الفهرس 
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Abstract
Diabetes mellitus is a serious disease with potentially devastating complications and is common among all age groups worldwide. Diabetes disturbs children and families’ lifestyles, personality and mental, social, and economic conditions. Like other chronic diseases, diabetes is a heavy burden for families and society. Besides increasing treatment costs, the short- and long-term complications of T1DM cause serious problems in the life of children and their families, hence the introduction of Family centered care (FCC) to lessen the negative consequences of caregiving for children diagnosed with DM. So far, family-centered diabetes care has been successful and produced better diabetes outcomes in children, who are helped by family members to carry certain relevant tasks related to self-care practices.
Aim of study:-
This study aimed to assess family-centered care provided for their children suffering from diabetes mellitus
Research question:
What is the family-centered care provided for their children suffering from diabetes mellitus?
The present study was carried out through the following four main designs:
I. Technical design
II. Operational design.
III. Administrative design.
IV. Statistical design
I.Technical design:
A) Research design:
A descriptive study design was used in this study to assess family-centered care provided for their children suffering from diabetes mellitus.
B) Research setting
The study was conducted at Pediatric Diabetes Mellitus Outpatient Clinic at Tahrir General Hospital Giza Egypt.
C) Subject of the study:
A convenient sample of 100 family member care giver (mothers) of children suffering from diabetes regardless their characterisics from the previously mentioned study setting where data was collected over a 6 months period.
D) Tools of data collection: (Appendix II)
Tool I - Pre designed questionnaire format:
It was designed by the researcher in the light of relevant literature and studies. It was written in a simple Arabic language to suit the children with diabetes and their families’ level of understanding. It was consisted of three parts to gather data as the following:
Part I- characteristics of family member care giver & their children:
a- Characteristics of family member care giver, (mothers) that include: age, marital status, educational level, occupation, type of work if present, residence, number of family members, family monthly income, and type of family.
b- Characteristics of children suffering from diabetes which include: age, gender, level of education, child ranking, number of siblings, physical data (Height, weight, abdominal circumference, head circumference), physiological data (vital signs).
c- Medical history of children suffering from diabetes mellitus including: family history, the degree of kinship to the child, type of diabetes, its onset, duration, laboratory investigations, presence of diabetes related complications(phy sical and psychological complications), social effect, sholastic effect, treatment of diabetes, glycemic monitoring, responsible family member providing care to the child with diabetes.
Part II: Knowledge of family member care giver (mothers) about diabetes in children and family centered care:
a- It concerned with definition of diabetes mellitus, its causes, signs & symptoms, complication and management.
b- It includes definition of family centered care, its importance, care of children suffering from diabetes mellitus based on family centered care approach.
Scoring system:
Each correct answer scored by one grade, incorrect answer scored by zero grade, each question has more than one correct answer. The total number of the close ended questions were 8 with total grade of 43 that converted into percentage and equal 100%.
-Total scoring was classified into 3 categories:
- Good knowledge if score >75%. (> 32 grade)
- Average knowledg if score 60 % <75%. (25<32 grade)
- Poor knowledg if score <60%.( <25 grade)
Tool II -Family-Centered Care Assessment Scale:
The Family-Centered Care Assessment Scale (FCCAS) was developed by TasArslan, (2019), and adopted by the researcher to assess family-centered care. The scale developed for parents and consists of 21 items. The scale is composed of three sub-dimensions which are support (10 items), collaboration (8 items), and respect (3 items).The lowest and highest scores that could be obtained from the scale are 21 and 105. The average response time of the scale was 15 minutes. A high total score indicates that family-centered care is applied.
Scoring system:
Each statement was scored by (5) grade if done and (zero) grade if not done with total grade105 that converted into percentage and equal 100%.
Total scoring was classified into 3 categories:
- High level if score >75%. (>78 grade)
- Average level if score 60 % <75%. (63<78 grade)
- Low level if score <60%. (<63 grade)
II. Operational design:
The operational design includes: a preparatory phase, pilot study, and field work.
A) The Preparatory Phase:
It includes reviewing the related literature for the various aspects of the study using books, articles, periodicals, magazines and websites. During this phase, the researcher also visited the selected place, met, identified all family member care giver to start work.
Tools validity: (Appendix IV)
The validity of the tools was tested for content validity by three experts in the field of Pediatric Nursing from Ain Shams University.
Tools reliability
Testing the reliability of the proposed tools was done statistically by Cronbach Alpha test that was 0.91.
B) Pilot study:
The pilot study was conducted in August 2022, involving 10% (10 family member care giver (mothers) of the total study subjects (100). The pilot study was conducted to confirm clarity, feasibility, and applicability of the study tools and to estimate the time required. The time needed for filling the sheet was ranged between 20 and 30 minute &15 minute for tool II. Sample of pilot study was included in the main study sample as there was no major modifications in the study tools.
C) Field Work:
Before starting the data collection, the researcher met with the manager of the study setting and family members (mothers) after introducing herself, and explaining the nature & purpose of the study to gain their approval and cooperation. Data was collected daily for 2 days/week (Saturday &Wednesday) for six months during morning shift (8am-2pm).
The data collection was lasting from the begning of September 2022 to the end of February 2023.The researcher explained the aim of this study and got oral approval from the family member care giver (mothers) to participate in this study, then the researcher clarified the study aim, tools expected outcomes. The time consumed to fill out tool I ranged from 20 to 30 minutes &15 minute for tool II.
