Effect of Nursing Snippet-Based Intervention on Parents' Burden and Self-Efficacy towards Caring for their Children undergoing Limb Lengthening Surgery

Effect of Nursing Snippet-Based Intervention on Parents' Burden and Self-Efficacy towards Caring for their Children undergoing Limb Lengthening Surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of Nursing Snippet-Based Intervention on Parents' Burden and Self-Efficacy towards Caring for their Children undergoing Limb Lengthening Surgery Rawia Abd El-ghany Mohamed, Nora Abd El-Alim Ebrahim, Hanan Elsayed Metwally This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8681721/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background: Parents frequently experience severe anxiety when their child has surgery, which can have a detrimental effect on their emotional health and possibly affect the child's recuperation. Aim: To evaluate the effect of nursing snippet-based intervention on parents' burden and self-efficacy towards caring for their children undergoing limb lengthening surgery. Methods: The present study was carried out utilizing a quasi-experimental research design. Setting: The present study was conducted at the inpatient pediatric surgical department, at Benha Specialized Pediatric Hospital in Benha city. Study sample: A purposive sample of 55 parents accompanying their children undergoing limb lengthening surgery. Study tools: Five tools were used for data collection, Tool I: A structured interviewing questionnaire. Tool II: Child medical data. Tool III: Parents' reported practices checklist. Tool IV: Caregiver Self-Efficacy Scale. Tool V: Burden interviewing questionnaire. Results: The majority of the studied parents had satisfactory level of total knowledge and competent level of total practice immediately post nursing snippet-based teaching intervention. Also, less than half of them had high self-efficacy level and little burden immediately post nursing snippet-based teaching intervention. Conclusion: A nursing snippet-based intervention had a positive effect on improvement of parents' self-efficacy and diminished burden level. Recommendation: Establish training programs for clinical staff to optimize fidelity and effectiveness of nursing snippet-based interventions. Children Limb lengthening surgery Nursing Snippet-Based Intervention Parents' burden Self-efficacy Figures Figure 1 Figure 2 Introduction Limb lengthening surgery is one of the possible elongation procedures and represents a challenging pathway burdened by a high rate of complications. Additionally, this operation is still the only viable way for children with achondroplasia to restore body proportions more in line with the regular population and reach a stature comparable to the normal population range at maturity ( 1 ). The functional and cosmetic consequences of limb deformity and shortening necessitate surgery. While more English-language publications support the practice of treating lower limb deformities and extending bones, fewer articles discuss upper extremity lengthening. Dick and Tietjen reported the first instance of humeral lengthening in 1978 ( 2 ). Limb length disparity, a condition where one limb is shorter than the other owing to congenital, developmental, or post-traumatic factors, can be corrected with limb lengthening, a crucial orthopedic operation. Children who have limb lengthening surgery might improve their psychological and emotional well-being while gaining more independence in everyday activities like sports, public transportation, and personal cleanliness ( 3 ). Limb lengthening with external fixation can correct the lower extremity deformity ( 4 ). While, internal lengthening devices became more popular than external fixators. This was attributed to their effectiveness and lower complication rates ( 5 ). The care of children undergoing surgery places a substantial burden on parents, both emotionally and in terms of practical caregiving responsibilities. The level of burden of care varies depending on the type, intensity and duration of the disease of the person receiving the care. Furthermore, giving care to a sick child, monitoring the treatment and medications used, meeting the child's nutrition and personal care needs, and hospitalizations affecting family integrity adversely affect parents’ lifestyle and further deepen the difficulties they experience ( 6 ). The suffering that a family member's primary caregiver experiences, including consequences for their health, psychological well-being, finances, and social life, is referred to as caregiver's load. In this context, a caregiver is someone who gives unpaid care to a sick child and who has a relationship with the child, either biologically or by friendship. Mothers, fathers, grandmothers, and aunts are typically considered caregivers ( 7 ). Family caregiver burden is a complicated reaction to the financial, social, emotional, psychological, and physical strains of providing care. The biological, psychological, sociological, ethnic, cultural, and religious facets of the life of formal caregivers are all impacted by this complex process ( 8 ). Understanding the caring burden, stress, and personal resources of parents is crucial. The child's chronic illness affects both parents. In terms of personal requirements, mothers and fathers have disadvantages as compared to parents of healthy children ( 9 ),( 10 ). Self-efficacy describes how respond to stressful events in life and is only used in the care sector to explain how caregivers deal with persistent difficulties ( 11 ). In the context of pediatric surgery and long-term care, parents frequently take on the role of primary caregivers and bear heavy responsibilities in managing their child's recuperation and daily requirements. Additionally, improving parental understanding may boost parental efficacy and confidence. Therefore, nurses should be able to comprehend the emotional and psychological responses of the parents, as well as establish a great learning atmosphere and show crucial interest and support ( 12 ). Educating families of children having surgery has been the subject of numerous research. Numerous techniques have been linked to lowering anxiety in children and their relatives. Strong interpersonal interactions between hospital staff and parents/children, emphasizing rapport, communication, and honesty, as well as education for parents/children. One method of preparing parents for the stress levels encountered during a preoperative period is through interventions ( 13 ). The use of microlearning in education has been shown to improve learners' knowledge and self-assurance. Health professions educators support microlearning as a way to support parent education, training, and continuing education. Microlearning is the acquisition of knowledge or skills in the form of small units ( 14 ). A nursing snippet-based intervention is a cutting-edge method of instruction that presents material in brief, targeted chunks, or "snippets." When used in parent education, this approach improves learning outcomes and engagement by giving parents short, planned learning units that fit into their everyday schedules. The idea is based on micro-learning theory, which prioritizes brief, focused learning opportunities over lengthy class periods ( 15 ). Additionally, short modules and instructional films have been shown to be successful in enhancing parental scaffolding abilities and self-efficacy, allowing parents to better assist their