http://doi.org/10.33698/NRF0189 – Rajinder Kaur, Rupinder Kaur, Sukhwinder Kaur, Late. R.K. Marwaha, Deepak bansal
Abstract :Thalassemia is the most common hereditary blood disorder and approximately 240 million people worldwide carry beta thalassemia.1 β-Thalassemia is the commonest single-gene disorder in the Indian population. 2 Ten percent of the total world thalassemics are born in India every year.3 Chronic nature of thalassemia causes changes in different aspects of life in patients. The assessment of self-care behavior in children suffering from thalassemia is of particular importance. This study was conducted with the aim to assess the effectiveness of learning program through a cartoon picture book on self-care behavior of children suffering from thalassemia. Pre-experimental study was carried out at Thalassemia day care centre, APC, PGIMER, Chandigarh. Total 52 children suffering from thalassemia enrolled for the study using total enumeration sampling technique from July-August 2014. Tool comprised of Socio-demographic profile, clinical profile and self-care behavior assessment tool. Pre-assessment of self-care behavior and implementation of learning program through a cartoon picture book was done on initial visit and post assessment of self-care behavior was done after 25 days. The findings of the study showed that learning program through a cartoon picture book resulted in a statistically significant change in self-care behavior of children suffering from thalassemia after intervention as per t- test (p <0.05). So nursing intervention such as learning program through a cartoon picture book on self-care behavior is recommended as a routine practice so as to improve the health and wellbeing of children suffering from thalassemia by offering them education and support.
Keywords
Thalassemia, self-care behavior, cartoon picture book
Correspondence at
Mrs Rupinder Kaur
Clinical Instructor
National Institute of Nursing Education, PGIMER, Chandigarh
Introduction
Thalassemia is the most common hereditary blood disorder.1 Thalassemic children suffer in all dimensions of their lives: physiologically (anemia, weakness, fatigue, shorter stature, large abdomens and delayed puberty), psychologically (poor self-image and peer group rejection), socio-culturally (limited participation in peer/social/athletic activities, isolation, and school absenteeism) and spiritually (feelings of aimlessness, powerlessness, hopelessness and worthlessness) according to their developmental stage (Aydin et al4, 1997; Gorree5, 2001).
Self-care is needed to maintain and promote the health of the children, prevent the complications and hence promoting their life. Self-care is the performance or practice of activities initiated and performed by an individual, family or community tomeasures to be studied, as it reflects the individual health status, adjustment and coping to the illness. Nurses working in Thalassemia day care center provide care to the children, administer packed red blood cells, monitors and maintains the record of the child health, educate them about the home based care. Various studies showed that educational media such as learning maintain life, health and well-being. Self- program6, video tape7 and teaching care is the primary form of primary care due to illness.6 It contributes to the maintenance of well-being and personal health and promote human development. Various studies conducted in other countries showed that educational media,7-8, learning program6 and teaching program 9 improved the self-care behavior of the children with thalassemia.
Thalassemia is a treatable disorder that can be well managed with transfusions and chelation therapy to reduce iron overload. Although it is challenging to stick to treatment, but it helps to live a full and satisfying life to manage the disorder. “Management” involves paying attention to every aspects of daily life in order to stay healthy. Daily maintenance of health, taking healthy diet, follow the medical regimens, maintaining good dental hygiene and health, recognizing infections at earliest, doing exercises and participating in sports, managing stress, to cope up and adjust with the disease, deal with emotions and thoughts in a positive way, and communication of feelings are necessary to lead a healthy life.10 In Thalassemia Self-care abilities of children decrease due to physically, mentally and socially affected life. There is need to improve the self-care behavior of the children. While caring for children with thalassemia, it is the responsibility of the nurses to assess their self care behavior and educate them as per requirements of the child. Self-care behavior is one of the important outcome program9 improved the self-care behavior of the children with thalassemia. This study was planned to assess the effectiveness of learning program through a cartoon picture book on self- care behavior of children between 4-10 years of age suffering from thalassemia.
Materials and Methods
The study was conducted in Thalassemia day care centre, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh. Patients of all age groups suffering from thalassemia visited this center for blood transfusions every month according to the Hemoglobin level. Daily about 20 – 22 patients visited thalassemia day care for blood transfusion. In present study sample consisted of 52 children (37 male and 15 females) between 4-10 years of age suffering from thalassemia visited thalassemia day care centre PGIMER, Chandigarh in the month of July- August, 2014. Terminally ill children were excluded from the study.
