Effect of Nursing Interventions on Reducing Postoperative Complications among Children with Imperforate Anus and Mothers' Anxiety

: Child's hospitalization for imperforate anus surgery considered a source of anxiety for the children and the parents that persists for a long time after discharge. Therefore, involving mothers in treatment of their children are extremely required to decrease their anxiety and children's postoperative complications. Aim: The present study aimed to investigate the effect of nursing interventions on reducing postoperative complications among children with imperforate anus and mothers' anxiety. Design: A quasi experimental design [study and control groups], pre / post-tests were used. Setting: This study was carried out at pediatric surgical department and surgery outpatient clinic affiliated to Mansoura University Children's Hospital, Egypt. Sample: A purposive sampling composed of 70 mothers of children with imperforate anus, who were admitted to the previous setting, after fulfilling inclusion criteria. They were divided into 2 equal groups (study and control). Tools: 5 tools were used.1. A structured Interview Questionnaire [Socio-demographic characteristics of mothers and children, surgical history and mothers' knowledge]. 2. Performance Observational Checklists. 3. Postoperative Complications Assessment Questionnaire. 4. State-Trait Anxiety Inventory. 5. Zarit Psychosocial Burden Interview Scale. Results: The present study revealed that, there were high statistical significant differences between both groups (p <0.001) after intervention regarding studied mother's knowledge and practice. In addition, the children in study group have less postoperative complications than those children in control group post intervention. Also, about two third (60.0%) and three quarter (74.3%) respectively of mothers in study group had mild anxiety level post one week and one month, compared to about one quarter (20.0% & 28.6% respectively) of mothers in control group. Also, more than one third (37.1%) and about half (48.5%) of mothers in study group have little or no psychosocial burden level after one week and one month, compared to less than one quarter (14.3% & 20.0% respectively) of mothers in control group. There were statistical significant differences between both groups after intervention. Conclusion: Nursing interventions affected positively on mothers' knowledge, practice, decrease children's postoperative complications and decrease mothers' anxiety, psychosocial burden level. Recommendation: It was suggested replication of this nursing interventions on a larger sample and future research to monitor the long-term postoperative complications. individually interviewed using the previously mentioned study tools to fulfill the questionnaire '' pre-post tests after one week and one month '' to assess mothers' knowledge about the disease and postoperative care for their children with imperforate anus using tool 1 and mothers' practice was assessed by using observational checklists using tool 2, also assess mothers' anxiety level using tool 4 and mothers' psychosocial burden using tool 5. The questionnaire and the answers were marked by the researchers. The interview lasted for 20- 30 minutes for each mother to complete the questionnaire. The nursing interventions were developed by the researchers depending on the mothers' needs after reviewing the related literatures, it was given to the mothers and their children in study group. Then, the study group was divided into small groups (2-3 mothers) as mother class, according to number of mothers who available in the study setting. Several teaching methods were used such as [ lectures, group discussion, demonstration and re- demonstration]. explain how perform it at home accurately to prevent complications as bleeding, suture site infection and stricture of anal canal. This finding was in the same line with Temple et al, (2012) ) (5) they studied [ Is daily dilatation by parents necessary after surgery for hirschsprung disease and anorectal malformations? ] and stated that, the postoperative complications of hirschsprung disease and anorectal malformations, anastomotic leak or stricture is one of the most difficult to manage. To prevent these anastomotic complications, most pediatric surgeons have suggested daily dilatation of the anastomosis by the mothers and educate the mothers how perform it at home. of stool Regarding association between mothers' knowledge and their anxiety and practice in the study group post 1 month (Table 7) , the result of this study revealed that, there were highly significant relationship between mothers' knowledge and their anxiety and practice, the majority of studied mothers which have good knowledge had mild anxiety level and satisfactory practice, this may be due to availability of booklet containing information which result in increases mothers' knowledge lead to improve in their practice, in addition mothers' understand of disease and how they deal with their children this result in decrease their anxiety. This result was supported with Goudarzi, et al., (2016) (11) who showed that, the empowerment program was effective in increases mothers' knowledge, practice and alleviating mothers’ stress. The hypothesis 5 was supported by this result.