الفهرس 
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Abstract
Neonates are observed closely in the first few hours of life. This is particularly true for premature births, which occur before the 37th week of pregnancy, or if there are any complicationss during delivery. Full term neonate goes through important growth throughout pregnancy, including in the final months and weeks. Premature neonates can have immature lungs, difficulty in regulating body temperature, poor feeding, and slow weight gain. Immediately after birth, a medical team quickly checks the neonate’s vital signs, alertness, and overall health. Supplemental oxygen and other emergency care may be provided if the neonate has breathing difficulties (Fukuoka et al., 2019).
Neonatal renal problems may be the result of either specific inherited developmental abnormalities or acquired events in the prenatal or postnatal period. Therefore, an understanding of the developmental process and the differences of renal physiology in the neonatal period compared to that at later ages is necessary for evaluation that includes a detailed review of the presenting clinical features and relevant laboratory and radiologic findings (Brooks et al., 2013).
The mortality of neonatal renal failure may be as high as 60% in medical ARF and even higher in neonates with congenital heart disease, or with anomalies of the genitourinary system. Knowledge regarding care of neonatal renal disorders among nurses’ is low. Early awareness and educational programs may help to early detection of neonatal renal disorders and prevent complications, (Bauer, & Harer. 2018).
Nursing responsibilities and role in renal disorders begins with observation of the neonates for any manifestations that might indicate dysfunction. The most significant ongoing assessment in neonates with renal conditions is accurate measurements and recording of weight, intake and output and blood pressure. This assessment is necessary not only for neonates with known renal dysfunction, but also for those neonates at risk for developing renal complicationss (Hockenberry & et al., 2017).
The neonatal nurse plays a vital role in providing information, care, support, understanding and therapeutic counseling to the family of the neonates throughout the entire illness. The nursing management must be provided in order to reducing the complicationss of renal function and the stresses of dealing with a life threatening illness (James &et al., 2018).
Aim of the study:
The current study was conducted to assess the nurses’ performance regarding care of neonates suffering from renal disorders through:
• Assessing nurses’ knowledge, attitudes and practice regarding care of neonates with renal disorders.
Research questions:
What are the nurses ’ knowledge regarding care of neonates suffering from renal disorders?
What are the nurses’ attitudes regarding care of neonates suffering from renal disorders?
What are the nurses ’practices regarding care of neonates suffering from renal disorders?
Are there relation between nurses’ knowledge, attitudes and practices regarding care of neonates with renal disorders and their characteristics?
Subjects and Methods
I. Technical design.
II. Operational design.
III. Administrative design.
IV. Statistical design.
I- Technical design:
The technical design included study design, settings, subject and tools for data collection.
Study design:
A descriptive design was used to conduct this study.
Study Settings:
This study was carried out in the Neonatal Intensive Care Units (NICUs) in Abo- Elreash AL Monira Hospital Cairo University affiliated to Ministry of High Education and Scientific Research and Shibin Alqanater Center Hospital affiliated to Ministry of Health.
Study Subjects:
1- A convenient sample composed of 90 nurses who are working in the previously mentioned settings regardless their age, gender, qualifications and years of experience.
2- All available neonates diagnosed with renal disorders within 6 months from the beginning of data collection.
Tools of data collection:
Data collected by the use of the following tools:
Tool 1: Pre-designed Questionnaire Sheet:
It was designed by the researcher after reviewing the related literature and after reviewing from research supervisors. It was written in simple Arabic language for gathering data. It included of the following two parts:
Part 1: Which include the following?
A. Characteristics of studied nurses such as their (age, gender, level of education, training programs, and years of experience)
B. Characteristics of studied neonates such as their (gender, gestational age, birth weight, length, chronological age, diagnosis, duration of hospital stay, methods of feeding and how to diagnosis)
Part II: It’s consisted of nurses’ knowledge regarding care of neonates with renal disorders.