Self-care behavior tool and protocol was prepared from an extensive review of literature, relevant to the areas including self-care behavior and care of children suffering from thalassemia; and an informal observation in the concerned area of study and an informal interview with children suffering from thalassemia. Cartoon picture book was prepared using do2 learn: educational resources for special needs. Do2learn is an international website which provides educational resources for children with special needs. Permission was taken from do2learn for using their picture cards. Pictures are collected and edited using photo editor. The validity of the tool and protocol was done by experts from the field of nursing and Pediatrics.
Tool for collecting data was interview schedule comprised of Socio-demographic profile of children and parents, clinical profile and self-care behavior of children. Self-care behavior tool consisted of three domains general health, mental health and medical adherence. It consist of 44 items. Items (1-15) were rated from 3 (Never) to 1 (Almost always) and negative phrased items (16-34) were reversely scored 1 (Never) to 3 (Almost always). Each sub item was scored individually. Summation score of items ranged from 44-132.The scores from items that address each specific domain are averaged together to get score under each domain and then further summation of scores of three domains was done for final scores. Categorization of self-care behavior was done based upon scores: less than 50% scores – poor self-care behavior, 51-75% scores- average self-care behavior and more than 75% scores – good self-care behavior.
Ethical approval for the study was obtained from the ethical committee of the institution. Written permission was obtained from the head of the department, Pediatric Hematology Unit, Advanced Pediatric Center, PGIMER, Chandigarh. Children and their parents visited thalassemia day care center were approached. A written informed consent was obtained from the parents of children suffering from thalassemia. Initial assessment was done by interviewing the children and their parents using self-care behavior tool and then learning program through a cartoon picture book on self-care behavior was given to children. Teaching was done by using cartoon picture book and copy of cartoon picture book on how to do self-care was given to each child after implementation of learning program. Cartoon picture book is an animated book on self-care comprised of activities and good health habits related to maintenance of general health, mental health and medical adherence. Parents were encouraged to use the book to teach the children about self- care at home. Self-care behavior was reassessed during the follow up visit after 25 days. Analysis and interpretation of data was done using descriptive and inferential statistics. In descriptive statistics; percentage, mean, median, standard deviation and range were used to analyze the data. In inferential statistics chi-square (McNemar and Bowker McNemar) and paired t- testwere applied to determine the level of significance. Findings of the study were presented through tables and graphs.
Results
Sample consisted of 52 children in the age of 4-10 years with mean age of 7.2 ± 1.83 years. About three fourth (71.2 %) of children were in the age group of 7-10 years and were male and 76.9 % were studying in primary class. More than half (55.8 %) were residing in urban area, majority (82.7 %) belongs to Hindu religion and 57.7% were living in joint family. No of family members were in the inter quartile range of 4-9 with the median of 6. 63.5% were having 2 siblings with the median of 2. More than half (55.8%) were of 1st birth order. Inter quartile range (median) of birth order was 1- 2 (1). Only 7.7% of parents were having consanguineous marriage and very few (13%) were having family history of thalassemia. More than half (53.8%) were having family history of thalassemia in first degree relatives.
All the children were suffering from Beta Thalassemia Major. Majority (82.7%) of children were getting blood transfusions before the age of 1 year. The age of start of transfusion was in the range 1 month to 84 months with mean age of 10±13.03 months. Most of them (80.8%) were getting blood transfusions at the frequency of 20-25 days. The range of frequency of transfusion was 20-30 days with mean frequency of 23±2.92 days. Most of the children were presented with features of irritability (94.2%) and anemia (92.3%). The problems faced by them were facial bone deformity (86.5%), fatigue (78.8%), pallor (63.5%), enlarged liver or spleen (61.5%), pain (53.8%) and shortness of breath (5.8%). All the children were getting blood transfusion (100%), folate supplements (100%), calcium supplements (100%). Majority of them were getting chelation therapy (96.2%). Only 3.8% of
Table 1: Impact of cartoon picture book on self-care behavior of subjects related to general health.
