviewed by Nedaa Q. Tuoma, MScN and Mohammed F. Khalifa in that the majority of these participants were female (65.6%), (20-29) and (40-49) years old (28.1%). In
addition, specialist nursing graduates (65.6%) enrolled
≥21 years (46.9%), of whom (62.5%) had (1-10) years of pediatric training at IMNCI (50.0%), prepared and accepted Baquba Medical Nursing Area I (Table 1). And (Table 3) results show that most of these caregivers are women (60.7%), (40-49) years old (39.3%). Personally, technical secondary school graduates (60.7%) have been employed for (1-10) years, and ≥21 years (39.3%) among them (75.0%) are willing to enter IMNCI and have (1-10) years of paediatrics (57.2%) In the second district of Baquba medical service manifestations of this quality indicate that healthcare professionals are similar in their orientation, age, education, preparation and practice, yet differ in their operations.

In place of my view note in this table and through the examples, there is a little level of holders of four year certifications in nursing sciences, and none of those compartments of higher degrees by any stretch of the imagination. Ages from 20-30 years, this shows the shortfall of absence of involvement and practice as well as equality among ladies and men.

Table 4-2: Overall Assessment of Nurses’ Practices about Care of Children with Diabetes Ketoacidosis.

Table 4-2: Overall Evaluation of Nurses’ Practices about Care of Children with Diabetes Ketoacidosis.

This table shows the overall assessment of nurses’ practices about care of children with diabetes ketoacidosis; the table indicates that nurses show poor level of practices (M±SD=31.76±19.575) among 86% of nurses during the pre-test time whereas through the post-test time, the nurses show increasing in level of practices during the post-test time 1(M±SD=77.04±26.293) among 56% of them and post- test time 2 (M±SD=80.98±24.416) among 54%of them, which indicates an improvement in their practices after application of interventional program.

This result is consistent with Ameer et al. (2019). The response rate was 95.4%. Respondents had clear comments and attitudes towards the general guidelines and the DKA guidelines; 98.7% considered the CPG to be a valuable source of guidance that improves well-being and reduces risk and diversity over time.

This result is consistent with Khudhair, SH (2016) concerned about the review findings that healthcare professionals have unfortunate practices in pre- testing. In each case, follow-up revealed a high level of practice by the neonatal emergency department nurses in managing neonatal jaundice. The plan takes into account the impact on physician practice. There is no measurable major correlation between nurses' practice and its segment quality End: There is no de facto critical correlation between the training of medical staff and its segment characteristics. The review indicated that, in the NICU, poor nurses were trained pre-test to care for infants with neonatal jaundice and good practice in post- test 1 and post-test 2.

This result is consistent with Ahmed (2019). A total of 73 surveys included in the study, and the response rate was 90.12%, with male and female participants being 43.83% and 56.16%, respectively. When asked about the priority of blood sugar control, 81.25% and 90.24% of the male and female respondents respectively gave the correct answer. The missing information is related to World Diabetes Day. About 37% of the respondents were diabetics. Only 12 of 73 respondents knew what triggered DKA. 8 out of 73 knew that the exam had to be done in DKA. Considering the risk of diabetes, about 43.84% of the respondents were aware of the statutory screening provisions [12].

This outcome concurs with Aula I. Abd-Alrazzaq& Afifa
R. Aziz (2021). This study can be shown that moms, no matter what their age, when one of her youngsters is determined to have sickle cell illness, she really buckles down on the most proficient method to deal with her kid in a sound manner and secure the right data that assists her with that. Additionally, the degree of training of mother is assists with understanding the data being given during the program educating meeting.

This outcome concurs with Mohammed AQ. Study was gathered by utilizing a developed poll through a utilization of direct meeting and perception agenda. The information was examined by utilizing two factual methodologies: Graphic, Inferential measurements. The review uncovered that the medical attendant's information about NG tube was 54.3% (Poor), trailed by the people who have 37.1% (fair) information.

In place of my view this table shows, as a general rule, the degree to which clinical and nursing care is given when the presentation of the mediation program. We note that in 31% of the pre-test and after the test and execution of the program, we note the expansion in nursing practices and care for analysis youngster’s present test1 on 70%. Here, the expansion in nursing practices and really focusing on analysed kids present test2 on 80%. This shows that the mediation program has been effective [13].

Conclusion

The characteristics of study sample, the common greatest for nurses usually are female and also age (20- 39) years, graduated from institute of the medicinal and have (1-5) year's period of employments, not having courses for training associated to subject study, and not having source reading. The nurses of the hospital of teaching for pediatric at Ramadi city ensure no have appropriate and adequate nurses' practice regarding the nursing care and management for pediatric patient with diabetic's ketoacidosis.

Recommendations

Anbar Health Directorate at Iraqi Health Ministry to upcoming improve for policies interventions that aimed to assisting, understanding and then supporting the nurses and ill children with diabetic's ketoacidosis lasts instructional programs for nurses must be recognized to elevate the nurses' practice regarding the diabetics ketoacidosis to be expert. Training course and workshops for nurses of the hospital teaching of pediatric in Ramadi city regarding diabetics ketoacidosis.

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