Effect of Accident Prevention Program on Nursery School Teachers’ knowledge and Practices.

Introduction

Accidental injuries in young children are often serious, but are largely preventable with appropriate information and safe practices. Young children are particularly vulnerable to accidents due to their innate desire to explore their world and the inability to perceive the dangers of their actions. As children learn through experience, minor injuries are inevitable but providing a safe environment can reduce the risks (Akturk& Erci ,2016).

Every day nearly2, 300 children and adolescents die from injuries sustained from motor vehicle injuries, drowning, poisoning, falls, burns, and violence. Overall, more than 95% of all injury-related deaths occur in low- and middle-income countries (LMICs) in all age groups. In high-income countries (HICs), injuries account for more than 40% of all deaths among children and adolescents Many of those who do not die due to these injuries are at an increased risk of lifelong disabling health consequences (World Health Organization,  2015).

The climbing and running activity of  the  typical  toddler  is complicated  by  total  neglect    and  lack  of appreciation  of danger, immature coordination, and  a high  center  of  gravity. Falling  from  furniture  is  a major  cause  of  injury, with more children  in  this age-group  sustaining head  injuries  than older children  (Hockenberry  & Wilson, 2017 ).             

Developmental and behavioral properties including unawareness of hazards and being active as well as physical properties including narrower airways, smaller body mass predispose children to injuries and carry a higher risk. Usually; children have minor bruises but at times, they may face major injuries resulting in fractures, bleeding, fainting thus, first aid like medical management is important (Masih et al;2014 ) Children   spend a significant portion of their day in kindergarten. Therefore, pediatric emergencies due to unintentional accident that may results in physical injuries are more likely to occur in this setting. In the absence of parents or caregivers, kindergarten is the best place to give care to children (Muneeswari , 2014).

First aid is an urgent attention delivered to victims of sudden illness or injury until medical helps arrive. So that, early treatment of such emergencies decreases morbidity and deaths (Khatatbeh, 2016)  First aid can be obtained by everybody and comprises self-care, so that first aider can be any person exist in the scene of emergency and provides such care like parents, teachers, policeman, fireman, first responder, professional medic, etc (Singletary, et al., 2015).

Pediatric nurses can play an important educational role by teaching caregivers about expected behaviors for their child’s upcoming developmental stage. This alerts them to the types of injuries common to that age group and to potential environmental hazards (Potts, & Mandleco, 2012). Nurses can initiate safety programs in schools, neighborhoods and cities. Nurses have important roles particularly in education. Unfortunately, not all schools in have health professionals. Thus, even small accidents could cause difficult situations because of teachers who do not know how to intervene or who intervene wrongly. For instance, as s/he does not know how to do first aid, the teacher gets nervous and thus cannot help the student. Therefore, nurses, particularly those who have the health educator role, should visit schools in some certain intervals and give basic first aid education. This way, teachers could perform first aid in a more conscious and rapid manner (Arli & Yildirim, 2017).

 Teachers are almost the first and the main caregiver represented the first line to protect school children, in addition, teachers’ role complements the parent’s role. School teachers during the school hours, are the real first-respondent to emergencies, injuries resulting from school accidents. Therefore, they have to be capable to act accurately with health emergencies affected the school children (Sönmez et al., 2014).

Significance of the study

Children spend a significant portion of their day in the kindergartens, so pediatric emergencies such as the accidental physical injuries are more likely to occur in those settings. Kindergartens are the best place to give care to those children in absence of mothers (Muneeswari, 2014). Kindergarten teacher has crucial role in caring for children, supervision and prevention of health hazards. They should be well trained on first aid and emergency control to save children lives and the first aider should have adequate knowledge and skills about what is he doing and be encouraging and reassuring to the victims (Olympia, et al., 2010) . In Egypt, 2009, more than 746,000 injured cases were registered in to the Ministry of Health hospitals. Around 38% of all injuries occur among children and young adults less than20 years of age (El -Sayed, 2012).

While in Egypt 2013 the mortality   rate from injury in children less than five years was 3% of total death.  (WHO, 2013) and the mortality rate of children under five years  from injury at 2014 was 4% of total death in Egypt (WHO, 2014) . And in   Egypt too the mortality rates from unintentional poisoning were 0.5 per 100000 population in 2015 (WHO, 2015).

In the nursery schools at Minia city, children are more susceptible to accidents and injuries because of their large numbers in relation to teachers' numbers which predispose them to accident because lack of supervision.