n=52
| Items related to general health | Before intervention
n (%) |
After intervention
n (%) |
z2 (df) p value | |
| Problem in maintaining personal hygiene: | ||||
| Bathing | ||||
| 47 (90.4) | 49 (94.2) | 19.90 (1) | ||
| Never | ||||
| Sometimes | 5 (9.6) | 3 (5.8) | 0.5 | |
| Brushing | ||||
| Never | 51 (98.1) | 51 (98.1) | 12.49 (1) | |
| Sometimes | 1 (1.9) | 1 (1.9) | 1.0 | |
| Toileting | ||||
| Never | 52 (100.0) | 52 (100.0) | # | |
| Grooming | ||||
| Never | 51 (98.1) | 52 (100.0) | # | |
| Sometimes | 1 (1.9) | Nil | ||
| Dressing | ||||
| Never | 51 (98.1) | 52 (100.0) | # | |
| Sometimes | 1 (1.9) | Nil | ||
| Trouble while : | ||||
| Walking | ||||
| 47 (90.4) | 51 (98.1) | 2.25 (2) | ||
| Never | ||||
| Sometimes | 4 (7.7) | 1 (1.9) | 0.5 | |
| Almost Always | 1 (1.9) | Nil | ||
| Running | ||||
| Never | 28 (53.8) | 35 (67.3) | 6.4 (2) | |
| Sometimes | 22 (42.3) | 16 (30.8) | 0.04 | |
| Almost Always | 2 (3.8) | 1 (1.9) | ||
| Climbing stairs | ||||
| Never | 39 (75.0) | 44 (84.6) | 2.78 (2) | |
| Sometimes | 11 (21.2) | 8 (15.4) | 0.4 | |
| Almost Always | 2 (3.8) | Nil | ||
| Doing simple talk | ||||
| Never | 52 (100.0) | 52 (100.0) | # | |
| Playing | ||||
| Never | 21 (40.4) | 32 (61.5) | 36.23 (2) | |
| Sometimes | 27 (51.9) | 19 (36.5) | <0.01 | |
| Almost Always | 4 (7.7) | 1 (1.9) | ||
| Eating | ||||
| Never | 52 (100.0) | 52 (100.0) | # |
# No statics are computed because value is a constant. Bowker McNemar applied on cells having zero frequency. children had undergone splenectomy. 61.5% of the children were having iron overload and 40.4 % were having transfusion reactions.
Findings of the study depicts significant improvement in general health. Majority of the children were not having problem in maintaining personal hygiene (bathing, brushing, toileting, grooming and dressing) and not having any trouble while walking, climbing stairs, doing simple task and eating before and after intervention. There was significant improvement in running (p = 0.04) and playing (p <0.01) after intervention. (Table 1) There was significant difference in reduction of pain(p = 0.05), decrease in number of absenteeism (p = 0.02) and trouble completing schoolwork(p = 0.01) after intervention. (Table 2)
Table 2: Impact of cartoon picture book on self-care behavior of subjects related to general health.
N= 52
| Items related to general health | Before intervention
n (%) |
After intervention
n (%) |
z2 (df) p value |
| Feel pain Never Sometimes
Almost Always |
25 (48.1) 21 (40.4) 6 (11.5) |
29 (55.8) 19 (36.5) 4 (7.7) |
64.55 (2) 0.05 |
| Avoid physical activities
Never Sometimes Almost Always |
43 (82.7) 7 (13.5) 2 (3.8) |
47 (90.4) 4 (7.7) 1 (1.9) |
25.59 (2) 0.08 |
| Tiredness Never Sometimes
Almost Always |
14 (26.9) 34 (65.4) 4 (7.7) |
23 (44.2) 27 (51.9) 2 (3.8) |
18.06 (2) 0.3 |
| Absenteeism due to disease and treatment
Never Sometimes Almost Always |
12 (23.1) 35 (67.3) 5 (9.6) |
18 (34.6) 31 (59.6) 3 (5.8) |
48.57 (2) 0.02 |
| Trouble completing schoolwork
Never Sometimes Almost Always |
22 (42.3) 16 (30.8) 14 (26.9) |
25 (48.1) 20 (38.5) 7 (13.5) |
68.06 (2) 0.01 |
# No statics are computed because value is a constant
Result shows significant improvement in mental health. Findings depicts significant improvement in peer interaction (p <0.001), reduction of anger outburst episodes (p <0.001),reduction of sadness episodes (p = 0.02), decrease in pessimistic ideas about health (p = 0.002), decrease in episodes of frustration (p = 0.01)] and worries (p = 0.01) after intervention. (Table 3)
Table 3: Impact of cartoon picture book on self-care behavior of subjects related to mental health.