Part II1: It’s consisted of nurses’ knowledge regarding care of neonates with some renal disorders
Tool 2: Nurses’ Attitudes Scale:
This scale adapted from, Holsti L., etal, (2011). It assessed nurses’ attitudes regarding care of neonates suffering from renal disorders. ”Agree”, ”Uncertain” and ”Disagree”.
Positive attitude: If the total nurses’ score more than or equal 80%.
Negative attitude: If the total nurses’ score less than 80%.
Tool 3: Observational Checklists:
It was adapted from, Green berg and Bowden, (2016), MacDonald, M., Ramasethu, J., and Rais-Bahrami k. (2019)., and Jamieson E., Whyte L., and McCall J. (2017) .It assessed nurse’ practice regarding nursing care of neonates suffering from renal disorders., measuring weight, abdominal circumference, measuring vital sings, fluid and electrolytes assessment, recording intake and output, blood glucose test, assess skin integrity, diaper care, care of urinary catheter).
Content validity and reliability
It ascertained by jury of experts (5) in field of Neonatal and neonatal nursing to test its content validity and reliability.
Validity:
Content validity carried out to determine whether the tool covers its aim through a group of 5 experts in the field of Neonatal and neonatal nursing, Ain Shams University, and the study tool reviewed regarding the clarity, relevance, comprehensiveness and simplicity.
Reliability:
It was test statistically to assure that the tool is reliable before data collection. Testing the reliability of the same tool was done through chronbach Alpha Coefficient test, and it was proven to be high as shown in the following table:
Tools Reliability Validity Internal consistency
Reliability Coefficient Cronbach’s Alpha Self-validate Content validate
Pre-designed Questionnaire Sheet 0.822 0.909 0.857 0.920 Satisfactory
Nurses’Attitudes Scale 0.893 0.931 0.975 0.931 Satisfactory
Observational Checklists 0.848 0.885 0.927 0.885 Satisfactory
Translation and back translation:
To ensure the suitability of the used tools to the purpose of the current study, part from the tools of data collection (observational checklists and nurses’ attitude scale) were translated into Arabic using a translating and back translating technique and committee approach. A bilingual researcher blindly translated the instruments from English to Arabic and a second bilingual researcher back- translated it independently. A panel of three bilingual experts in healthcare workforce management and in health research reviewed the translated instruments in comparison with the English format and assured their validity.
II. Operational Design:
Preparatory phase:
During this phase, the study tool was be prepared through be reviewing the available local and international related literature and theoretical knowledge of varies aspects of the study using textbooks, articles, internet, periodical, magazines to be acquainted with the research problem and develop the study tools and contents. During this phase, the researcher also visited the selected places to get acquainted, permission to start the study setting.
Ethical Considerations:
The research approved to obtain from the Scientific Research Ethics Committee at the Faculty of Nursing, Ain Shams University. The researcher explained the aim of the research to the studied nurses who agreed to participate in the study. Anonymity and confidentially of the study subjects had been assured. They were being informed that all collected data would be used for research purpose only; and they were assured about right to withdraw from the study at any time and without giving any reasons. In addition to, oral consent was taken from the neonates’ parents.
A-Pilot study: A pilot study conducted on 10% of nurses (9) to evaluate the validity, applicability, and clarity, the effectiveness and time consumed to fill in study tools. The pilot has also served to estimate the time needed for each subject to fill the study tools. According to the results of the pilot, some correction and omission of items were performed as needed. The pilot participants were excluded for the main study sample.
B-Field work: The actual field work carried out in the period from the beginning of August 2022 to the end of January 2023 using the previously mentioned study tools.
The researcher started by introducing herself to head nurse at the NICUs, giving a clear and brief idea about the aim of the study and its expectations. The researcher was available 2 days/ week in the morning shift (Sunday and Tuesday) from 9 am - 2pm to collect data by using the previously mentioned study tools. The researcher was collected the data through pre- designed questionnaire to assess knowledge, nurses’ attitude scale to assess attitude and observational check list to assess practice.