children's learning and healing processes ( 16 ). Thus, snippet-based instruction offers a productive, parent-centered framework that enhances the parent's role as an effective caregiver and educator, encourages active learning, and lessens cognitive overload ( 17 ). Significance of the study Surgery has been linked to anxiety and severe psychological reactions in children and parents due to concerns about anesthesia, fears of cancer or death, and anticipated pain and physical discomfort. Even in surgeries that doctors deem "minor," these have been shown to negatively impact surgical procedures and the patient's recuperation. Given the evident yet crucial role parents play in managing children with surgical conditions, it would be pertinent to understand the caregiver burden ( 7 ). Children's surgeries are known to be stressful experiences for both the child and the family. Expectations, views of the sickness, and the healing process all contribute to the high level of parental stress that persists during a child's hospital stay. Additionally, both children and their parents may have unpleasant and challenging experiences as a result of pediatric surgery. "Burden of care" refers to the negative effects of a caregiver's caregiving, including physiological, psychological, economic, social, and familial issues ( 6 ). For those with achondroplasia, the most prevalent skeletal dysplasia with an estimated prevalence of 1:22,000 live births and over 250,000 affected individuals globally, limb lengthening surgery is a controversial option. The combined prevalence of achondroplasia in Europe is 3.5 per 100,000 live births. Impaired endochondral bone formation is the outcome of a heterozygous pathogenic mutation in the Fibroblast Growth Factor Receptor 3 gene (FGFR3) ( 18 ), ( 19 ). Rehabilitation and postoperative care are mostly the responsibility of the parents of children undergoing surgery. Research indicates that a high caregiver burden might have a detrimental effect on child outcomes by increasing parental stress and decreasing adherence to care routines. On the other hand, parental self-efficacy-boosting therapies greatly lessen load and promote the wellbeing of both parents and children ( 7 ). Theoretical framework The theoretical framework of this study was developed to explain how a snippet-based teaching strategy can influence parents’ burden and self-efficacy while caring for their children undergoing limb lengthening surgery. Parents of children who undergo this complex surgical procedure often experience high levels of physical, emotional, and psychological burden due to the long treatment period, intensive care requirements, and fear of complications. At the same time, their ability to cope and provide effective care depends largely on their level of knowledge, skills, and confidence. Current study is guided by Bandura’s Self-Efficacy Theory ( 20 ), ( 21 ), ( 22 ) supported by Lazarus and Folkman’s Stress and Coping Theory ( 23 ),( 24 ). According to the concept, parents perceived self-efficacy is a key factor in evaluating their capacity to manage the caring responsibilities related to limb lengthening surgery. Increased parental self-efficacy improves coping mechanisms and caregiving techniques, which lessens the perceived burden of parenting. On the other hand, parents' self-efficacy may be severely impacted and their burden may grow due to increased caregiving obligations and child-related clinical variables. Methodology Research design The present study was carried out utilizing a quasi-experimental research design to evaluate the effect of nursing snippet-based intervention on parents' burden and self-efficacy towards caring for their children undergoing limb lengthening surgery. This study aimed to evaluate the following three research hypotheses: Parents who participate in nursing snippet-based intervention are expected to have an improvement in their knowledge and practice score, toward caring of their children undergoing limb lengthening surgery Parents' burden level will be diminished after nursing snippet-based intervention, toward caring of their children undergoing limb lengthening surgery. Parents' self-efficacy level will be improved after a snippet-based teaching strategy, toward caring of their children undergoing limb lengthening surgery. Sample A purposive sample of 55 parents accompanying their children undergoing limb lengthening surgery who attended the previously mentioned setting through two shifts (morning and afternoon shifts) for a period of six months. - The sample size was calculated by the following formula: n = N/1 + N(e) 2 ( 25 ) Where; n = sample size = 55 N = Total population size = 64 parents e = Margin of error = 0.05 Therefore, sample size (n) = 64/ (1 + 64*0.0025) = 55.1 . They were taken according to the following Inclusion criteria for children : From both genders. Children who have already undergone limb lengthening surgery. Ages ranged from 5–12 years. Free from any other previous leg surgeries. Exclusion criteria for children : -Children with cognitive or developmental delays that prevent understanding of instructions Inclusion criteria for parents Willing to participate in the snippet-based teaching strategy sessions. Parents who own a smartphone and are able to access digital teaching materials. Exclusion criteria for parents Parents with psychiatric or cognitive conditions that may interfere with participation Setting: The current study was conducted at the inpatient pediatric surgical unit at Benha Specialized Pediatric Hospital affiliated to Ministry of Health in Benha City. It included two pediatric surgical departments that were located at Building B of the hospital on the second and third floors, each department comprises five rooms, each room contains four beds, and the recovery room contains two beds. Tools of data collection Five tools were used to obtain data relevant to the current study. It was prepared in simple Arabic language. Each parent was interviewed exclusively for filling the knowledge questionnaire sheet. These included the following tools: Tool (I): A structured interview questionnaire: This tool was developed by the researchers after reviewing the scientific and relevant literature. That was written in an Arabic and consisted of two parts: Part ( 1 ) Parents’ characteristics such as; age, level of education, occupation, residence, consanguinity relation between parents and attendance of training courses regarding the care of their children undergoing limb lengthening surgery. Part ( 2 ): Parents' knowledge regarding limb lengthening surgery. It was designed by the researchers in the light of related studies and researches ( 26 ), ( 27 ). It contained (31 questions) in the form of multiple choice and true/false, which included definition and purpose of limb lengthening (2 questions), risks/benefits of surgery(2 questions), types of devices used (1 question), importance of preoperative medical evaluation and investigations(3 questions), role of the parent in preparing the child physically and psychologically(4 questions), expected duration of the lengthening and consolidation phases (2 questions), postoperative Care (7 questions), signs of complications (1 questions), home care and follow-up (5 questions), and expected outcomes (4 questions). Scoring system : The parents' knowledge was checked with the model answer after completing the interview questionnaire. The correct answers scored ( 1 ), and the incorrect