Nurses' Perception Toward Therapeutic Strategies for Children with Pneumonia

Upper and lower respiratory tract infections are sub classified as acute respiratory tract infections. Pneumonia, a common and severe illness of the lower respiratory tract, is known as the hidden killer of children, killing between 1.1 and 1.4 million children annually and accounting for 17 to 19% of all deaths among children younger than five. The vast majority of these deaths occur in low-and middle-income nations [1] Pneumonia is a type of acute lower respiratory infection that affects the lungs and is the leading infectious cause of infant mortality globally. 740 children under the age of five died of pneumonia in 2019, accounting for 14% of all deaths among children under five years but 22% of all among children aged between 1 to 5 years. Pneumonia affects children and families globally, with the highest mortality rates in South Asia and sub-Saharan Africa [2].

In poor nations, pneumonia is the leading cause of bacterial pediatric pneumonia. Infections of the lower respiratory tract can be caused by microorganisms usually found in the upper respiratory tract. They can also spread through coughing or sneezing droplets in the air or through the blood, especially during and shortly after birth. Pneumonia is the leading cause of death among children under the age of five, surpassing all other known childhood diseases. Childhood pneumonia is a significant cause of mortality and morbidity in children under the age of five, with developing countries bearing the greatest pneumonia burden [3].

According to the statistics of the Iraqi Ministry of Health, which stated that the rate of admission of children aged less than five years in children's hospitals in Iraq, and the highest five governorates in the incidence of pneumonia among children were:

Figure 1. Distribution characteristics of comprehensive health degree of samples

Pneumonia remains a leading reason of morbidity and mortality among children under five years. Risk factors include childhood age, malnutrition, immunosuppression, cigarette smoke, or air pollution exposure. There is a need for widespread implementation of available, effective interventions and the development of management strategies [4]. Pneumonia is a leading cause of death globally among children under the age of five, and good therapy has contributed to a decline in mortality from approximately one million in 2013. WHO recommends injectable ampicillin and gentamicin as the first-line treatment for severe pneumonia, with third-generation cephalosporin as the second-line treatment [5]. Antibiotics are considered the appropriate treatment for community-acquired pneumonia patients in all hospitals by 14-35%, but there is an urgent medical need to develop some therapeutic strategies to help improve the condition of patients) [6]. On the other hand, a study conducted by [7] refers to the most effective strategies in improving pneumonia as physiotherapy, such as Thoracic Expansion Exercises (TEE) and Chest Physiotherapy.

A Convenient sample of 47 nurses in Baghdad city from three hospitals (the determination of the instrument reliability occurs by calculation of Alpha Cronbach's test (Alpha Correlation Coefficient); internal consistency method used for determining the reliability for determination of the present study instrument reliability Alpha Correlation Coefficient applied by application of Statistical Package for Social Science Program (IBM SPSS) version 24.0.

The result of the questionnaire reliability was Cronbach's Alpha = 0.819, indicating the questionnaires with sufficient level of internal consistency and equivalence measurability.

Table 1 presents the statistical results for the demographic variables of the sample in the study, that 58.7% (27) of them at age (20-25) years of age. 89.1% (41) of them were female. 56.5% (26) of them have a nursing diploma at the educational level. 58.7% (27) of them have (1-5) years of general service in the nursing field and 63.0% (29) of them also have (1-5) years of service in the pediatric ward.

Table 2 shows the statistical results for the sample that participated in training courses or reading information related to children with pneumonia, 63.0% (29) of them did not participate in workshops or courses related to pneumonia, but 32.6% (15) of the sample that has Participated in workshops or courses related to pneumonia between (1-2) time of participation. 82.6 % (38) of them were read information about pneumonia. 26.1% (12) of the sample was reading information from social media sites source.

Table 3 presents the statistical results for the sample information level regarding children with pneumonia. That 50.0% (23) of them have an excellent level at information levels with a chi-square of 15.174 and significance at p.value (0.001).

Table 4 presents Statistical Results for the Sample information regarding management and treatment strategies for Children with Pneumonia, These results show that most of the sample results Strongly disagreed level for the information regarding management and treatment strategies for Children with Pneumonia

Table 5. Statistical Correlation between the Sample information level regarding Children with Pneumonia with Demographic Variables

Table 5 shows the statistical correlation between the sample information level regarding children with pneumonia with demographic variables. There was a non-significant correlation between the sample information level regarding children with pneumonia with all demographic variables except there was a significant correlation with Reading information there was a significant correlation at p.value (0.041) only.

6. Statistical Correlation between Sample information regarding management and treatment strategies for Children with Pneumonia with Demographic Variables

Table 6 presents the statistical correlation between sample information regarding management and treatment strategies for children with pneumonia with demographic variables. There was a non-significant correlation between age and information level regarding children with pneumonia, except there was a significant correlation with knowing the causative agent and the disease degree necessary to choose the treating antibiotic at p.value (0.047), giving intravenous antibiotics because they are the fastest in treatment at p.value (0.023), also with raising the head of the bed 45 degrees to increase ventilation and prevent inhalation at p.value (0.023) only. There was a non-significant correlation between educational and information levels regarding children with pneumonia, except a significant correlation with helping prevent pneumonia. Vaccines should be given to children according to the Vaccination Schedule at p.value (0.041); giving oxygen is one of the important steps to increase the level of oxygen in the blood at p.value (0.033), raising the head of the bed 45 degrees to increase ventilation and prevent inhalation at p.value (0.030) only.