N=52
| Items related to General health | Before intervention
n (%) |
After intervention
n (%) |
z2 (df)
p value |
| Poor peer interaction
Never Sometimes Almost Always |
25 (48.1) 5 (9.6) 22 (42.3) |
30 (57.7) 15 (28.8) 7 (13.5) |
49.1 (2) 0.001 |
| Angry outburst Never Sometimes Almost Always |
3 (5.8) 14 (26.9) 35 (67.3) |
10 (19.2) 28 (53.8) 14 (26.9) |
7.5 (2) 0.001 |
| Sadness due to disease condition
Never Sometimes Almost Always |
32 (61.5) 14 (26.9) 6 (11.5) |
34 (65.4) 17 (32.7) 1 (1.9) |
51.35 (2) 0.02 |
| Pessimistic ideas about health
Never Sometimes Almost Always |
14 (26.9) 24 (46.2) 14 (26.9) |
15 (28.8) 35 (67.3) 2 (3.8) |
45.58 (2) 0.002 |
| Frustrated about health
Never Sometimes Almost Always |
15 (28.8) 20 (38.5) 17 (32.7) |
21 (40.4) 21 (40.4) 10 (19.2) |
31.79 (2) 0.01 |
| Excessive worries about health
Never Sometimes Almost Always |
18 (34.6) 23 (44.2) 11 (21.2) |
22 (42.3) 23 (44.2) 7 (13.5) |
38.21 (2) 0.01 |
| Social isolation Never Sometimes
Almost Always |
47 (90.4) 4 (7.7) 1 (1.9) |
47 (90.4) 5 (9.6) Nil |
0.16 (2) 0.9 |
| Poor social interaction
Never Sometimes Almost Always |
34 (65.4) 10 (19.2) 8 (15.4) |
36 (69.2) 11 (21.2) 5 (9.6) |
24.84 (2) 0.1 |
Bowker McNemar applied on cells having zero frequency.
Result shows significant improvement in feeling healthy (p = 0.003), paying attention in homework (p = 0.05),enjoying leisure activities(p = 0.01)] after intervention. (Table 4)
Table 4: Impact of cartoon picture book on self-care behavior of subjects related to mental health.
N= 52
| Items related to mental health | Before intervention
n (%) |
After intervention
n (%) |
z2 (df) p value |
| Feels healthy Never Sometimes Almost Always |
6 (11.5) 31 (59.6) 15 (28.8) |
2 (3.8) 21 (40.4) 29 (55.8) |
18.12 (2) 0.003 |
| Pay attention in homework
Never Sometimes Almost Always |
5 (9.6) 6 (11.5) 41 (78.8) |
2 (3.8) 6 (11.5) 44 (84.6) |
38.59 (2) 0.05 |
| Likes physical appearance
Never Sometimes Almost Always |
4 (7.7) 9 (17.3) 39 (75.0) |
2 (3.8) 9 (17.3) 41(78.8) |
30.40 (2) 0.3 |
| Enjoy doing leisure activities
Sometimes Almost Always |
17 (30.8) 35 (69.2) |
6 (11.5) 46 (88.5) |
0.24 (1) 0.01 |
| Participate in group activities
Never Sometimes Almost Always |
9 (17.3) 11 (21.2) 32 (61.5) |
5 (9.6) 12 (23.1) 35 (67.3) |
10.07 (2) 0.73 |
| Verbalise health problem with others
Never Sometimes Almost Always |
21 (40.4) 9 (17.3) 22 (42.3) |
12 (23.1) 16 (30.8) 24 (46.2) |
12.25 (2) 0.16 |
Findings of the study depict significant improvement in medical adherence. All the children were having good medical compliance after the intervention. Children were having regular follow up, follow treatment plan, get medical attention when needed and take medicine on time after intervention (Table 5).
There was significant improvement in performing exercise (p < 0.01), yoga (p<0.01), taking rest between activities (p =0.003), taking small and frequent meals (p <0.01), preventing contact with sick persons (p <0.01) and using protective devices (p <0.01) after intervention (Table 6).
Table 5: Impact of cartoon picture book on self-care behavior of subjects related to medical compliance.