or do not know answers scored (0). The total degree ranges from 0–31 (31 questions). The parents’ total knowledge was classified as the following: ≥60% was considered a satisfactory level of knowledge <60% was considered an unsatisfactory level of knowledge. Tool (II): Child medical data: It was developed by the researchers and consisted of two parts as the follow: Part 1 : - Personal characteristics of the studied children, it included age, gender, and child rank. Part 2 : - Medical history of children, it included medical diagnosis, complications that occurred as a result of limb lengthening surgery. Tool (III): Parents' reported practices checklist : It was adapted from( 28 ), ( 29 ), ( 30 ) & ( 31 ) to assess parents' reported practice towards care of their children after limb lengthening surgery. It includes 11 main items and the total steps were 65 steps including; immediate post operative care (6 steps), pain and analgesia management (5 steps), essential wound care/ daily cleaning of pin sites (8 steps), skin and personal hygiene management (6 steps), emotional/psychosocial support (4 steps), assist with mobility and safe transfers (6 steps), home environment & equipment management (7 steps), device/frame care & adjustments (7 steps), physiotherapy / range-of-motion exercises (5 steps), monitoring for complications & early reporting (7 steps), adherence to follow-up schedule after surgery (4 steps). Score ( 1 ) was given to a correctly done step. Score (0) was given to incorrectly done or not done step. The total steps included 65 steps. Scoring system for parents’ reported practice : Total scores were ranged from (0–65). Accordingly, parents' reported practices were classified as the following: Less than 85% was considered incompetent practice level Equal to or more than 85% was considered competent practice level Tool IV: Caregiver Self-Efficacy Scale (CSES) adopted from ( 32 ). It was written in an Arabic language and consisted of 15 items measuring confidence in managing caregiving tasks and obtaining respite, within 3 subscales (self-efficacy for obtaining respite /support, self-efficacy for responding to child’s distress/disruptive behaviors, and self-efficacy for controlling upsetting caregiving-related thoughts). Scoring system for Caregiver Self-Efficacy Scale: 0–100 confidence rating scale, classified as 0-33.3% considered Low self-efficacy, 33.4%-66.6% considered Moderate self-efficacy, and 66.7%-100% considered High self-efficacy. Tool V: Burden interviewing questionnaire : Modified version of Zarit Burden Interviewing questionnaire (ZBI) developed by ( 33 ). This tool was used to measure the extent of family caregiver have physical, social and psychological burden. The ZBI questionnaire consisted of 22 items Burden in the relationship 6 items, Emotional wellbeing 7 items, Social and family life 4 items, Finances 1 items, and Loss of control over one's life 4 items. Categorized in three main sections: 3-point Likert scale of response for each statement indicates how often the caregiver feels that way: (0) never, ( 1 ) rarely, ( 2 ) sometimes, ( 3 ) quiet frequently, nearly always ( 4 ). The scale scoring system: The burden level was rated from (0–20) little burden, ( 21 – 40 ) mild burden, from (41–60) moderate burden, from (61–88) high burden. It aims to assess the level of burden experienced by the principal caregivers of older persons with dementia and disabled persons. The ZBI provides an assessment of subjective burden, that is, the appraisals caregivers make of the impact that providing care has on their lives. Subjective appraisals are a fundamental dimension in understanding the stress process. Measures of the patients’ symptoms or problems in functioning and behavior provide a context in which burden is experienced, but caregivers’ subjective experiences of the impact of problems on their lives can vary considerably. Subjective burden as measured by the ZBI is a critical dimension, because caregivers’ perceptions of the impact of providing care on their lives will affect their actions and the decisions they make, such as about seeking help or continuing in the care role. Preparatory phase: In order to become more familiar with the various parts of the study, this phase involved reviewing pertinent local and worldwide literature as well as recent studies. It also involved constructing the study's tools using journals, scientific books, magazines, and evidence-based articles. Tools validity and reliability: A panel of three pediatric nursing specialists from Benha University's Faculty of Nursing evaluated the study tools' validity in order to assess the items' clarity, relevance, and applicability. The changes were made to guarantee their accuracy and applicability. The Cronbach's alpha test was used to determine the measures' internal consistency. It was 0.85 for practice and 0.78 for knowledge. Pilot study : It was carried out on six parents, or 10% of the study participants, in order to assess the study tools' applicability and calculate the time needed to finish them. No significant changes were made to the study instruments in light of the pilot study's findings. As a result, the study sample was expanded to include the parents from the pilot study. Procedure for data collection: The researchers were found in the study setting by using rotation two days per week (Saturday and Wednesday) during the morning shift to gather data using the previously mentioned tools. The fieldwork was completed over a six-months period. The following phases were carried out to achieve the aim of the current study; assessment, planning, implementation and evaluation phases. Assessment phase the researchers interviewed each parent individually; the aim and duration of the study were explained. Oral and written consents to participates in the study before data collection obtained. Planning phase: The researchers developed the nursing snippet-based intervention after reviewing the related literature and determined the needs in the assessment phase. The nursing snippet-based intervention utilized in the current study included three methods as following: 1- Snippet videos : Snippet videos are short, focused, and easily digestible video segments that deliver essential information in a concise and engaging way. They are particularly useful for educating parents about child care, medical procedures, rehabilitation, and health promotion. - The duration of video Typically 5–7 minutes per video, focused on one topic or skill at a time, visual demonstrations (e.g., physiotherapy exercises, wound care). Also, videos can be accessed anytime, often via mobile device. - Snippet had a great importance for parents through enhancing understanding because parents can focus on one concept at a time. Moreover, short videos are easier to remember than long lectures. Also, snippet videos increase engagement because videos with visuals and animations grab attention better than text. - Parents can pause, replay, or share videos, allowing flexible learning. Furthermore, it supports practical skills and demonstrates procedures like bandage changing, physiotherapy exercises, or limb-lengthening care. Helps parents gain confidence in applying care techniques at home and feel less anxious when guided visually 2- Snippet Infographics are visual representations of information, or instructions that combine graphics, icons, charts, and brief text to make complex content easy to understand. Focus on a single concept