Developing Clinical Protocol for Nursing Practice: Improving Care of Children with Nephrotic Syndrome

Abstract

Summary N ephrotic syndrome (NS) in children is a common chronic disorder and serious medical condition, characterized by alterations of permselectivity at the glomerular capillary wall. The classic triad of proteinuria, hypoproteinemia, and edema defines the syndrome. The prevalence of nephrotic syndrome in children is being 15 times greater than in adults (Hockenberry and Wilson, 2013). The use of evidence-based clinical protocols is an important fact in our health care system. Nurses are regularly involved in patient education, assessment, and treatment. The use of clinical protocols has benefited physicians, nurses and patients. Because each protocol contains a comprehensive, up-to-date review of the disease process and provides the rationale for each therapeutic decision (Mills et al., 2011). The aim of the study The aim of this study was to develop clinical protocol for nursing practice for improving care of children with nephrotic syndrome through: • Assess nurses' knowledge and practices regarding to nephrotic syndrome • Design, implement and evaluate the effect of clinical protocol regarding to care of children with nephrotic syndrome. Hypothesis of the study The developing of clinical protocol for nursing practice will improve the care of children with nephrotic syndrome. Subjects and Methods Research design: An intervention design (Quasi-experimental research design) was used to conduct this study, with pre/ post and follow up assessment to evaluate the effect of implementation of nursing protocol for nurses towards nephrotic syndrome. Research settings: The study was conducted at the in-patient and out-patient department in Nephrology Department affiliated to Abo Elresh Pediatric Hospital and Ain Shamse Pediatric Hospitals. Sample size and characteristics: A purposive of sample that comprised fifty nurses worked at the previously mentioned settings and given care for children with nephrotic syndrome from both gender and regardless of their qualifications and years of experience, thirty nurses worked at the Nephrology in-patient and outpatient department affiliated to Abo Elresh Pediatric Hospital and twenty nurses worked at the Nephrology in-patient and Outpatient Department at Ain Shams Children's Hospital. Fifty children diagnosed with nephrotic syndrome in previous mention setting included in the study with the following inclusive criteria: - Diagnosed with nephrotic syndrome. - Both sex and their age ranged from three to five years. - Free from other mental or physical diseases. Study tools: Data were collected through using the following tools: 1) Questionnaire format for nurses (pre, post and follow up format). It was designed by the researcher in simple Arabic language by the researcher based on the relevant literatures review and guided by the supervisor. It comprised form two parts as following: Part I: Characteristics of the studied nurses that include age, sex, marital status, level of education, level of occupation (registered nurse or head nurse), and years of experience, attendance of previous training programs related to nephrotic syndrome. Part II: Concerned with nurses’ knowledge regarding nephrotic syndrome such as; definition, causes, clinical manifestations, complications, treatment, methods of prevention and nursing care of nephrotic syndrome. 2) Observational checklist: It was adopted from Hockenberry and Wilson (2011) and modified by the researcher to assess the nurses’ actual procedure regarding care of children with nephrotic syndrome such as performance collection of urine specimen, taking of blood specimen, genital care, abdominal girth, measuring weight and taking vital signs. 3) Protocol of care construction; it was designed by the researcher after extensive revised and modified by supervisors. Pilot Study: It was carried out on 10% of total sample size to evaluate the clarity, content validity and applicability of the study tools, which was used in data collection, results of the pilot study helped to make modifications on the tools. Some items of questionnaire were modified and unnecessary questions were omitted. It takes about one month from the end of July to the end of August 2012. The subjects included in the pilot study were excluded from the study sample. The protocol of care evaluation: protocol of care appraisal was done by comparing the nurses' knowledge and skills through pre, post and at follow up (after 4 months) of the protocol intervention, using pre test format and observation checklist. Results The important findings that obtained from the study could be summarized as follows: - Less than half (34.0%) of nurses' age were ranged between +30 < 40 years old, with mean 35.3±8.7 years. Also 96.0% of nurses were female. - The years of experience for 48.0% of nurses were +5 to 15 years with mean ± S.D equal to 15.1±7.6 years. Also 80.0% of nurses not attended any training course about nephrotic syndrome. - There was a highly statistically significant difference was found between nurses' total knowledge related to nephrotic syndrome before and after implementation of nursing protocol (P< 0.001). Where, the majority of nurses had poor knowledge about nephrotic syndrome at the pre protocol phase, while, the nurses' knowledge improved at the post protocol intervention. The nurses' knowledge declined at the follow up phase.