The aims of the current study were to:

• Assess the  knowledge and practices of nursery school teachers about accident prevention and first aid measures
• Develop and apply the program for nursery school teachers' about accident prevention and first aid measures for common childhood accident.
• Evaluate the effect of accident prevention and first aid  program on  nursery school teachers' knowledge and practices

Research Hypothesis

• There will be a significant difference between the nursery school teachers' knowledge and practices about accident prevention and first aid after receiving an educational program.     
• There will be a significant association between teachers' knowledge and reported practice and demographic characteristics of the studied teachers.

Subject and Methods

Research design: 

Pre /   post   quasi-experimental research design was used in this study. A quasi experimental design is one type of experimental design that is very similar to the true experimental design except there is loss one criteria which is control, manipulation, or randomization (Burns & Grove,   2012).

Setting:

The selected  nursery schools represented all geographic areas of Minia city including both private nursery schools (El Zahra El – Ganobia   and  Salah El – Dien) and governmental nursery schools (El-Fath nursery school and LogatKafr El-Mansoura) Kafr El -Mansoura  nursery school was changed to (El -Tagrebia nursery school ) because of refusal of the director to conduct the program there .

Sample:

A convenient sample of 60 nursery school teachers, 30 from private and 30 from governmental nursery schools.

Sample size was calculated by G power program depending on mean Score of total knowledge pre (17.40 ± 15.35) and post (39.40 ± 11.61) as resulted by (Mersal & Aly, 2016) at power of 97%. The calculated sample was 52 increased to 60 to avoid dropouts.

Tools for data collection:

Pre-designed questionnaire sheet for nursery school teachers as pre/ posttest that was designed by the researcher in an Arabic language after reviewing of the related literature to assess the nursery school teachers' knowledge toward accident prevention and first aid. It comprised the following parts;

Part I: Demographic data about teachers as teacher’s age, marital status, qualifications,     years of experience and previous training courses.

Part 2 : This part was including the following;

Teachers' knowledge about  accident prevention and first aid  which include: Definition, types and risk factors for accident include (5questions)Definition ,causes and types of wound , fracture, burn and suffocation include (16 questions) meaning of first aid and first aid measures for common childhood accident  at nursery school (12questions).

An observational checklist was used to assess first aid measures about wound, epistaxis, convulsion, suffocation, poisoning, fractures, burn and fainting.

Scoring system:

Scores of teachers’ knowledge was one score for correct answer and zero for incorrect answer. These scores were converted into a percent. The teachers’ knowledge was considered satisfactory if the percent is 60% or more and unsatisfactory if less than 60%. While Scoring of teachers’ practices was one score for done skill, and zero score was given for not done skill,. These scores were converted into a percent. The teachers’ practices were considered satisfactory if the percent score was 60% or more and unsatisfactory if less than 60%. The observations were carried out in pre- test and post- test to assess the teachers' practice about first aid measures.

Educational and training program was designed in Arabic form of educational program by the researcher based upon the actual need assessment of teachers. It was also supplemented with information based on review of relevant literature (nursing textbook, journals and internet resources) about accident prevention and first aid.

The program

The program was designed by the researcher. A review of the past and current available literature in various aspects of the problems using textbooks, articles, periodicals and magazines was necessary to be acquainted with all aspects of the study problem and also in order to develop relevant tools for data collection.

The time and methods of training sessions was organized according to the time available for the teachers in each nursery school, the time required for the program implementation was six months, the total duration of the program was18hours, 1hour orientation, 2hours pretest and 15hours for the program sessions. Implementation of the program was done for each group  with 5 hours theoretical and 10 hours practical ,the program sessions was 12sessions for each group, each session lasted (60- 120 minutes ),two sessions per day, the nursery school  teachers divided into  8 groups each group had 7:8 teacher, the teachers are interviewed two days per week from 9am :12pm to cover all information about accident prevention and first aid .Different teaching methods were used to motivate and reinforce teaching such as praising and recognition during the program sessions. The method of teaching which used during the program sessions were lectures, discussion, pictures, poster ,brochure  and videos for  easily understanding  and demonstration.

The procedures of first aid were performed on the doll and the real equipment and supplies for first aid was used to facilitate education and training of the teachers.              

The program was revised by medical and pediatric nursing specialist. A copy of program in a form of Arabic booklet was given for each participant. The "post–test" carried out immediately and after three months following   implementation of the training program to evaluate the effect of the program on nursery school teachers' knowledge and practices about accident prevention and first aid. 