or procedure per infographic, can be printed or shared digitally Importance of Infographics for Parents - It simplifies complex information by showing step-by-step instructions visually (e.g., limb care after surgery). Also, parents can keep a printed or digital copy for fast guidance at home. 3-Snippet Single-Focus Modules are short, focused teaching units that cover one specific skill or concept at a time using brief text explanations. It covers one topic per module, easy to share digitally or use in print, and supports better adherence to care instructions it was applied by using the following steps: One Skill per Snippet – Focus on a single task. Show Then Explain – Demonstrate first, then give 1–3 sentences summarizing steps. Use Simple Language – Parent-friendly, avoid jargon. Use printed colored cards summarizing critical steps (such as pain management, pin-site care, and danger signs) were also provided during hospital discharge Highlight Key Points – Emphasize warnings or critical steps. Share Accessibly –WhatsApp, or printed handouts. Implementation phase: The nursing snippet-based intervention was applied through short, focused instructional segments that covered essential aspects of their child’s limb lengthening care. These snippets were presented sequentially and reinforced through direct guidance. The researchers ensured consistent delivery, clarified questions, and supported parents’ skill development throughout the snippet teaching strategy implementation considering the appropriate level of Arabic language for the parents' education. - Session’s implementation schedule was established to suit parents including date, time, place, topics, and duration of all snippet sessions. - There were eight meetings in all, lasting 40 to 50 minutes over the course of four months. Moreover, eight sessions containing the study objectives and carried out through (3 session for the theoretical as showed in Table A and 5 sessions for the practical part as showed in Table B) using different snippet teaching strategies. Ten groups of parents were created, with five to six parents in each group. Table A: A nursing snippet-based intervention for theoretical part Theoretical part Snippet Video Infographic / Visual Snippet Single-Focus Modules (Brief Text Explanation) Definition and Purpose of Limb Lengthening Short animation explaining the concept of bone lengthening and how new bone forms. Diagram showing bone segments, external fixator/device, and distraction process. Clear text module defining limb lengthening, goals, and indications in simple language. Risks and Benefits of Surgery Video summarizing common risks (infection, pain, nerve irritation) and expected benefits (corrected deformity, improved function). Risk–benefit comparison chart with icons. Brief text listing major risks and benefits, with emphasis on parental understanding and early reporting. Types of Devices Used Demonstration video showing external fixators and internal lengthening nails. Device comparison chart with labelled diagrams. Step-by-step explanation of each device, its purpose, and how it works. Importance of Preoperative Evaluation & Investigations Video explaining required investigations (X-ray, blood work, anesthesia assessment). Flowchart of preoperative assessment steps. Module explaining why each investigation is needed and what parents should expect. Role of the Parent in Preparing the Child Physically & Psychologically Video showing parent–child interaction, preparation routines, and communication tips. Checklist visual for psychological and physical preparation. Short text guiding parents on how to reduce anxiety, encourage cooperation, and prepare physically (nutrition, hygiene, rest). Expected Duration of Lengthening & Consolidation Phases Visual timeline video showing each phase week by week. Timeline graphic from surgery → distraction → consolidation → full healing. Explanation of typical timeframes and what happens during each phase. Postoperative Care (General) Video on positioning, monitoring, and early home care. Postoperative care flow diagram. Simple instructions describing daily tasks parents must perform. Signs of Complications Scenario-based video showing early signs of infection or device issues. Red-flag warning poster with visual icons. Focused text describing when to seek emergency help. Home Care & Follow-Up Home-setting demonstration of daily routines, mobility support, and device care. Home care checklist. Clear explanation of home care responsibilities and follow-up visit schedule. Expected Outcomes Motivational video showing recovery progress and typical long-term outcomes. Before/after visual comparison of expected limb improvement. Text module outlining realistic outcomes and factors influencing success. Table B: A nursing snippet-based intervention for Practical part Practical Task / Skill Snippet Video Infographic / Visual Snippet Single-Focus Modules (Brief Text Explanation) Immediate Postoperative Care Demonstration video showing positioning, monitoring vital signs, limb elevation, and maintaining a safe environment. Step-by-step flowchart for immediate postoperative care. Brief text describing the essential steps of immediate postoperative care clearly and sequentially. Pain and Analgesia Management Video showing clear explanation of pain recognition, medication timing, monitoring effectiveness, and comfort measures. how to assess pain in children, administer prescribed analgesics, and document response. Infographic showing step by step analgesia management. ''Give pain medications as prescribed. Keep child comfortable and in recommended position.” Essential Wound Care Video of step-by-step dressing removal & application Labeled diagram of wound care steps & warnings “Wear gloves, remove old dressing carefully, clean area, apply new dressing gently. Watch for redness or discharge.” Daily Pin Site Cleaning Video demonstrating aseptic pin-site cleaning using real equipment. Visual guide with steps for pin-site care. ''Check screws and pins gently; do not force. Call doctor if pins feel loose or cause pain.” Hand Hygiene 1–2 min video showing proper handwashing Stepwise diagram of handwashing steps “Wash hands with soap for 20 sec before care. Dry with a clean towel.” Skin and Personal Hygiene Management Video of safe bathing, skin inspection, and maintaining hygiene around device. Hygiene checklist with essential tasks. “Keep the skin clean and dry, bathe carefully around the device, and check for irritation or injury.” Emotional / Psychosocial Support Video demonstrating comforting techniques, parent–child communication, reassurance, and coping strategies after surgery. Infographic showing emotional support tips parents should perform. ''Offer praise, calm voice, gentle touch. Encourage child to express feelings.” Assist with Mobility & Safe Transfers Video demonstration of safe bed-to-chair transfers, walking with aids, and protecting the operated limb. Mobility infographic with safety rules. -Diagram of safe walking techniques ''Use assistive devices as instructed. Ensure clear floor and maintain balance.”. Home Environment & Equipment Management Short video illustrating safe space, removing hazards, and equipment placement. Diagram of safe home layout “Remove obstacles, keep floor dry, provide stable furniture to prevent falls.”