N= 52
| Items related to adherence to medical compliance | Before intervention
n (%) |
After intervention
n (%) |
| Regular follow up Sometimes Almost Always |
3 (5.8) 49 (94.2) |
Nil 52 (100.0) |
| Follow treatment plan
Never Almost Always |
1 (1.9) 51 (98.1) |
Nil 52 (100.0) |
| Get medical attention when needed
Almost Always |
52 (100.0) |
52 (100.0) |
| Take medicine on time
Sometimes Almost Always |
12 (23.1) 40 (76.9) |
Nil 52 (100.0) |
No statics are computed because value is a constant
Mean scores of self-care behavior before and after intervention were 105.63±8.10 and 114.34±5.37 respectively. Result showed significant difference in mean scores of self-care behavior before and after intervention [t51 (10.03) p (<0.001)]. Mean general health scores before and after intervention were 42.90±3.01 and 44.40±2.53 respectively. There was significant difference in mean general health scores before and after intervention [t51 (8.098) p (<0.001)]. Mean mental health scores before and after intervention were 35.36±4.95 and 37.98±2.81 respectively. This difference was significant in mean mental health scores before and after intervention [t51 (4.105) p (<0.001)]. Mean medical adherence scores before and after intervention were 27.36±2.44 and 31.96±2.23 respectively. Result showed significant difference in mean medical adherence scores before and after intervention [t51 (13.13) p (<0.001)].
(Table 7)
Percentage distribution of scores as per categories of self-care behavior of children suffering from thalassemia before and after intervention measured by using chi- square. Before intervention 73.1 % of children were having average self-care behavior and 26.9 % were having good self- care behavior. After intervention 23.1 % of children were having average self-care
Table 6: Impact of cartoon picture book on self-care behavior of subjects related to adherence to medical advice.
N=52
| Items related to adherence to medical advice | Before intervention
n (%) |
After intervention
n (%) |
z2 (df) p value |
| Hand washing: a) Before eating | |||
| Never | 8 (15.4) | 4 (7.7) | 6.8 (2) |
| Sometimes | 28 (53.8) | 22 (42.3) | 0.1 |
| Almost Always | 16 (30.8) | 26 (50.0) | |
| b) After visiting washroom | |||
| Sometimes | 7 (13.5) | 2 (3.8) | 6.76 (1) |
| Almost Always | 45 (86.5) | 50 (96.2) | 0.06 |
| Exercise daily
Never Sometimes Almost Always |
48 (92.3) 4 (7.7) Nil |
5 (9.6) 37 (71.2) 10 (19.2) |
39.6 (2) <0.01 |
| Perform yoga
Never Sometimes Almost Always |
49 (94.2) 3 (5.8) Nil |
26 (50.0) 25 (48.1) 1 (1.9) |
20.04 (2) <0.01 |
| Get enough sleep
Sometimes Almost Always |
1 (1.9) 51 (98.1) |
Nil 52 (100.0) |
# |
| Take rest between activities
Never Sometimes Almost Always |
17 (32.7) 24 (46.2) 11 (21.2) |
9 (17.3) 23 (44.2) 20 (38.5) |
46.23 (2) 0.003 |
| Take small and frequent meals
Never Sometimes Almost Always |
9 (17.3) 31 (59.6) 12 (23.1) |
4 (7.7) 22 (42.3) 26 (50.0) |
13.62 (2) <0.01 |
| Eat a well-balanced diet
Never Sometimes Almost Always |
8 (15.4) 24 (46.2) 20 (38.5) |
4 (7.7) 22 (42.3) 26 (50.0) |
10.01 (2) 0.1 |
| Prevent contact with sick persons
Never Sometimes Almost Always |
46 (88.5) 3 (5.8) 3 (5.8) |
8 (15.4) 31 (59.6) 13 (25.0) |
15.42 (2) <0.01 |
| Use protective devices while playing
Never Sometimes Almost Always |
49 (94.2) 2 (3.8) 1 ( 1.9) |
26 (50.0) 16 (30.8) 10 (19.2) |
4.2 (2) <0.01 |
# No statics are computed because value is a constant
behavior and 76.9 % were having good self- care behavior. Result showed significant increase in number of children having good self-care behavior after intervention than before. [z2 (2.74) p value (<0.01)] (figure 1)
Table 7: Impact of cartoon picture booket on self-care behavior of children.