Each family member care giver (mothers) was given the opportunity to fill-in the tools under the guidance and supervision of the researcher, the tools was filled either by the study subjects (educated) or by the researcher (illiterate).
E. Ethical Considerations: (Appendix III)
The study proposal was approved by the Scientific Research Ethical Committee of the Faculty of Nursing, Ain Shams University. All participants gave their informed consent to participate in the study. They informed about the study aim and about their rights to refuse or withdraw from the study at anytime. The confidentiality of the information obtained was ascertained. The study maneuvers do not entail any harmful effects on participants.
III. Administrative Design: (Appendix V)
The necessary adminstraive approval was obtained. An official letter was issued from the Dean of the Faculty of Nursing, Ain Shams University, to obtain permission from the the manager of El Tahrir General Hospital about conduction the study. The researcher met out patient clinics directors to explain the aim of the study and get their oral and written approval to collect data and seek their support.
IV. Statistical design
A) Data management & Statistical Analysis:
The collected data were revised, coded, presented in tables & figure and subjected for statistical analysis. Statistical analysis was performed by SPSS version 20; also, Microsoft Office Excel was used for data handling and graphical presentation package for 20.0). Data were presented using descriptive statistics in the form of number, percentage, Standard deviation (SD), Chi-square (x2) were used to estimate the statistically significant difference that was considered at P-value <0.05.
b) Analytical Statistics:
1- Chi-square test was used to examine the relationship between two qualitative variables but when the expected count is less than 5 in more than 20% of the cells.
2- Pearson Correlation Coefficient (r): Correlation was used as a measure of the strength of a linear association between two quantitative variables. The Pearson correlation coefficient, r, can take a range of values from +1 to -1. A value of 0 indicates that there is no association between the two variables. A value greater than 0 indicates a positive association, a value less than 0 indicates a negative association.
P-value: Level of significance:
- P-value <0.05 was considered significant.
- P-value <0.001 was considered as highly significant.
- P- value>0.05 was considered non-significant.
Results:
The findings of the current study can be summarized as the following:
An analysis of characteristics of the studied mothers, the present study revealed that, more than two fifths (42.0%) of the studied mothers are ages from 28 to less than 33 years with ) ¯x ± SD 32.71 ± 1.21(.
Less than one two fifths (38.0%) of them are illiterate and most of them (82.0%) living at rural.
More than three quarters (78.0%) of the studied mother’s are not working..
Most (82.0%) the studied mother are living at nuclear family.
An analysis of characteristics of the studied children, the current study reported that, half (50.0%) of them are ages from 9-<12 years old with ) ¯x ± SD 12.23 ± 2.4(.
Less than three quarters (70.0%) of the studied diabetic children are males and most (88.0%) of studied children have type I diabetes.
More than three fifths (62.0%) of children have sudden onest of diabtes mellitus and most (95.0%) of them have dibetes related complications.
Regarding total knowledge level among studied mothers regarding diabetes mellitus, the present study represented that, half (50.0%) of the studied mothers has average total level of knowledge regarding diabetes mellitus, less than half (46.0%) of them have poor total level of knowledge, while minority (4.0%) of them have good total level of knowledge.
Concerning total knowledge level among studied mothers regarding diabetes mellitus, the current study mentioned that, half (50.0%) of the studied mothers have average knowledge level regarding diabtes mellitus, also more than one third (46.0%) of them have poor level of knowledge while minority (4.0%) of them have good knowledge level regarding diabtes mellitus.
Concerning total knowledge level among studied mothers regarding family-centered care, the current study mentioned that, more than half (54.0%) of the studied mothers have poor knowledge level regarding family-centered care. Also more than one third (34.0%) of them have average level of knowledge and less than one fifth (12.0%) of them have good knowledge level regarding family-centered care.
In relation to total family-centered care scale level among studied mothers, the current study found that, less than two thirds (64.0%) of the studied mothers have low family centered care level. While more than one quarter (26.0%) of them have average level of family centered care and the minority (10%) of them has high level of family centered care.
There is highly statistically significant difference between total studied mother’s knowledge regarding diabetes mellitus and their type of family. Also there is statistically significant difference between total studied mother’s knowledge regarding diabetes disease and their age, residence and number of family membersThere is highly statistically significant difference between total studied mother’s knowledge regarding family centered care and their educational level, mother work and types of family. Also, there is statistically significant difference between total studied mother’s knowledge regarding family centered care and their age, marital status, number of family members and monthly income income.
There is highly statistically significant difference between total studied mother’s family-centered care level and their marital status, educational level, number of family members and Family monthly income at (p<0.001) .while there is no statistically significant difference between total studied mothers family-centered care level and their age, mother work, residence and type of family at (p >.05)
Concerning correlations between total knowledge of studied mothers regarding diabetes & family centered care and family centered care level, the present study mentioned that, there is highly statistically significant positive correlation between total studied mother knowledge regarding family centered care and total family centered care level (p<0.001). In addition, there is statistically significant positive correlation between total studied mother knowledge regarding diabetes and total family centered care level (p<0.05).While there is no statistically significant positive correlation (negative correlation) between total studied mother knowledge regarding diabetes and knowledge regarding family centered care (p>0.05).
Conclusion:
Based on findings of the present study concluded that: less than half of the studied mothers have poor total level of knowledge regarding diabetes mellitus and more than half of them have poor knowledge level regarding family centered care. Moreover, less than two thirds of the studied mothers have low family centered care practices provided for their children suffering from diabetes mellitus.