. Device / Frame Care & Adjustments Step-by-step video demonstrating daily inspection and safe frame adjustments. Diagram of device care with labeled parts. “Clean and inspect device daily '' Physiotherapy / Range-of-Motion Exercises Physiotherapist-led demonstration of Range-of-Motion exercises, stretching, and strengthening. Exercise infographic with Range-of-Motion steps. ''Lift child’s leg slowly, bend knee gently, repeat 5 times per session, twice daily. Stop if painful.”. Monitoring for Complications & Early Reporting Scenario-based video showing early signs of infection, hardware problems, or neurovascular issues. Red-flag infographic with warning signs requiring immediate reporting. “Check for redness, swelling, pus, or fever. Contact doctor immediately if any appear.” Adherence to Follow-Up Schedule After Surgery Video explaining importance of regular clinic visits, X-rays, and frame adjustments. Calendar-style visual showing follow-up timeline. “Keep calendar of appointments. Attend all follow-ups to check progress and adjust care.” Evaluation Phase (Post nursing snippet-based intervention) : The parents' burden, self-efficacy, knowledge and practice were immediately evaluated after a nursing snippet-based intervention and after 3 months of nursing snippet-based intervention. The same pretest collection tools were used to conduct the post-tests. Data analysis Using (SPSS version 22), the data was coded and converted into a specifically created format for computer entry. Frequency, percentages, mean, and standard deviation were used as descriptive statistics. Additionally, chi-square was used to assess the study's premise. At p-value ≤ 0.001, a highly significant difference was found; at p-value p ≤ 0.05, a statistical difference was found; and at p-value P > 0.05, no statistical difference was found. Results Table 1 reveals the parents' characteristics; it was found that, the mean age of the studied parents was 35.94 ± 3.52 years and the majority (87.3%) of them were mothers. According to parents' educational level more than two thirds (69.1%) of them had university education. Additionally, it was noticed that, slightly less than two thirds (61.8%) of parents not occupied and more than two thirds (67.3%) of them from rural area. Moreover, less than three quarters (70.9%) of the studied parent had no consanguinity relation and all (100%) of them not attended any previous training courses regarding limb lengthening surgery. Table 2 shows children’s personal characteristics; it was observed that, the mean age of the studied children was 8.32 ± 2.53. As regards gender it was found that slightly less than two thirds (65.5%) of children were females. Additionally, it was noticed that, two fifth (40.0%) of the studied children was the first child in order. Table 3 explains children's medical history; it was found that less than half (45.3%) of them diagnosed with congenital short femur. Additionally, more than one quarter (29.3%) of children had complications as a result of limb lengthening surgery and less than half (45.5%) of children who had complications were complicated with joint stiffness. Table 4 describes parents' total knowledge regarding limb lengthening surgery pre, immediately post and after 3 months of a snippet-based teaching strategy implementation. It was found that, the majority (83.6%) of the studied parents had unsatisfactory knowledge pre- nursing snippet-based intervention. While, (87.3% & 78.2%) of them had satisfactory total level of knowledge immediately post and after 3 months of nursing snippet-based intervention, respectively. Figure 1 portrays parents' total reported practice regarding care of their children after limb lengthening surgery at pre, post and after 3 months of nursing snippet-based intervention implementation. It was found that, more than three quarters (78.2%) of the studied parent had incompetent reported practices pre- nursing snippet-based intervention. In contrast, the majority (89.1% &81.8%) of them had competent total reported practice immediately post and after 3 months of nursing snippet-based intervention respectively. Figure 2 shows Parents' total level of self-efficacy regarding care for their children after limb lengthening surgery pre, immediately post and after 3 months of nursing snippet-based intervention. It was found that, less than two thirds (62.5%) of the studied parent had low self-efficacy pre- nursing snippet-based intervention. In contrast, (41.7% &35.5%) of them had high self-efficacy immediately post and after 3 months of nursing snippet-based intervention, respectively. Table 5 displays parents’ total burden levels at pre, immediately post and after 3 months of nursing snippet-based intervention; it was observed that (16.4% & 38.2%) had high and moderate burden level pre- nursing snippet-based intervention respectively. While, (40.0% & 36.4%) of them had low burden level immediately post and after 3 months of nursing snippet-based intervention respectively. Table 6 reveals correlation between total knowledge score, total reported practice score and total parents' self-efficacy level of the studied parent pre, immediately post and after 3 months of nursing snippet-based intervention. It was found that there was highly statistical positive correlation between the studied parents' total level of knowledge, total reported practices and their total self-efficacy level at pre, immediately post and after 3 months of nursing snippet-based intervention. Table 1 Percentage distribution of the studied parents according to their personal characteristics (n = 55). Parents' characteristics No. % Age in years 20->30 11 20.0 30->40 28 50.9 ≥ 40 16 29.1 Mean ± SD 35.94 ± 3.52 Consanguinity Fathers 7 12.7 Mothers 48 87.3 Educational level Intermediate education 11 20.0 University education 38 69.1 Post graduate education 6 10.9 Occupation Yes 21 38.2 No 34 61.8 Residence Rural 37 67.3 Urban 18 32.7 Consanguinity relation between parents Yes 16 29.1 No 39 70.9 Attendance of training courses regarding limb lengthening surgery Yes 0 0.0 No 55 100 Table 2 Percentage distribution of the studied children according to their personal characteristics (n = 55). Children's personal characteristics (n = 55) No. % Age in years 5-> 9 31 56.4 9-≥ 12 24 43.6 x̅±SD 8.32 ± 2.53 Gender Males 19 34.5 Females 36 65.5 Ranking of the child First 22 40.0 Second 14 25.5 Third 12 21.8 Fourth 7 12.7 Table 3 Percentage distribution of the studied children according to their medical history (n = 55). Children's medical history (n = 55) No. % Medical diagnosis of children under limb lengthening surgery Congenital short femur 34 45.3 Achondroplasia 20 26.7 Rotational deformity 16 21.3 Post traumatic damage 5 6.7 Complications that occurred as a result of limb lengthening surgery Yes 22 29.3 No 53 70.7 If yes, the complications are (n = 22) Pin- site infection 2 9.1 Muscle contractures 7 31.8 Joint stiffness 10 45.5 Deep venous thrombosis 3 13.6 Table 4 Percentage distribution of the studied parents’ total knowledge regarding limb lengthening surgery pre, immediately post and after 3 months of nursing snippet-based intervention (n = 55). Items Pre a snippet-based teaching strategy implementation (n = 55) Immediately post a snippet-based teaching strategy implementation (n = 55) After 3 months of a snippet-based teaching strategy implementation (n = 55) X2( 1 ) P-value X2( 2 ) P-value No. % No. % No. % Total knowledge level 28.16 P 0.05 ns Satisfactory (≥ 60%) 9 16.4 48 87.3 43 78.2 Unsatisfactory ( 0.05 X2( 1 ) Difference between pre-test and post-test X2( 2 ) Difference between post-test and follow-up test. Table 