The pre-designed questionnaire sheet was filled by nurse. The time consumed to answer the questionnaire and nurses’ attitude scale ranged from 30- 35 minutes for each one to complete the study tools. As similar observation checklist was performed during nurses’ practice when providing care neonates suffering from renal disorder, each procedure consumed (5) minutes. from the time consumed average of nurses in shift (25), and number of nurses assess was (2-3) in shift.
III- Limitation of the study:
The researcher did not take the study subjects from the NICU at Ain Shams Maternity and Gynecological Hospital affiliated to Ain Shams University Hospitals due to administrative constraints and refusing to obtain permission from the hospitals director.
IV. Administrative design:
An official permission to carry out the study obtained through an issued letter from the dean of Faculty of Nursing, Ain Shams University to directors of each hospital in the previously mentioned settings.
V. Statistical design:
Data collected from the studied sample was revised, coded and entered using PC. Computerized data entry and organized, Statistical analysis;
Recorded data were analyzed using the statistical package for social sciences, version 22.0 (SPSS) Inc., Chicago, Illinois, (USA). Quantitative data were expressed as mean (x-) standard deviation (SD). Qualitative data were expressed as frequency and percentage.
The following tests were done:
Chi-square (x2) test of significance was used in order to compare proportions between qualitative parameters.
Pearson’s correlation coefficient (r) test was used to assess the degree of association between two sets of variables
The confidence interval was set to 95% and the margin of error accepted was set to 5%. So, the p-value was considered significant as the following:
Probability (P-value)
– P-value <0.05 was considered significant.
– P-value <0.001 was considered as highly significant.
– P-value >0.05 was considered insignificant.
The main results obtained from the present study were as follows:
1. The mean age of studied nurses was 29.22+ 4.97, more than fifty total nursing age (20-30) years 63.3% approximately and 66.3% from them in female.
2. Regarding nurses’ qualification, it was found that 42.2% had bachelors of nursing.
3. As regards nurses’ experience. It was found that 41.2%of studied nurses had <3years of experience in general nursing and NICU.
4. Regarding nurses’ courses. It was found that 91.1% of studied nurses hadn’t courses about renal disorder in neonate.
5. 45.6% of the studied neonates their gestational age were 37≤40 weeks.
6. 60% their chronological age was 1-7 days of the studied neonates.
7. 72.6% were born in cesarean section of the studied neonates
8. Regarding birth weight were 38.9% is 1500≤2500; while, 44.4% were current weight 1500≤2500 gm. of the studied neonates.
9. 30% of the studied neonates their length of stay was <7 days.
10. 26.7% of the studied neonates their diagnoses were respiratory distress syndrome (RDS), and 16.7% of them were renal on admission.
11. 38.9% of the studied nurses had satisfactory knowledge regarding renal system in neonatal while 32.2% had average and 28.9% had unsatisfactory.
12. 32.2% of the studied nurses had satisfactory knowledge regarding nursing care in neonatal renal disorder while 30.0% had average and 37.8% had unsatisfactory.
13. 35.6% of the studied nurses had average total knowledge regarding some neonatal renal disorder.
14. 87.8% of the studied nurses had positive attitude regarding nursing care in neonatal renal disorder.
15. Regarding nurses’ practice. It is notice that 75.6% had competent.
16. 76.7% of studied nurse had competent of performance. While, 23.3% of them had incompetent of performance regarding care of neonates suffering from renal disorders.
17. Regarding knowledge of components of renal system 85.6% is satisfactory.
18. Regarding knowledge of functions of renal system 88.9% is satisfactory.
19. 86.7% of studied nurses had correct knowledge regarding types of neonatal renal disorders.
20. 66.7% and 66.7% of studied nurses had correct knowledge about definition and diagnoses of neonatal renal disorders.
21. 87.8% of studied nurses had correct knowledge regarding O2 saturation (PaO2); on the other hand, 61.1% of them had incorrect knowledge about Ph. in blood.
22. 51.1% of nurses had correct knowledge regarding normal level of urea. On the other hand, most (90%) all of them had incorrect knowledge about normal level of calcium.
