الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
B
reast cancer remains a major public health problem, and prevalence is increasing particularly in developing countries. For most women with breast cancer, surgery is part of the treatment process. Majority of cancer patients experience suffering during their care. Therefore, Nurses should to be fully equipped with appropriate knowledge, practice and attitude in order to care for the patients effectively and thereby achieving patient satisfaction.
Aim of the Study
This study aimed to improve nurses’ performance to meet satisfaction of patients undergoing breast cancer surgery through the following:
5. Assess level of knowledge, practices and attitude for the studied nurses.
6. Develop and implement the educational guidelines
7. Evaluate effect of these guidelines on nurses` knowledge, practices and attitude.
8. Assess level of patients` satisfaction with the nursing care.
Research hypothesis:
It was hypothesized that improving nurses’ performance through educational guidelines have a positive effect to meet satisfaction of patients undergoing breast cancer surgery.
Methodology:
A) Design
A quasi-experimental study design was utilized to conduct this study.
B) Setting
The study was conducted in the Surgical Departments at El-Demerdash Hospital, affiliated to Ain Shams University
C) Subjects:
Subjects included two groups as follows:
First group: A convenience sample was composed of 40 nurses with different ages, educational level and years of experiences.
Inclusion criteria:
• Nurses working in surgical wards with patients undergoing breast cancer surgery.
• Nurses who are willing to participate.
Second group: A purposive sample of (50) patients from the above mentioned setting enrolled in the study. They were selected according to the sensitive analysis in relation to the number of women undergoing breast cancer surgery within the year 2014 in El Demerdash Surgical Hospital according to statistical department which affiliated to the setting. They were taken as follows:
Inclusion criteria:
• Women undergoing breast cancer surgery.
• Women who will agree to participate in the study.
• Conscious women with non co – morbid conditions.
Sample size: It was determined according to the statistical calculation which guided by:-
• Power of the test=80%
• Confidence level=95%
• Accepted level of error=5%
D) Tools of data collection
Tool (I):
Self administered questionnaire (pre/post and follow-up tests) (Appendix I): It was developed by the researcher in simple Arabic language based on the extensive review of relevant and recent literatures (Long et al., 2010, Osborn et al., 2010, christensen & Kockrow, 2011 and Daniels et al., 2012). It included the following:
Demographic characteristics: It included age, qualifications and clinical experience of the studied nurses.
Nurses’ knowledge assessment sheet: This tool was developed to assess levels of nurses’ knowledge related to anatomy of the breast, definition of breast cancer, risk factors, signs and symptoms, investigations, surgical management, complications of surgical management, wound care, pain management, arm exercises, breast self examination, self-care activities and follow – up visits.
Scoring system: Nurses’ responses were scored as follows:
• Correct answer = 1
• Incorrect answer = zero
Level of knowledge was considered satisfactory if the total score was 70% or more and unsatisfactory if less than 70%.
Tool (II):
An observational checklist (pre/post and follow up tests) (Appendix II). It was adopted from Taylor et al. (2012), Lynn (2011) & Long et al. (2010) to evaluate practices of nurses caring for patients undergoing breast cancer surgery regarding pre/postoperative preparations, wound care, pain assessment and management, arm exercises and breast self examination technique.
Scoring system: Each item in every checklist was observed and scored into the following:
• Correctly done = 1
• Incorrectly done = zero
Level of practices was considered satisfactory if the total score 70% or more and unsatisfactory if less 70%.
Tool (III):
Nurses’ attitude assessment sheet (pre/post and follow up tests) (Appendix III): It was developed by the researcher in simple Arabic language to assess attitude of nurses toward cancer and care of patients with breast cancer surgery. It was composed of 11 items.
Scoring system: It was scored on a 4-point Likert scale format (1= strongly disagree, 2= disagree, 3= agree, 4= strongly agree). The lower score represent negative attitude which held towards cancer.
Level of attitude was considered positive if the total scores = 70% or more and negative if less than 70%.
Tool (IV):
Patients` satisfaction with nursing care scale (PSNCS) (Appendix IV): It included the following:
• Demographic characteristics of the studied patients such as: age, marital status, level of education, type of surgery ….etc.
• Satisfaction scale: It was developed based on Cox’s Interaction Model of client health behavior (1982). It completed by interviewing of the studied patients to determine their level of satisfaction and divided into four domains: health information, affective support, decisional control and professional-technical competencies (Tang et al., 2013).
Scoring system: It was scored on a 4-point Likert scale format (1= strongly disagree, 2= disagree, 3= agree, 4= strongly agree). The score was categorized into low, moderate and high level of satisfaction as follows:
- High level of satisfaction ≥ 70 %
- Moderate level of satisfaction 50 - ˂70 %
- Low level of satisfaction < 50%
Results of the present study:
More than half (55%) of studied nurses were more than 30 years and had nursing diploma. More than two thirds (70%) had more than 10 years work experience and the work was a source of information for most of them.
The studied patients (52%) had the age of 50 years and more. 36% of them were not read and write. the majority of them were married, housewives and hospitalized for less than 3 days (80%, 84% & 92% respectively). Conservative surgery for the breast cancer was represent 62% of them.
There was a highly statistical significant difference between pre / post guidelines intervention as regards studied nurses` satisfactory knowledge, practices and attitude on caring of patient with breast cancer surgery. More improvement was indicated post guidelines compared to pre.
Half of patients (50%) were highly satisfied and two fifths (40%) of them were moderately satisfied while fifth (10%) of patients were low satisfied with nursing care.
The highest domain for patients’ satisfaction was profession-technical competencies. Meanwhile decisional control was the lowest.
There was a statistical significant difference between nurses` satisfactory knowledge pre/post guidelines as regards their socio-demographic characteristics.
There was a statistical significant difference between nurses` satisfactory practices pre/post guidelines as regards their socio-demographic characteristics.
There was a statistical significant difference between nurses` positive attitude pre/post guidelines as regards their socio-demographic characteristics.
There was a highly statistical significant difference between patients’ satisfaction levels (low, moderate and high) post guidelines as regards their demographic characteristics.
There was a statistical positive relation between total nurses’ performance (knowledge, practices and attitude) and patients ` satisfaction post guidelines intervention.
Conclusion:
On light of the current study results, it can be concluded that, educational guidelines had a positive effect on nurses’ performance to meet satisfaction of patients undergoing breast cancer surgery. A highly statistical significant difference between pre / post guidelines interventions regarding nurses’ knowledge, practices and attitude were indicated. Half of the studied patients were highly satisfied with nursing care. Moreover, there was a statistical positive relation between nurses’ performance and patients’ satisfaction with nursing care after guidelines interventions.
Recommendations:
o In-service education at the workplace can be of additional benefit.
o There is a need to study in-depth the parameters relevant to patients’ satisfaction with nursing care.
o Standard nursing procedures booklet should be available for such group of study nurses.
o Nurses should be updated on their knowledge through attending seminars, workshops, lectures and reviewing researches.
o An orientation program for newly graduated nurses in surgical wards should be prepared.
o Further studies are needed to confirm the long-term impacts of the educational guidelines intervention.