5 Percentage distribution of parents’ total burden levels at pre, immediately post and after 3 months of nursing snippet-based intervention (n = 55). Items Pre a snippet-based teaching strategy implementation (n = 55) Immediately post a snippet-based teaching strategy implementation (n = 55) After 3 months of a snippet-based teaching strategy implementation (n = 55) X2( 1 ) P-value X2( 2 ) P-value No. % No. % No. % Parents’ total burden levels 15.79 P 0.927 ns Little burden 7 12.7 22 40.0 20 36.4 Mild burden 18 32.7 21 38.2 18 32.7 Moderate burden 21 38.2 9 16.4 13 23.6 High burden 9 16.4 3 5.5 4 7.3 **Highly statistical significant difference at p value ≤ 0.001 ns No statistical significant difference at p value P > 0.05 X2( 1 ) Difference between pre-test and immediately post-test X2( 2 ) Difference between immediately post-test and follow-up test Table 6 Correlation between total knowledge score, total reported practice score and total parents' self-efficacy level of the studied parents pre, immediately post and after 3 months of nursing snippet-based intervention (n = 55). Variables Total knowledge Total reported practices Total parents' self-efficacy level Pre Immediately post After 3 months r p r p r p Total knowledge - - 0.621 0.001** 0.538 0.001** Total reported practices 0.452 0.001** - - 0.579 0.001** Total parents' self-efficacy level 0.385 0.005* 0.551 0.001** - - **A highly statistical significant difference (p ≤ 0.001) *A statistical significant difference (p ≤ 0.05) r- Pearson Correlation Coefficient Discussion Due to their vulnerability, children and parents require close monitoring during the entire perioperative period. These findings highlight the importance of preoperative psychosocial assessment and continuous emotional support throughout healing and recovery. The best method for orthopedic surgeons to enhance children's physical health and quality of life is to incorporate a parent's self-efficacy oriented strategy into treatment plans ( 34 ). Parents are important participants and practitioners in pediatric postoperative limb surgery ( 35 ).Therefore, they should be able to provide extensive information to nurses on behalf of their children and provide timely feedback on the effectiveness of clinical interventions. A nursing snippet-based intervention support parents were able to better understand caregiving processes without feeling overburdened by the information presented in brief, focused portions. This method probably lessened anxiety and cognitive overload, which are frequently experienced by parents of children with complicated medical or surgical demands ( 36 ). Regarding parents' characteristics; it was found that, the mean age of the studied parents was 35.94 ± 3.52 years, the majority of them were mothers and according to parents' educational level more than two thirds of them had university education. This result was in the same line with ( 37 ) whose study entitled " Swedish parents' experiences of their role in treatment for children with congenital limb reduction deficiency: Decision-making and treatment support" and founded that, the mean age of the studied parents was 40 years, less than three quarter of them 70.5% were mothers and according to parents' educational level more than two thirds 64.7% of them had university education. The researchers reflect these results to the fact that mothers are first care giver to their children who provide all attention to improve their health status and their education level help researchers to use a nursing snippet-based intervention effectively. According to attendance of training courses regarding limb lengthening surgery, all parents' not attending training courses. From the researchers' point of view the limb lengthening surgery is a complex procedure cause parents' burden and effect self-efficacy which reflect importance of study. The current study showed that, mean age of children need limb lengthening surgery was 8.32 ± 2.53 year which inconsistent with the previous studies conducted by ( 38 ), ( 39 ), whose studies entitled "Quality of life evaluation following limb lengthening surgery in patients with achondroplasia" & "Comparison between upper and lower limb lengthening in patients with achondroplasia: A retrospective study.", respectively and reported that, 12 children had received upper-and lower-limb lengthening; mean age at initial surgery 11.8 years with achondroplasia. The researchers reflect this as a result of differ sample size and setting of study. Related to complications that occurred as a result of limb lengthening surgery it was founded that, more than one quarter had complications and less than half of them had joint stiffness. This result was agreed with ( 40 ) whose study entitled "calcaneal lengthening for correction of symptomatic flexible flat foot in children." and founded complications were reported in 17.5% on children. On the other hand, current study disagreed with ( 41 ) Whose study entitled " Results and complications of bilateral limb lengthening in achondroplasia: a retrospective analysis." and demonstrated that a 4.7% increase in the risk of developing complications. Additionally, current study inconsistent with ( 42 ),( 43 ). Whose study entitled "Limb lengthening in achondroplasia" & "Bilateral double level tibial lengthening in dwarfism" and founded that, the complications were 33 out of 36 lengthened segments (92%), 28 out of 28 lengthened segments (100%), respectively. Also, in contrast, in the study by ( 44 ). Whose study entitled "Femoral lengthening in achondroplasia: magnitude of lengthening in relation to patterns of callus, stiffness of adjacent joints and fracture." all 20 patients reported temporary joint stiffness and fractures of bone regenerate occurred in 15% of cases. From the researchers' point of view, there were high chance of complications after limb surgery but with cooperating care from parents and health care providers which provided with impower parents with knowledge and share in care plan can easily minimize risks and prevent complications. This was accomplished with the nursing snippet-based intervention in current study. As founded, parents' total knowledge regarding limb lengthening surgery pre, immediately post and after 3 months of nursing snippet-based intervention. It was found that, the majority of the studied parents had unsatisfactory knowledge pre- nursing snippet-based intervention. This result compatible with ( 45 ) whose study "Parental postoperative pain management perceptions, attitudes, and practices in pediatric limb fractures" and founded that, parents had insufficient knowledge about limb surgery, pain assessment tools, analgesics and causes of pain in children. This could be mainly attributed to negligence by health care professionals, unavailability of assessment tools, and inadequate limb surgery and pain related education. The present study mentioned that, the majority of parents had competent total reported practice immediately post and after 3 months of nursing snippet-based intervention. This result competent with ( 37 ) which highlight the complex nature of the parental role of being a treatment supporter for a child with limb surgery, and founded that, the majority of parents performed a number of duties to support the treatment process. Unexpectedly from the parents' point of view, they were given the role of an ‘extended arm’ of the healthcare team, in which they carried out direct and indirect treatment duties