ارزيابي آگاهي معلمين مدارس ابتدايي از اختلال عملكرد ادراري محصلين مقطع دبستان در شهرستان اروميه

ssessment of the Knowledge of the Primary School Teachers about the Voiding Dysfunction of Students in the City of Urmia

ﻟﺪﻳﻦ ﻣﯽ ﺷﻨﻮﻧﺪ. ﻣﻌﻠﻤﻴﻦ ﻣﻲ ﺗﻮﺍﻧﻨﺪ ﻣﺸﺎﻭﺭﺍﻧﻲ ﺑﺎﻟﻘﻮﻩ ﺩﺭ ﺷﻨﺎﺳﺎﻳﻲ ﻭ ﻛﻤﻚ ﺑﻪ ﺑﭽﻪ ﻫﺎﻱ ﻣﺒﺘﻼ ﺑﻪ ﺍﺧﺘـﻼﻻﺕ ﺍﺩﺭﺍﺭ ﻛـﺮﺩﻥ ﺑﺎﺷﻨﺪ. ﺍﺯ ﺳﻮﻱ ﺩﻳﮕﺮ ﻧﺪﺍﺷﺘﻦ ﺁﮔﺎﻫﻲ ﻣﻨﺎﺳﺐ ﺁﻧﻬﺎ ﻣﻲ ﺗﻮﺍﻧﺪ ﺑﻪ ﺑﺪﺗﺮ ﺷﺪﻥ ﺍﻳﻦ ﻣﺸﮑﻞ ﺑﻴﺎﻧﺠﺎﻣـﺪ. ﻫـﺪﻑ ﺍﻳﻦ ﺗﺤﻘﻴـﻖ ﺍﺭﺯﻳﺎﺑﻲ ﺁﮔﺎﻫﻲ ﻣﻌﻠﻤﻴـﻦ ﺍﺑﺘﺪﺍﻳﻲ ﺍﺯ ﺍﺧﺘﻼﻝ ﻋﻤﻠﻜـﺮﺩ ﺍﺩﺭﺍﺭﻱ ﻣﺤﺼﻠﻴﻦ ﻣﻘﻄﻊ ﺩﺑﺴﺘﺎﻥ ﺍﺳﺖ ﮐﻪ ﺩﺭ ﺷﻬـﺮ ﺍﺭﻭﻣﻴﻪ، ﻣـﺮﮐﺰ ﺍﺳﺘﺎﻥ ﺁﺫﺭﺑﺎﻳﺠﺎﻥ ﻏﺮﺑﻲ ﺍﻧﺠﺎﻡ ﮔـﺮﻓﺖ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﻣﻄﺎﻟﻌﻪ ﺑﺮ ﺭﻭﻱ ﻳﻜﺼﺪ ﻭ ﻳﻚ ﻧﻔﺮ ﻣﻌﻠﻢ ﻣﺪﺭﺳﻪ ﺍﺑﺘﺪﺍﻳﻲ ﺑﺎ ﻣﻴﺎﻧﮕﻴﻦ ﺳﻨﻲ 41±6/77 ﺳﺎﻝ ﺍﺯ 12 ﻣﺪﺭﺳﻪ ﺷﻬﺮ ﺍﺭﻭﻣﻴﻪ ﻛﻪ ﺑﻪ ﺭﻭﺵ ﺧﻮﺷﻪ ﺍﻱ ﭼﻨﺪ ﻣـﺮﺣﻠﻪ ﺍﻱ ﺍﻧﺘﺨﺎﺏ ﺷﺪﻧﺪ، ﺍﻧﺠﺎﻡ ﭘﺬﻳﺮﻓﺖ. ﺩﺭ ﻫﺮ ﻳﻚ ﺍﺯ ﻣﺪﺍﺭﺱ ﻣﻨﺘﺨـﺐ ﺗﻤـﺎﻣﻲ ﻣﻌﻠﻤﻴـﻦ ﺑﻪ ﺗﻜﻤﻴﻞ ﭘﺮﺳﺸﻨﺎﻣﻪ 21 ﺳﺌـﻮﺍﻟﻲ ﻓﺎﺭﺳﻲ ﺷﺪﻩ ﮐﻪ ﺭﻭﺍﻳﻲ ﻭ ﭘﺎﻳﺎﻳﻲ ﺁﻥ ﺩﺭ ﻣﻄﺎﻟﻌﺎﺕ ﻗﺒﻠﻲ ﻣﺎ ﺗﺄﻳﻴﺪ ﺷﺪﻩ ﺑﻮﺩ، ﭘﺮﺩﺍﺧﺘﻨـﺪ. ﻫﻤﻪ ﻣﻌﻠﻤﻴﻦ ﺍﻧﺘﺨﺎﺏ ﺷﺪﻩ ﭘﺎﺳﺨﻨﺎﻣﻪ ﻫﺎ ﺭﺍ ﺑﺮﮔـﺮﺩﺍﻧﺪﻧﺪ. ﺁﻧﺎﻟﻴـﺰ ﺁﻣﺎﺭﻱ ﺍﺯ ﺟﻤﻠﻪ ﺁﺯﻣـﻮﻥ ﻫﺎﻱ ﺩﻗﻴﻖ ﻓﻴﺸﺮ، ﻣﺎﻥ ﻭﻳﺘﻨﻲ ﻭ ﮐﺮﻭﺳﮑﺎﻝ ﻭﺍﻟﻴﺲ، ﻣـﻮﺭﺩ ﺍﺳﺘﻔـﺎﺩﻩ ﻭﺍﻗﻊ ﺷﺪﻧﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﺗﻌﺪﺍﺩ 40 ﻧﻔﺮ ﺍﺯ ﻣﻌﻠﻤﻴﻦ ﺍﻇﻬﺎﺭ ﺁﮔﺎﻫﻲ ﺍﺯ ﺍﺧﺘﻼﻻﺕ ﺩﻓﻌﻲ ﺩﺭ ﮐﻮﺩﮐﺎﻥ ﮐﺮﺩﻧﺪ. ﺍﺯ ﻣﻴﺎﻥ ﻣﻌﻠﻤﻴﻦ ﺑﺮﺭﺳﻲ ﺷﺪﻩ ﺗﻨﻬﺎ 9 )8/9 ﻣﻌﻠﻢ ﺑﻴﺎﻥ ﮐﺮﺩﻩ ﺍﻧﺪ ﮐﻪ ﺩﺭ ﻣﺪﺭﺳﻪ ﻣﺮﺑﻲ ﺑﻬﺪﺍﺷﺖ ﻧﺪﺍﺭﻧﺪ. ﺩﻩ ﻣﻌﻠـﻢ ﺍﻇﻬﺎﺭ ﺩﺍﺷﺘﻨﺪ ﻛﻪ ﺭﻭﺯﻱ ﻳﮏ ﺑﺎﺭ ﺑﻪ ﺗﻮﺍﻟـﺖ ﻫﺎﻱ ﺩﺍﻧﺶ ﺁﻣﻮﺯﺍﻥ ﺳﺮ ﻣﻲ ﺯﻧﻨﺪ، ﺍﻣﺎ 80 ﻧﻔﺮ ﺗﻘﺮﻳﺒﺎﹰ ﻫﻴﭻ ﻭﻗﺖ ﺍﻳﻦ ﻛﺎﺭ ﺭﺍ ﻧﻤﻲ ﻛﻨﻨﺪ. ﻣﻴﺎﻧﻪ ﺗﻌﺪﺍﺩ ﺗﻮﺍﻟﺖ 10 ﻋـﺪﺩ ﺩﺭ ﻫـﺮ ﻣﺪﺭﺳﻪ ﺣـﺪﺍﻗﻞ ﻳﮏ ﺗﻮﺍﻟﺖ ـ ﺣﺪﺍﮐﺜﺮ 12 ﺗﻮﺍﻟﺖ( ﺍﺳﺖ. ﻭﺿﻌﻴﺖ ﻧﻈﺎﻓﺖ ﺳﺮﻭﻳﺲ ﻫﺎﻱ ﺑﻬﺪﺍﺷﺘﻲ ﺍﺯ ﻧﮕﺎﻩ ﻣﻌﻠﻤﺎﻥ ﭼﻨﻴﻦ ﺍﺳﺖ: 19 ﻧﻔﺮ ﻫﻤﻴﺸﻪ ﺗﻤﻴـﺰ ﺍﺳﺖ، 32 ﻧﻔﺮ ﻓﻘـﻂ ﺍﻭﻝ ﻭﻗﺖ ﺗﻤﻴﺰ ﺍﺳﺖ 32 ﻧﻔﺮ ﺩﺭ ﻃﻮﻝ ﺭﻭﺯ ﮐﺜﻴﻒ ﺗﺮ ﻣﻲ ﺷﻮﺩ ﻭ 18 ﻧﻔﺮ ﻫﻴﭻ ﻭﻗﺖ ﺗﻤﻴـﺰ ﻧﻴﺴﺖ. ﻣﺤـﺪﻭﺩﻳﺖ ﺯﻣﺎﻧﻲ ﺩﺭ ﺯﻧﮓ ﺗﻔـﺮﻳﺢ ﺑﺎﻻﺗﺮﻳﻦ ﺩﻟﻴﻞ ﺑﺮﺍﻱ ﺧﺮﻭﺝ ﺍﺯ ﮐﻼﺱ ﻣﻄﺮﺡ ﺷﺪﻩ ﺍﺳﺖ. ﺗﻌـﺪﺍﺩ ﻧﺎﮐﺎﻓﻲ ﺩﺳﺘﺸﻮﻳﻲ ﻭ ﺑﻬﺎﻧﻪ ﺑﺮﺍﻱ ﺧﺮﻭﺝ ﺍﺯ ﮐﻼﺱ ﺩﺭ ﺟﺎﻳﮕﺎﻩ ﺑﻌﺪﻱ ﻣﻄﺮﺡ ﺷﺪﻩ ﺍﻧﺪ. ﺗﻌـﺪﺍﺩ 46 ﻧﻔﺮ ﺍﺯ ﻣﻌﻠﻤﻴﻦ ﻭﻗﺖ ﺍﺿﺎﻓﻲ ﻏﻴﺮ ﺍﺯ ﺯﻧﮓ ﺗﻔﺮﻳﺢ ﺑﺮﺍﻱ ﺩﺳﺘﺸﻮﺋﻲ ﺭﻓﺘﻦ ﺩﺍﻧﺶ ﺁﻣـﻮﺯﺍﻥ ﺍﺧﺘﺼﺎﺹ ﻣﻲ ﺩﻫﻨﺪ. ﺩﺭ ﭘﺎﺳﺦ ﺑﻪ ﺍﻳﻦ ﺳﺌـﻮﺍﻝ ﮐﻪ ﺍﮔﺮ ﺩﺍﻧﺶ ﺁﻣﻮﺯﻱ ﻫﻨﮕﺎﻡ ﺩﺭﺱ ﺍﺟﺎﺯﻩ ﺩﺳﺘﺸﻮﺋﻲ ﺭﻓﺘﻦ ﺑﮕﻴـﺮﺩ ﭼﻪ ﻣﻲ ﮐﻨﻴﺪ؟ 69 ﻣﻌﻠﻢ ﺍﻇﻬﺎﺭ ﮐﺮﺩﻧﺪ ﮐﻪ ﺍﺟﺎﺯﻩ ﻣﻲ ﺩﻫﻨﺪ ﺩﺍﻧﺶ ﺁﻣﻮﺯ ﺍﺯ ﮐﻼﺱ ﺑﻴـﺮﻭﻥ ﺑﺮﻭﺩ. ﺗﻌـﺪﺍﺩ 21 ﻧﻔﺮ ﺍﺯ ﻭﻱ ﻣﻲ ﺧﻮﺍﻫﻨﺪ ﺻﺒﺮ ﮐﻨﺪ ﻭ 4 ﻧﻔﺮ ﺍﻭ ﺭﺍ ﺗﺎ ﺩﺳﺘﺸﻮﺋﻲ ﻫﻤـﺮﺍﻫﻲ ﻣﻲ ﮐﻨﻨﺪ ﻭ ﺗﻨﻬﺎ 6 ﻧﻔﺮ ﻭﻱ ﺭﺍ ﺁﺯﺍﺩ ﻣﻲ ﮔـﺬﺍﺭﻧﺪ ﮐﻪ ﺩﺭ ﺻﻮﺭﺕ ﻟﺰﻭﻡ ﺩﺭ ﻫﺮ ﺯﻣﺎﻥ ﻻﺯﻡ ﺍﺯ ﮐﻼﺱ ﺑﻴﺮﻭﻥ ﺑﺮﻭﺩ. ﺩﺭ ﻣـﻮﺭﺩ ﻧﺤـﻮﺓ ﺑﺮﺧﻮﺭﺩ ﻣﻌﻠﻤـﺎﻥ ﺑﺎ ﺗﮑـﺮﺭ ﺍﺩﺭﺍﺭ، ﺧﻴﺲ ﮐـﺮﺩﻥ ﻭ ﺑﻲ ﺍﺧﺘﻴـﺎﺭﻱ ﻣـﺪﻓﻮﻉ ﺩﺍﻧﺶ ﺁﻣﻮﺯﺍﻥ ﺑﻪ ﺗﺮﺗﻴﺐ 15، 24 ﻭ 26 ﻧﻔﺮ ﺑﺎ ﺁﻧﻬﺎ ﺑﺮﺧﻮﺭﺩ ﻧﮑـﺮﺩﻩ ﺍﻧﺪ ﻭ 28، 19 ﻭ 17 ﻧﻔﺮ ﺑﻪ ﻭﺍﻟﺪﻳﻦ ﺍﻃﻼﻉ ﻣﻲ ﺩﺍﺩﻧﺪ ﻭ 44، 48 ﻭ 42 ﻧﻔﺮ ﺑﻪ ﻣﺮﺑﻲ ﺑﻬﺪﺍﺷﺖ ﺧﺒـﺮ ﻣﻲ ﺩﺍﺩﻧﺪ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﻃﺮﺯ ﺑﺮﺧﻮﺭﺩ ﻣﻌﻠﻤﻴﻦ ﻣﺪﺍﺭﺱ ﺍﺑﺘﺪﺍﻳﻲ ﺑﺎ ﻣﺸﮑﻼﺕ ﺩﻓﻌﻲ ﮐﻮﺩﮐﺎﻥ ﺁﮔﺎﻫﺎﻧﻪ ﻭ ﻣﻨﺎﺳﺐ ﻧﻴﺴﺖ. ﺑﻪ ﻧﻈﺮ ﻣﻲ ﺭﺳﺪ ﺁﮔﺎﻫﻲ ﻣﻌﻠﻤﻴﻦ ﺍﺯ ﺍﻳﻦ ﻣﻮﺿﻮﻉ ﺑﻪ ﻣـﺮﻭﺭ ﺯﻣﺎﻥ ﻭ ﺑﻪ ﻃﻮﺭ ﺗﺠـﺮﺑﻲ ﺻﻮﺭﺕ ﻣﻲ ﮔﻴـﺮﺩ. ﮔﻨﺠﺎﻧﺪﻥ ﻣﻄﺎﻟﺒﻲ ﺩﺭﺑﺎﺭﻩ ﺍﺧﺘﻼﻻﺕ ﺍﺩﺭﺍﺭﻱ ﻭ ﺩﻓﻌﻲ ﮐﻮﺩﮐﺎﻥ ﺩﺭ ﺑﺮﻧﺎﻣﻪ ﻫﺎﻱ ﺁﻣـﻮﺯﺷﻲ ﺗﺮﺑﻴﺖ ﻣﻌﻠﻢ ﻣﻲ ﺗﻮﺍﻧﺪ ﻣﻨﺤﻨﻲ ﻓـﺮﺁﻳﻨﺪ ﺁﻣـﻮﺯﺵ ﻣﻌﻠﻤﻴـﻦ ﺭﺍ ﮐﻮﺗﺎﻩ ﮐﻨﺪ ﻭ ﺯﻣﻴﻨﻪ ﻣﻨﺎﺳﺐ ﺑﺮﺍﻱ ﺑﺮﺧﻮﺭﺩ ﺍﻳﺸﺎﻥ ﺑﺎ ﻣﺸﮑﻼﺕ ﺩﻓﻌﻲ ﮐﻮﺩﮐﺎﻥ ﺭﺍ ﻓـﺮﺍﻫﻢ ﺳﺎﺯﺩ. ﺟـﺮﺍﺣﺎﻥ ﺍﻃﻔـﺎﻝ ﻭ ﺟـﺮﺍﺣﺎﻥ ﮐﻠﻴـﻪ ﻭ ﺳﺎﻳﺮ ﺍﻃﺒـﺎ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺍﻃﻼﻋـﺎﺕ ﺣﺎﺻـﻞ ﺍﺯ ﺍﻳﻦ ﺗﺤﻘﻴـﻖ ﻣﻲ ﺗﻮﺍﻧﻨﺪ ﺑﺮﺍﻱ ﮐﻮﺩﮐﺎﻥ ﻣﺒﺘـﻼ ﺑﻪ ﺍﺧﺘـﻼﻻﺕ ﻋﻤﻠﮑﺮﺩﯼ ﺩﺳﺘﮕﺎﻩ ﺍﺩﺭﺍﺭﻱ ﻭ ﻣﺪﻓـﻮﻋﻲ ﻫﻤـﺎﻫﻨﮕـﻲ ﻫﺎﻱ ﻻﺯﻡ ﺭﺍ ﺑﺎ ﻣﻌﻠﻤﻴـﻦ ﻭ ﺍﻭﻟﻴـﺎﺀ ﻣـﺪﺍﺭﺱ ﻓـﺮﺍﻫﻢ ﺁﻭﺭﻧﺪ ﺗﺎ ﺑﻪ ﻧﺘـﺎﻳﺞ ﺩﺭﻣـﺎﻧﻲ ﻣﻄﻠـﻮﺏ ﻭ ﻣـﺆﺛﺮﺗﺮﯼ ﺩﺳـﺖ ﻳﺎﺑﻨﺪ.

ntroduction & Objective: Pediatric surgeons and urologists when facing children with elimination disorders often listen to their parents for information regarding their toileting. Primary school teachers can be potential counselors that recognize and help children with dysfunctional voiding. Their lack of knowledge, on the other hand can worsen these children’s conditions. The purpose of this study was to assess the knowledge of the primary school teachers about the voiding dysfunction of students in west azerbaijan province. Materials & Methods: The