N= 52
|
self-care behavior scores in different health domains |
Mean ± SD |
t value (df) p value |
|
| Before Prevention | After Prevention | ||
| General health score (16 – 48) | 42.90 ± 3.01 | 44.40 ± 2.53 | 8.098 (51) <0.001 |
| Mental health score (14 – 42) | 35.36 ± 4.95 | 37.98 ± 2.81 | 4.105 (51) <0.001 |
| Medical adherence score (14 – 42) | 27.36 ± 2.44 | 31.96 ± 2.23 | 13.13 (51) <0.001 |
| Total scores (44 – 132) | 105.63 ± 8.10 | 114.34 ± 5.37 | 10.03 (51) <0.001 |
Poor self care behaviour Average self care behaviour Good self care behaviour
Discussion
Thalassemia is a chronic childhood disease found throughout the world. Thalassemia affects the ability to produce normal hemoglobin, and can result in either moderate or severe anemia (Weatherall, 2005)11. Affected children suffer in all dimensions of their lives: physiologically, psychologically, socio-culturally and spiritually according to their developmental stage (Aydin et al4, 1997; Gorree5, 2001).
Approximately 5% of the world’s population, 250 million people, have abnormal genes that can transmit thalassemia; about 300,000 children are born with thalassemia each year (WHO, 2006)12. Approximately 30% to 40% (20 to 24 million) are carriers of the genes that transmit thalassemia. The number of infants born with thalassemia has increased by 12,125 cases per year for the past 16 years (MoPH, 2006)13.
Studies showed that children with thalassemia feel difficulty in maintaining physical, mental and social health. cartoon storybook on self care behavior in school age children.6 Another quasi-experimental study conducted by Natiles P showed that after teaching by video tape on knowledge about thalassemia and self-care behavior, the subjects have significantly better self-care behaviour (p< 0.001). However some subjects still have inappropriate self-care behavior concerning exercise, detection of anemia and consultation with their
Thalassemia adversely affects their life. physician.7 Result of the study was Self-care abilities of children decrease due to physically, mentally and socially affected life. So there is need to improve the self- care behavior of the children. Self-care behavior is one of the important outcome measures to be studied, as it reflects the individual health status, adjustment and coping to the illness. Use of educational media showed significant improvement in self-care behavior of children.6-9. 14-15
Animated pictures were an attractive source of educational media and learning for consistent with the present study. Another comparative study conducted by Limjitsomboon A showed that self-care behavior of school-age children with thalassemia after being taught by Computer Assisted Instruction was significantly better than before at the 0.1 level.8 Result of the study was comparable with the present study. Mahanil W also showed significant difference in self-care behavior after the teaching program on knowledge and self- care behavior in the experimental group (p < the children. So this study was conducted to 0.05)9 which were consistent with the assess the effectiveness of learning program through a cartoon picture book on self-care behavior of children between 4-10 years of age suffering from thalassemia.
In the present study result showed that cartoon picture book has shown positive impact in improving self-care behavior of children in each domain i.e. general health, mental health, and medical adherence before and after intervention. Result of the present study was comparable with the quasi-experimental study conducted by Tombon P in Thalassemia clinic of Phontong Primary care unit, Nakornphanom Province. The results of this study showed significant improvement (p < 0 .01) in self-care behavior after the learning program through a group process and present study. One more study conducted by Mukrod S revealed that Self care behaviors of school age children with thalassemia after the supportive-educative nursing system (maternal care behavior and self care behavior) was significantly better than before at level 0.05 and was comparable with the present study. Self care behaviors of school age children with thalassemia received the supportive- educative nursing system was better than the control group at level 0.05. 14 Findings of the study were consistent with the another pre-experimental study conducted by Munkunnan R. Results indicated that the mean score of self-care deficit of older children with thalassemia was decreased significantly (p < .001) after receiving nursing care (self-care agency developing program on self-care deficit and health status).15
Learning program through a cartoon picture book on self-care behavior elicited a statistically significant difference in mean self-care behavior scores of each domain i.e. general health, mental health and medical adherence before and after intervention. So a nursing intervention such as learning program through a cartoon picture book on self-care behavior of children suffering from thalassemia, can be recommended as a routine practice by nurses, so that they can contribute to the well being of the children by offering them education and support.
This shows that Pediatric nurses working in thalassemia day care must be encouraged to provide learning program to the children suffering from thalassemia so as to promote their health and well being, prevent complications, and to restore health. Interventions must be designed to improve the self-care behavior of the children. This will help in improving their general physical and mental health and also improves the children compliance to medical treatment and advice.
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