There was a non-significant correlation between service in the ward and information level regarding children with pneumonia, except there was a significant correlation between helping prevent pneumonia, practicing good child hygiene (hand washing) at p.value (0.017), with breastfeeding and good nutrition helping prevent and reduce pneumonia at p.value (0.033) only. There was a non-significant correlation between the training Course and the information level regarding children with pneumonia, except there was a significant correlation with using simple measures to reduce the severity of the spread of the disease at p.value (0.010), with a hand washing and sterilization is preventing the spread of pneumonia among infected children at p.value (0.008), also with giving intravenous antibiotics because they are the fastest in treatment at p.value (0.037) only.

Table 1: The study's results present the nurse's demographic data in table (1). Most of the nurses' participants in the age group (20-25 years) were 27(58.7%). This result is in disagreement with the study [8] in Egypt. They mentioned that most of the study sample for nurses in the age group \(< 30\) was 35(70%). The majority of participating nurses were female, 41(89.1%), according to the study sample's findings, and this finding is consistent with a survey released by [9] in 2018, which found that 28(70%) of nurse participants were female at that time. The level of Education of most nurses' participants was a nursing diploma, which presented 26(56.5%). This result is similar to a survey in Egypt released by [10] in 2019. Most of them have diplomas in nursing. The general service for participating nurses in the nursing field was 58.7% (27) of them have (1-5) years. This finding agrees with a survey released by [11] in 2022. The majority of participating nurses had years of experience for < 5 years of experience (45.8%). Most of the participants, 63.0% (29) of the current study, served in the pediatric ward for (1-5) years; this result is in disagreement with a study by [12] in 2016, in which 36% (9) of the participant have more than \(\geq 13\) years of services in pediatric wards.

Table 2: Regarding nurses' participation in training courses, 63% of them participated, while 82.6% of them read information about pneumonia with evidence of the effect of social media on their information. The study result is consistent with the study of [13], where 63.6% of nurses participated in training courses. The researchers believed that the number of nurses who participated was few and that most of them had yet to attend workshops or training sessions on treating children with pneumonia. They also believed that since most participating nurses were interested in learning more about the topic, they tended to do so from social media rather than reliable academic sources, which could have provided inaccurate or unreliable information. The care provided to children with pneumonia will be improved by the nurses' participation in training sessions that impact the quality of childcare services and ensure that nurses are competent.

Table 3: 50.0% of the nurses have excellent information about children's pneumonia. The study results inconsistent with the study of [14] were (50.0 %) of the nurses had poor information regarding pneumonia in children and 0% of them had excellent information.

Table 4: According to the result, the majority strongly disagree (76.1%) about information and training for nurses. This does not correspond to the study by ([8]; [15]; [16]). They illustrate the improvement in nurses' knowledge and practice after a training and education program. More than half strongly disagree with teaching parents about smoking and the crowded effect (69.6%). This is compatible with a study by [17] where 16.09 percent of children died of severe pneumonia due to smoking. However, a study conducted in New Zealand by [18] was contradictory, which refers to overcrowding leading to acute respiratory disorder. While a low percentage (39.1) disagreed that the item increased ventilation by elevating the head by 45 degrees, this result resembles the study by [10]. (43.5%) of them disagree that pneumonia is considered a fatal disease. This result reverses a study by [19] adopted by the World Health Organization (WHO). Moreover, a study by [1] for mothers' perception of pneumonia was dangerous at 68.2%. Another study also refers to the result by [17], which was a high average of mortality related to severe pneumonia.

Table 5: Results show no association between nurses' demographic characteristics and their information level. However, a positive statistical correlation exists between the nurse's information level regarding children's pneumonia and their reading information. This result is inconsistent with the study of [20] that showed a significant association between nurses' knowledge and their age and years of employment.

Table 6: The current study shows a significant correlation between variable age, education level, service in the ward, training course, and nurses' perception of causative agents in medical and nursing management of pneumonia. This result agrees with a study by [14]. On the other hand, a study by [21] contravenes demonstrates that There is no effect of the level of Education on nurses' knowledge. In addition, another study by [22] contrary showed no significant difference between variables and nurses' knowledge about pneumonia. In the researchers' opinion, nurses' different perceptions are due to their lack of interest in information about pneumonia and linking it to work reality and its correct effect on response to treatment and prevention.

In general, we note that nurses were well aware of the strategies used for children with pneumonia, but the presence of gaps in some items is likely due to their information taken from social media.The study recommended enhancing awareness of some items related tostrategies through workshops and courses certifiedtraining. Educating mothers about some important procedures to reduce pneumonia infection such as hand washing, breastfeeding, and vaccinations. Activating the Ministry of Health's media on the importance of global strategies used in the treatment of children with pneumonia.

Recommendation

1. Enhancing awareness of some items related to strategies through workshops and courses certified training.
2. Educating mothers about some important procedures to reduce pneumonia infection such as hand washing, breastfeeding, and vaccinations.
3. Activating the Ministry of Health's media on the importance of global strategies used in the treatment of children with pneumonia.

Acknowledgements

The authors would like to thank all data collectors and study participants involved in the study.

Conflict of Interest

None declared.

Conflict of interest

The authors declare no conflict of interests.

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