الفهرس 
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Abstract
Summary
The human brain is a command center and an essential organ of the human nervous system responsible for accomplishing daily life activities. The brain collects stimuli or signals from the body’s sensory organs, handles processing, and directs the ultimate decisions and output information to the muscles. BTs is one of the most severe situations related to the human brain, where a group of abnormal brain cells grows in an undisciplined manner.BTs can be divided into two main types: primary and secondary metastatic. The primary brain tumors (BTs) are generally non-cancerous and originate from human brain cells. In contrast, secondary metastatic tumors spread to the brain with blood flow from other body parts.(Chahal, P.K et al., 2020)
A craniotomy is a major surgery. A surgeon usually considers this type of treatment after diagnosing a brain tumor or life-threatening condition. There are several types of craniotomy procedures. Their names relate to the location where your surgeon will remove a piece of your skull to access the brain may need a craniotomy to treat a tumor. A blood clot, an abnormal collection of blood vessels (vascular malformations).(Rao D et al., 2020).
Nurses play major role in the care of patients with craniotomy as it is life threating to prevent complications. Frequent assessment of neurological status focuses on the level of consciousness, eye signs, verbal response, and motor response. Also, it’s important to assess for signs of neurologic deficit, such as diminished response to stimuli, speech problems, difficulty in swallowing, weakness or paralysis of an extremities, visual changes, restlessness may occur due to pain, confusion, hypoxia, or other stimuli. Respiratory function assessment. Also, is vital of and essential because small degree of hypoxia can increases cerebral ischemia. Including what to be assess, check O2 saturation, maintaining airway, breathing and circulation are vital (Shah & Suarez, 2019).
Also the nurses play a vital role in early ambulation of the patients. The patient is encouraged to move while in bed to prevent pulmonary complications associated with bed rest. As the strength improves, patient is assisted to get out of bed and walk around under supervision. Pressure ulcer risk assessment measures to prevent bed sore. Care of tubes and lines, urinary catheter care, wound care. So, the nurses role you manege patients post crainotomy is vital and meed a professional nurses (Frontera, Silver & Rizzo, 2018).
Aim of the study:
Assess nurses’ performance for caring of patients during the first 48 hours post brain tumor craniotomy through:
1- Assessment of nurses’ knowledge regarding care of patients during the first 48 hours post craniotomy.
2- Assessment of nurses’ practice regarding care of patients during the first 48 hours post Craniotomy
Research questions:
The current study was formulated to answer the following questions: what is the nurses’ level of knowledge, practice regarding care of patients during the first 48 hours post craniotomy?
Subject and Methods:
Research design: A descriptive exploratory research design was utilized to achieve the aim of the present study.
Setting:
The current study was carried out in intensive care unit at EL Fayoum university hospital.
Subjects:
A convenient sample of all available nurses’ approximately (40) nurse working in intensive care unit in Fayoum University Hospital.
Tools of data collection:
Two tools were used in this study:
Tool (I): Nurses interview questionnaire:
1-Nurses’ Self administered questionnaire (appendix1) :
This tool was developed by the researcher in simple Arabic language based on the related literatures and include two parts:
Part I : Demographic characteristic nurses under this study:
It was concerned with assessment of demographic data of nurses as age, sex, level of education, marital status, years of experience and training courses in care of patients during the first 48 hours post craniotomy. The tool Contain nine question in form of closed, open ended and multiple-choice questions.
Part II: Nurses knowledge assessment sheet:
It was used to assess nurses, level of knowledge regarding care of patients during the first 48 hours post craniotomy. It was developed by the investigator in an Arabic language based on reviewing of scientific literature (Hassan, 2014).It consists of 59 questions in form of multiple -choice questions (MCQS). The 59 questions divided into Six (6) parts:
Part I: Nurses information about anatomy and physiology of brain:
This part aimed to assess nurses, knowledge about anatomy and physiology of brain. It includes questions about component of CNS, its parts, location, weighs and function of the brain. It contains eight questions in form of multiple-choice questions (N=8).
Part II: Nurses information about brain tumors craniotomy:
This part aimed to assess Nurses information about brain tumors craniotomy. It includes questions about definition, types, signs, Indications, contraindications of brain tumors craniotomy and duration of brain tumor craniotomy. It contains 6 questions in form of multiple-choice questions (N= 6).
Part III: Important preoperative nursing care of brain tumors craniotomy:
This part aimed to assess: Important preoperative nursing care of brain tumors craniotomy. It includes questions about investigation, preparations, responsibilities and role of nurses care preoperative brain tumors craniotomy. It consisted of 5 questions in form of multiple-choice (N=5).
Part IV: Nurses information about postoperative care for patients with brain tumor craniotomy:
This part aimed to assess nurses, knowledge about post –operative care for patients with brain tumor craniotomy. It includes questions about most important measures when receiving the patient post operatively, nursing procedures while receiving the patient postoperatively, Indication of endotracheal tube, time of suction, assess vital signs and level of consciousness, care of hypovolemic patient, symptoms of severe pain should be monitored, necessary measures to prevent pressure on the site of operation, things that the patient should avoided postoperatively, exact time to check wound dressing postoperatively, good time for change wound dressing postoperatively, appropriate time for changing position of patient postoperatively and signs that must be verified before oral feeding of patients postoperatively. It consisted of 18 questions in form of multiple-choice (N=18).
