الفهرس 
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Abstract
Many infants and young children with developmental delays or risk factors for poor developmental outcomes are not identified by pediatric practitioners in a timely manner until they reach school age. They are passing through health care systems undetected. When they are identified, they are often not referred to appropriate early intervention services or early childhood development programs. They are therefore denied the opportunity to benefit from programs documented to have long-lasting benefits for children.
Early identification of children with developmental delays such as mental retardation is important in the primary care setting. It helps in terms of treatment for some conditions, better planning and management of cases. Sometimes, it can help to limit the number and extent of the handicap. Researches have demonstrated that early detection of developmental disabilities and appropriate intervention can significantly improve functioning and reduce the need for lifelong interventions.
Nurses are the principal group of health personnel providing primary health care at all levels and maintaining links between individuals, families, communities and the rest of the health care system. Nurses have a vital role in primary health care, and therefore should be prepared to deliver all types of care, including measures for disability prevention and early detection. Early identification of mental retardation is one of the challenges facing health visitors or child health nurses.
Aim of the Study
The aim of this study is to develop the skills of primary health care nurses in early detection of mental retardation during childhood through:
1. Assessment of the nurses’ knowledge, attitudes, and practices in relation to early detection of mental retardation.
2. Develop and implement a training program on mental retardation according to the training needs of the primary health care nurses
3. Evaluate the improvement of the nurses’ knowledge, attitudes, and practices after implementing the training program.
Study Hypothesis
The knowledge, attitudes, and practices of primary health care nurses about early detection of mental retardation will be improved after implementation of the training program.
Research Design
A quasi-experimental research design was utilized in this study.
Setting
This study was conducted in primary health care centers in Giza city. These primary health care centers were randomly selected from the three geographical sectors of Giza City (one from each sector: north, south, and west only because the east sector is the Nile river).
The selected primary health care centers are:
àEl Giza, and El Monib family health center from south sector,
àEl Talbia, and El Omrania family health center from the west sector, and
àMadinat El Omal family health center in Imbaba from the north sector.
Subjects
The subjects of this study were the primary health care nurses. A purposive sample that involved all available nurses working in the above mentioned settings was recruited for participation in this study, the total sample is 47 nurses.
Data Collection Tools
Two tools were utilized to collect data for this study a structured interviewing questionnaire and observational checklist.
A. A structured interviewing questionnaire:
A structured interview with questionnaire was developed by the researcher after reviewing related literatures, and used in collecting the data for this study. They were used to assess the nurses’ knowledge and attitudes regarding early detection of mental retardation and their socio-demographic characteristics. The questionnaires written in Arabic language, it includes the following parts:
Part 1: Socio-demographic characteristics of the studied sample: That includes name, age, qualifications, total years of experience and pervious training courses.
Part 2: Knowledge assessment questionnaire sheet: This sheet was utilized to identify the nurses’ background information. It was written in the form of multiple choice questions, true and false questions, matching questions, completes the sentence, and yes/no questions.
Part 3 : Attitude questionnaire sheet:
A 20-item questionnaire of affective statements was constructed and utilized to assess the nurses’ attitudes toward early detection of mental retardation using Likert scale.
B. Observational Checklist:
An observational checklist was used to assess the nurses’ performance in detecting mental retardation in children.
Program Construction
The researcher started to conduct the training program after finishing the pre-test, by a brief introduction to the program. The program was implemented in eight sessions (five theoretical and three practical sessions). The program was implemented either individually or in groups from two to four nurses in a session according to the number of nurses, availability, work circumstances, and the physical and mental readiness of the nurses.
The duration of each session ranged from 1 hour to 1.5 hour per session including time for discussion and giving feedback. The maximum duration of training session per day was 1.5 hour at the end of the working day. By the end of the training program, the participants were examined using the same tools and checklists (post-test). After three months of completion of the training program, all nurses were examined again using the same tools and checklists (follow up test).
Study Results
The main results obtained from this study were as follows:
The entire sample was female nurses, their age ranged from 22 – 59 years old, with the mean age (36.7±11.0). Their level of education was secondary school of nursing in (44%) of them, (25.5%) of the sample has more than 25 years experience working in nursing field, while (25.5%) of them have from 10 to 15 year experience in pediatric nursing. None of the nurses attended training courses in mental disability or mental retardation. Most of the sample (93.6%) attended training courses in different areas that are dealing with maternal and child health and primary health care fields.
The baseline results revealed that none of the nurses gained satisfactory scores in their total knowledge about mental retardation before implementing the program in all topics of the program. These findings were improved after implementing the program to be (97.8%) in the post test, and (84.8%) in the follow up test. A statistical significant differences was observed between pretest and post test, and between pretest and follow up in the nurses’ knowledge about mental retardation (p<0.001).
The nurses’ attitudes toward early detection of mental retardation were positive in (48.9%) of the nurses before implementing the program. These findings changed to positive attitude immediately after implementing the program reaching (91.5%) and to (86.9%) in the follow up. These findings also were statistically significant when comparing pretest and post-test, and pretest and follow up (p<0.001).
The nurses’ practices were not adequately performed in the majority of the participants before implementing the program, only (12.8%) of the nurses who gained adequate scores in their total practices regarding early detection of mental retardation. These findings were changed to adequate performance immediately after implementing the program, in (91.4%) of the nurses in the post test and (85.8%) of the nurses in the follow up test. These findings also were statistically significant when comparing pretest and post-test, and pretest and follow up (p<0.001).
Based on the study results, the research hypnosis was proved as following; the knowledge, attitudes, and practices of primary health care nurses about early detection of mental retardation were improved after implementation of the training program. These improvements were 58% in the knowledge scores, 43% improvement in the attitude scores, and 78% in the practices scores. Furthermore, the programme attendance was the only statistically significant independent factor that could predict the improvement in the nurses’ knowledge scores after implementation of the program. While, program attendance, knowledge score, and age of the nurses were the statistically significant independent factors that could predict the improvement in the nurses’ attitude scores after implementation of the program. Lastly, program attendance, total experience in pediatrics, and knowledge score were the statistically significant independent factors that could predict the improvement in the nurses’ practices score after implementation of the program.