subjects of this study consisted of 101 primary school teachers with a mean age of 41±6.77 years from 12 schools in City of Urmia which were selected through multiple cluster sampling. In each selected school, all teachers completed a 21-item Farsi questionnaire, its validity and reliability had already been approved by our previous studies. All questionnaires were returned filled. Statistical tests were performed by Fisher’s exact, Mann-Whitney and Kruskal- Wallis tests. Results: Forty school teachers stated they had received some information about abnormal voiding and stooling. Only 9 teachers noted that their school does not have a school nurse. Ten teachers would pay a visit to students’ toilets once a day, but 80 teachers would almost never do that. Median number of toilets per school was 10 (1 to 12). As to the toilet sanitation, 19 teachers stated that they are “always clean”, 32 said that they are “clean at the start of the day”, 32 believed that “they become dirty progressively” and 18 said that they are “never clean”. In teachers’ opinion, short break time was the main reason for a permission to go to the toilet during class time, followed by the insufficient number of toilets, and as an excuse to leave the class. Forty-six teachers would offer set-times other than the breaks for the students to go to the toilet. In response to this question that what would you do if a student asked for the permission to leave during the class, 69 said they will grant the permission, 21 said they would rather ask to wait, 4 said they will accompany him/her to the toilet and only 6 said they would let the students leave on their will. As to the teachers’ attitude regarding the urinary frequency, urinary and fecal incontinence, 15, 24 and 26 of them had never encountered these problems, 28, 19 and 17 would notify the parents, and 44, 48 and 42 would notify the school nurse. Conclusions: The elementary school teachers’ attitude towards the abnormal voiding and stooling is not appropriate and informed. It seems that acquisition of information is gradual and by experience. Adding educational material regarding pediatric bladder and bowel function to primary school teachers’ college curriculum can shorten their learning curve and prepare them to confront these problems more efficiently. Pediatric surgeons and urologists and other primary care physicians can use the elementary school teachers knowledge for the benefit of more effective treatment plans.