Part V: Nurses knowledge about necessary medications post- operative brain tumors craniotomy:
This part aimed to assess nurses’ knowledge about necessary medications post- operative brain tumors craniotomy. It consisted of 5 questions in form of multiple-choice (N=5).
Part VI: Nurses knowledge about the complications of postoperative brain tumors craniotomy:
This part aimed to assess nurses’knowledge about the complications of postoperative brain tumors craniotomy. It includes questions about symptoms of increase intracranial pressure, hypovolemic shock, care of convulsions and seizures. It consisted of 17 questions in form of multiple-choice (N=17).
Results of the study:
The main findings of the current study revealed that:
Regarding main socio-demographic data of the patient’s age, the result showed that shows that, the mean age among study nurses was (24.4±2.3) years old ranged between (20 and 29) years with 55% of them were males and 45% were females. According to educational level 60% of them were educated in technical institute. For marital status 45% of them were married and 55% were single. 50% of the study nurses had experience duration between 1 and <5 year, While no one (0%) of the studied nurses received training courses about brain tumor craniotomy.
Regarding of the studied nurses total level of knowledge about caring of patients post brain tumors craniotomy (85%) of the studied nurses had a satisfactory total knowledge level as regards anatomy and physiology of the brain, 55% of them had un satisfactory total level of knowledge as regards of brain tumor craniotomy, 80% of the studied nurses had a satisfactory level of knowledge about preoperative nursing care, 10% of the studied nurses had a satisfactory level of knowledge about postoperative brain tumors craniotomy, it was noticed also the total knowledge 90% of the studied nurses had un satisfactory level of knowledge about postoperative brain tumors craniotomy, And as regards the total knowledge 10% of the studied nurses had a satisfactory level of knowledge about postoperative necessary medications, it was noticed also the total knowledge 90% of the studied nurses had unsatisfactory level of knowledge. It was noticed the total knowledge 90% of the studied nurses had a satisfactory level of knowledge regarding postoperative complications and total knowledge score 55% show a satisfactory level.
Regarding of total nurses practice level post brain tumor craniotomy 30% of the studied nurse had a satisfactory level of practice for immediate care practice, while 65% of them had a satisfactory level in the first 24 hours and regarding the next 24 hour (during 48 h) of postoperative brain tumor craniotomy care (80%) of nurses show a satisfactory level practice, and as regards the total nurses practice level post brain tumor craniotomy 65% of them had a satisfactory level of practice.
There were no statistical significant correlation between nurses total knowledge score and different practice care level (immediate care, first 24 h care, first 48 h care, and total practice care level) with p-value >0.05.
Conclusion
Based on the findings of current study, it can be concluded that, more than half of studied nurses had a satisfactory level of knowledge regarding the brain tumor craniotomy, while less than half of them had unsatisfactory level of total knowledge and this answered the first question,. Also less than one third of the studied nurse had a satisfactory level of practice for immediate care practice, while about two thirds of them had a satisfactory level in the first 24 hours and regarding the next 24 hour (during 48 h) of postoperative brain tumor craniotomy care, most of nurses showed a satisfactory level practice, and as regards the total nurses practice level post brain tumor craniotomy about two thirds of them had a satisfactory level of practice. and this answered the second question, Additionally there was no statistical significant difference relation between nurses total knowledge level and their different practice care level (immediate care, first 24 h care, next 24 h care, and total practice care level) with p-value >0.05 and this answered the third question.
Recommendations
Based on the current study findings, the following recommendations:
The curriculum facilitates the learning experience for the staff nurses, the nurse educators need to impart adequate knowledge and inculcate positive attitude toward safe patient care.
Nursing administrators need to plan and organize staff development programmes in hospitals regarding care of patient with craniotomy during first 48 hours, which will help the staff nurses on craniotomy care.
Specialized units like ICU dealing with craniotomy patients need expert nurses. While newly graduate nurses should have to be exposed to training first.
Realize the knowledge of nurses about indication of craniotomy and there approach.
Providing continuous in-service education for nurses to update their knowledge related to nursing care for care of patient postoperative brain tumor craniotomy.
Nurses should be encouraged to attend national and international conferences, workshops, and training courses related to care of patient postoperative brain tumor craniotomy.
Designating and distributing a booklet to all nurses, those who are working in neurosurgical ward about care of patient with craniotomy after discharge.
Collaborate as a member of the multidisciplinary team in care of patient with craniotomy practice, education, and research.
Further researches:
A similar study can be conducted on different settings to strengthen the findings.
Replication of the current study on a large probability sample from different geographical areas of Egypt to raise the efficiency of nurses, performance in caring for patients with brain tumor craniotomy to achieve more generalized results.