The methods of teaching which used during the program sessions were lectures, discussion, pictures, poster ,brochure  and videos for easily understanding  and demonstration The procedures of first aid  was performed on the doll and the real  equipment and supplies to facilitate education and training of the teachers.

Validity and reliability

Data collection tools were tested for content and face validity by three of experts in the field of pediatric nursing to test tool validity.

Cronbach alpha coefficient test was used to assess the reliability of the tool to confirm its consistency. It was 0.70 and .71 respectively.

Pilot study

After developing the tools, a pilot study was conducted on 10% (6) of the teachers at Minia city nursery schools. A pilot study was conducted to test clarity, and visibility as well as to determine the time required for filling the data sheets. According to the results of pilot, the needed modification, omissions and/or additions for some items were done.

Ethical consideration

Primary approval was obtained from ethical committee, Faculty of Nursing, Minia University. An oral consent was taken from all teachers to participate in the study. The purpose and nature of the study were explained by the researcher through direct personal communication prior starting to the conduction of the study. This data will be confidential and it will be used for the purpose of the research only.

Data Collection Procedure

Primary approval was obtained from ethics committee, Faculty of Nursing, Minia University .An official permission was obtained from the directors of the nursery schools. A total of 60 nursery school teachers were divided in to two groups, 30 from private and 30 from governmental nursery schools. The researcher gathered data of the study through personal interviewing of the studied teachers, pretest was done to assess the nursery school teachers' knowledge and practices about accident prevention and first aid. The time and methods of training sessions was organized according to the time available for   the teachers in each nursery school. The teachers were interviewed two days / week   from 9 am to 12 pm.  The program was conducted over two sessions / day to cover all information about accident prevention and first aid. The method of teaching used during the program sessions were lecture, discussion, and use of illustrated pictures for easily understanding and demonstration.

Statistical analysis

Data entry was done using compatible personal computer. Statistical   analysis was done using SPSS-20 statistical software package and excel for figures. The content of each tool was analyzed, categorized and then coded. Data were presented using descriptive statistics in the form of frequencies and percentages for qualitative variables, means and standard deviations for quantitative variables. Quantitative continuous data were compared by using student T-test in case of comparisons between the mean scores of the two studied groups. Qualitative studied variables were compared using Chi-square test. Statistical significance used at P value <0.05.

Results:

Table (1): Distribution of the Studied Teachers According to Their Demographic Characteristics (No.  = 60)

Table (1) Illustrates that more than two fifth of the studied teachers (45%) had >30 years old with a mean of age 33.32 ± 7.478. All the teachers (100%) had Bachelor of Science, while more than two fifth of them (41.7%) attended training courses, more than half of those who attended training courses (56%) attended one course. The majority of the studied teachers (85%) were married; more than half of them (51.4%) had one child.

Table (2): Frequency Distribution of Teachers ' knowledge about Past History of Accident 

Table (2) proved that more than half (57.5%) of the teachers has confronted with closed wounds to the children compared to 10%   of them has exposed to epistaxis during their years of working in nursery school.

Table (3): Comparison of Teachers'   Knowledge   Pretest  ,  Immediate Posttest   and After 3 Months Posttest Regarding Accidents

Table (3) Illustrated  that in immediate posttest  the teachers had the highest mean score related to their knowledge  about accident, wound, fracture, burn, suffocation, convulsion, fainting, poisoning, first aid knowledge and the total knowledge of the teachers about accident prevention and first aid  with highly statistical significant difference between  pretest, immediate posttest and posttest after 3 months at p-value 0.0001, except accident; the significant differences was p-valueat0.001

Table (4): Comparison of Teachers' Practices   Pretest /Immediate and after 3 Months Posttest

Table (4) Illustrated  that in immediate posttest  the teachers had the highest mean scores related to their practices about wound, fracture, burn, epistaxis, convulsion, fainting, poisoning, suffocation and total score of first aid  with highly statistical significant difference in pretest, immediate, posttest and posttest after 3months at p- value0.0001.                                     

Table (5) Correlation between The Total Scores of Teachers' Knowledge and Demographic Characteristics of the Studied Teachers  .

Table (5) clarified that there were no statistical significant correlation between the teachers' knowledge and all items of their demographic characteristics.

Table (6): Correlation between the Total Scores of Teachers' Practices and Their Demographic Characteristics.

Table (6) proved that there were no statistical significant correlation between the teachers' practices and all items of their demographic characteristics except for number of children where there was positive statistical correlation with p < 0.01.