23. 90% of studied nurses had correct knowledge regarding to importance of measuring intake and output. On the other hand, almost all of them 82.2% of nurse had incorrect knowledge about normal amount of urine output.
24. 50% and 56.7% of studied nurses had correct knowledge regarding to types of neonatal CKD and etiology of neonatal CKD, respectively. On the other hand, almost all of them 84.4% of nurse had incorrect knowledge about the effect of neonatal CKD on the neonate’s health condition.
25. 72.2%, 70% and 61.1% of studied nurses had correct knowledge regarding to nursing intervention regarding neonatal CKD, diagnosis of neonatal CKD and treatment of neonatal CKD respectively.
26. 60% of studied nurse presence of AKI in neonates had incorrect knowledge about of clinical manifestation.
27. 57.8% and 67.8% of nurse had incorrect knowledge about of complications and assessment of neonatal acute kidney injury (AKI), respectively.
28. 80.0%, 68.9% and 66.7% of studied nurses had incorrect knowledge about of causes, definition and diagnosis of ARF in neonates, respectively.
29. 68.9%, 76.7% and 61.1% of studied nurses had correct knowledge regarding treatment of neonatal ARF, nurses’ role regarding care of neonates with ARF and health education for parents of neonates with ARF, respectively.
30. 80% of studied nurses were competent in their practices regarding anthropometric measurements for neonates suffering from renal disorders.
31. 76.7% of studied nurse had competent practices regarding measuring vital signs for neonates suffering from renal disorders.
32. 80% of studied nurse had competent practices regarding monitoring of neonates suffering from renal disorders.
33. 70% of studied nurse had competent regarding total of diaper care, skin care of neonates with urinary catheterization.
34. there were highly statistically significant relation between level of total knowledge regarding neonatal renal system & care of neonates suffering from renal disorders according to their presence of Protocol for care of neonates with renal disorders in NICU at (p-value <0.001).
35. There were a statistically significant relation between level of knowledge and their educational level, years of experience and training courses at (P<0.05).
36. There is no significant relation between level of knowledge and their Age at (P>0.05).
37. There were highly statistically significant relation between level of total attitudes regarding care of neonates suffering from renal disorders according to their educational level at (p-value <0.001).
38. There were a statistically significant relation between level of attitude and their years of experience, training courses and presence of protocol for care of neonates with renal disorders in NICU at (P<0.05).
39. There is no significant relation between level of attitude and their Age at (P>0.05).
40. There were highly statistically significant relation between level of total practice regarding care of neonates suffering from renal disorders according to their years of experience, training course, presence of Protocol for care of neonates with renal disorders in NICU at (p-value <0.001).
41. There were a statistically significant relation between level of practice and their educational level at (P<0.05).
42. There is no significant relation between level of practice and their Age at (P>0.05).
43. There were highly statistically significant relation between total level of nurses performance regarding care of neonates suffering from renal disorders regarding their educational level, years of experience at (p-value <0.001).
44. There were a statistically significant relation between total level of nurses’ performance and their training courses and presence of protocol for care of neonates with renal disorders in NICU at (P<0.05).
45. There is no significant relation between total level of nurses’ performance and their age at (P>0.05).
46. There were statistically significant positive correlation between mean score of total level of nurses’ knowledge, attitude and practices regarding care of neonates suffering from renal disorders, with (r=0.496, p<0.001; r=0.517, p<0.001 and r=0.438, p<0.001) respectively.
Conclusion:
The current study findings concluded that more than one third of the studied nurses had unsatisfactory total knowledge level regarding caring of neonates suffering from renal disorders, while more than three quarters of the studied nurses had positive attitudes regarding caring of neonates suffering from renal disorders, On the other hand, equal three quarters of studied nurses had competent practices regarding caring of neonates suffering from renal disorders, in addition to, positive correlations between total levels of the studied nurses’ knowledge, attitudes and practices regarding care of neonates suffering from renal disorders.
According to study findings, it recommended