that were crucial to the treatment outcomes. From the researchers' point of view, the snippet-teaching strategy provided parents with step-by-step, achievable learning units, enabling them to gain confidence in managing caregiving activities such as medication administration, wound care, and monitoring warning signs. As regards parents' total level of self-efficacy regarding care for their children after limb lengthening surgery, there were founded that, the majority of parents had high level of self- efficacy immediately post and after 3 months of nursing snippet-based intervention this result congruent with ( 34 ) whose study "Core psychosocial issues for children and adolescents in the context of limb lengthening and reconstruction surgery treatment" and showed, the majority of parents were weighted toward limb lengthening surgery and in the same time feel high self-efficacy after empowered with information about surgery. From researchers' point of view, parents' self-efficacy depends on understanding full picture about their children case. According total parents' burden levels, the current study founded that, more than half of parents had moderate and high burden level pre- nursing snippet-based intervention implementation which congruent with ( 46 ) Whose study entitled "The factors associated with the caregiving burden among family caregivers of pediatric patients with fractures: A descriptive cross-sectional study" and founded that, most family caregivers were mothers comprising 56% of the total and 81.5% of caregivers had moderate or severe burden. From researchers' point of view, this finding reflects that most participants were mothers, who are generally more emotionally responsive and more closely engaged in their children’s care. Also, increase parents' burden linked to the lengthy course of limb lengthening therapy, which frequently entails numerous surgeries, multiple hospital stays, intense home care and ongoing condition monitoring. The simplicity, clarity, and accessibility of the nursing snippet-based intervention may be responsible for the decrease in parental burden seen in the current study. Regarding correlation between parents' total level of knowledge, total reported practices and their total self-efficacy level, there were highly statistical positive correlation between the studied parents' total level of knowledge, total reported practices and their total self-efficacy level at pre, immediately post and after 3 months of a nursing snippet-based intervention. These results were consistent with ( 47 ). Whose study entitled "Family caregiver strain and challenges when caring for orthopedic patients: a systematic review" and founded, Orthopedic caregivers without enough information had less security in dealing with the children’ disease than those who received an appropriate education from health care team members: this is a finding that was consistent with the stress, self- efficacy and coping model of caregiving. This finding aligns with Bandura’s self-efficacy theory, which highlights how people's perceived capacity to successfully carry out caregiving responsibilities can be diminished by a lack of knowledge and skills ( 22 ). Implications of the study The findings of the study suggest that using simple and attractive methods for teaching as A nursing snippet-based intervention can significantly increase parents’ self-efficacy, compliance with care plan and decreases parents' burden. These improvements can directly influence child health. Conclusion of the study The current study findings were used to validate the research hypotheses. In conclusion, nursing snippet-based intervention reinforces the critical role of improve parents' knowledge, practice, self- efficacy and decreases parents' burden toward caring of their children undergoing limb lengthening surgery. Recommendations: The current study recommended that future research validate and build upon these findings utilizing longitudinal designs and larger, more varied samples in other contexts. Additionally, establish training programs for clinical staff to optimize fidelity and effectiveness of nursing snippet-based intervention. Limitations of the study There are a number of limitations to this study. First, the study was carried out in a single Egyptian public hospital, which would restrict the findings' applicability to other facilities. Second, the study might be biased because it only included people with smartphones and access to digital instructional resources. Third, social desirability bias or inaccurate parental perceptions may have affected the data acquired via questionnaire sheets. Furthermore, although the study found important correlations between knowledge, practices, self-efficacy, and parents' burden, other variables like clinical experience and personal motivation were not evaluated and may have affected the results. Abbreviations CSES Caregiver Self-Efficacy Scale FGFR3 Fibroblast Growth Factor Receptor 3 gene ZBI Zarit Burden Interviewing Declarations Clinical trial number Not applicable. Ethical approval and consent to participate In accordance with the Declaration of Scientific Research Ethics Committee, Faculty of Nursing Benha University, Egypt, the approval was obtained; code REC-PN-P79 prior to beginning the actual work. The submission of an official letter from the hospital manager and the supervisors of the surgical unit was done. The objectives, aim, and benefits of the study were adequately explained to each parent. Each parent gave written informed consent before participating in the study. The researchers made it clear that parents' involvement in the study was completely voluntary and that they might withdraw at any time without experiencing any repercussions. Confidentiality was further ensured by coding the data. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Author details 1,2,3 Pediatric Nursing, Faculty of Nursing, Benha University, Benha, Egypt. Funding Open access funding provided by The Science, Technology & Innovation Funding Authority (STDF) in cooperation with The Egyptian Knowledge Bank (EKB). Open access funding was provided by the Science, Technology & Innovation Funding Authority (STDF) in cooperation with the Egyptian Knowledge Bank (EKB). Author Contribution A. Every author contributed to the development of the research topic, goal, and plan. B. Gathering and presenting the research's scientific foundation. C. Taking part in the creation of instruments for gathering data. D. Taking part in choosing the research sample's size and methodology. E. Research applied practically. F. Taking part in statistical analysis and reporting the findings of the study. G. Taking part in producing recommendations, conclusions, and indexing the research's references. Acknowledgements The authors thank and appreciate all the study subjects who were involved in this study. Data Availability The data and resources utilized in the current study cannot be made publicly available due to confidentiality considerations. On reasonable request, they can be obtained from the corresponding author. References Giorgino R, Cornacchini J, Sillmann YM, Kostyra D, Berkane Y, Peretti GM, et al. Aesthetic lower limb lengthening techniques: a systematic review of efficacy, complications, and patient satisfaction. J Orthop Surg Res. 2025;20(1):415. El-Hamid A, Ahmed M, Hosny AG, A Anter M. Humeral lengthening: Systematic Review and Meta Analysis. Benha J Appl Sci Benha Univ. 2023;8(3):151–8. Xi F, Xue X, Ji E, Zhang Q, Zhao S, Li K, et al. Relationship between leg length discrepancy and functional scoliosis in children and adolescents. BMC Musculoskelet Disord. 2025;26(1):428. Wu C, Huang P, Mo Y, Wang D, Ning B. How do lesions affect limb lengthening in children with Ollier’s disease? BMC Musculoskelet Disord. 2025;26(1):13. Youssef AR, Gumaa M, Hosny GA. Are internal lengthening devices effective and associated with less complications compared to other lengthening devices? A systematic review and meta-analysis. J Pediatr Orthop B. 2022;31(2):e219–26. Karaarslan D, Çelik NK, Ergin D. Relationship between the care need levels of patients hospitalized in the pediatric surgery service and the caregiving burden of their parents: A cross-sectional study. Enfermería Clínica (English Edition). 2025:502210. Elebute OA, Campbell EA, Ademuyiwa AO, Ihediwa CG, Bode CO. Psychological burden of care in parents/caregivers of children with surgical conditions–A local experience. J Clin Sci. 2023;20(1):8–14. Moursi HA, Sabry SS. Effect of educational guidelines for family caregivers of elderly cancer patients regarding burden of care. Assiut Sci Nurs J. 2022;10(28):94–109. Cohn LN, Pechlivanoglou P, Lee Y, Mahant S, Orkin J, Marson A, et al. Health outcomes of parents of children with chronic illness: a systematic review and meta-analysis. J Pediatr. 2020;218:166–77. e2. Lee S, Seo S, Choi H, Choi DJ. A Qualitative Study on the Caregiving Experiences of Parents of Young Adults with Mental Disorders. J Korean Acad psychiatric Mental Health Nurs. 2024;33(4):404–12. Azar RMZ, Maedeh B, Hamideh AL. Relationship between self-efficacy and perceived burden among schizophrenic patients’ caregivers. J Nurs Midwifery Sci. 2019;6(2):91. Tork HM, Mansour HEM, Mohamed E-g, Abd R. Effect of empowerment program on parents' self competence regarding care of their children with cochlear implantation. Int J health Sci. 2022;6(S9):2852–73. Batsalya ALR, Kanak K, Hiramani P, Rakshya S. Communication is the key: Does strategic perioperative counseling decrease anxiety in parents of the pediatric patient undergoing surgery? Birat J Health Sci. 2024;8:2174–8. De Gagne JC, Park HK, Hall K, Woodward A, Yamane S, Kim SS. Microlearning in health professions education: scoping review. JMIR Med Educ. 2019;5(2):e13997. Emara EAE-HM. Using Authentic Video Snippets for Developing Non-Major Students' EFL Listening Skills and Growth Language Mindset. J Fac Educ Benha Univ. 2024;35(1393):31–90. Leyva AZVS, Steiner L, Carley-Rizzuto K. A Parental Involvement Program: Facilitating parental scaffolding with literacy strategies to support students’ mathematical skills. Discover Education (2025). Della Porta SL, Sukmantari P, Howe N, Farhat F, Ross HS. Naturalistic parent teaching in the home environment during early childhood. Front Psychol. 2022;13:810400. Forman DA, Forman GN, Avila-Mireles EJ, Mugnosso M, Zenzeri J, Murphy B, et al. Characterizing forearm muscle activity in university-aged males during dynamic radial-ulnar deviation of the wrist using a wrist robot. J Biomech. 2020;108:109897. Maghnie M, Semler O, Guillen-Navarro E, Selicorni A, Heath KE, Haeusler G, et al. Lifetime impact of achondroplasia study in Europe (LIAISE): findings from a multinational observational study. Orphanet J Rare Dis. 2023;18(1):56. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191. Bandura A. Social foundations of thought and action. Englewood Cliffs NJ. 1986;1986:23–8. Bandura A. Self-efficacy: The exercise of control. Freeman; 1997. Lazarus RS, Folkman S. Stress, appraisal, and coping. Springer publishing company; 1984. Folkman S. Stress: appraisal and coping. Encyclopedia of behavioral medicine. Springer; 2013. pp. 1913–5. Slovin E. Slovin’s formula for sampling technique. Retrieved July 21, 2021. 1960. Ringnér A, Ljung M, Rullander A-C. Parents' and nurses’ experiences when children undergo limb lengthening treatment. Int J Orthop Trauma Nurs. 2025;57:101176. Beger C, Alves I, Carl-Innig P, Sessa M, Mohnike K, Cheung MS. Limb lengthening in individuals with achondroplasia: Analysis of an international survey. Bone. 2025;195:117462. Salimi M, Sarallah R, Javanshir S, Mirghaderi SP, Salimi A, Khanzadeh S. Complication of lengthening and the role of post-operative care, physical and psychological rehabilitation among fibula hemimelia. World J Clin Cases. 2022;10(24):8482. Trofimchuk V, Dossanov B, Lozovoy V, Khmyzov S, Dossanova A, Angelov A, et al. Quality of Life in Children With Achondroplasia Undergoing Paired Limb Lengthening With an External Fixator and Modified Distraction Control: Observational Nonrandomized Study. JMIR Rehabilitation Assist Technol. 2024;11(1):e49261. Radler C, Calder P, Eidelman M, Horn J, Kold S, Langendörfer M, et al. What’s new in pediatric lower limb reconstruction? J Child Orthop. 2024;18(4):349–59. Catena N, Arrigoni C, Carvalho M, Matic I, Farr S. External fixators and lengthening systems in pediatric upper limb. J Child Orthop. 2025;19(2):139–50. Steffen AM, McKibbin C, Zeiss AM, Gallagher-Thompson D, Bandura A. The revised scale for caregiving self-efficacy: reliability and validity studies. Journals Gerontol Ser B: Psychol Sci social Sci. 2002;57(1):P74–86. Zarit S. ZBI-Zarit Burden Interview Version 1.0: Scaling and Scoring. Lyon: Mapi Research Trust; 2018. Hamilton AA, Mehta R, Sue Epstein B, Fabricant PD, Fragomen AT, Robert Rozbruch S. Core psychosocial issues for children and adolescents in the context of limb lengthening and reconstruction surgery treatment. J Child Orthop. 2021;15(2):122–9. Beltramini A, Milojevic K, Pateron D. Pain assessment in newborns, infants, and children. Pediatr Ann. 2017;46(10):e387–95. Neri HG. Disparities in the Lanterman Developmental Disabilities Services Act. Walden University; 2022. Sjöberg L, Hermansson L, Lindner H, Fredriksson C. Swedish parents' experiences of their role in treatment for children with congenital limb reduction deficiency: Decision-making and treatment support. Child: Care,. Health and Development, 2020;46(6):723 – 32. Batıbay SG, Balcı, H. İ., Bayram, S., Chodza, M., Göksoy, Ş., Hürmeydan, Ö. M., …Kocaoğlu, M. Quality of life evaluation following limb lengthening surgery in patients with achondroplasia. Indian Journal of Orthopaedics, 2020; 54(Suppl 1):39–46. Kim SJ, Agashe MV, Song SH, Choi HJ, Lee H, Song HR. Comparison between upper and lower limb lengthening in patients with achondroplasia: a retrospective study. J Bone Joint Surg Br Volume. 2012;94(1):128–33. Hegazy M, Bassiouni H, Al-Ashhab. M. calcaneal lengthening for correction of symptomatic flexible flat foot in children. Benha Med J Benha Univ. 2020;36(3):98–106. Verdoni FGR, Virgilio C, Nannini A, Viganò M, Curci D, Peretti GM, Mangiavini L. Results and complications of bilateral limb lengthening in achondroplasia: a retrospective analysis. Front Pead.2023; 11. Chilbule SK, Dutt V, Madhuri V. Limb lengthening in achondroplasia. Indian J Orthop. 2016;50(4):397–405. Burghardt RDYK, Kashiwagi N, Yoshino S, Bhave A, Paley D, et al. Bilateral double level tibial lengthening in dwarfism. J Orthop. 2015;12(242):7. Venkatesh KPMH, Devmurari K, Yoon JY, Anupama BR, Song HR. Femoral lengthening in achondroplasia: magnitude of lengthening in relation to patterns of callus, stiffness of adjacent joints and fracture. J Bone Joint Surg Br. 2009;91(1612):7. Zhang SM, Chan YY, Lai LL, Liang PR, Lin M. Parental postoperative pain management perceptions, attitudes, and practices in pediatric limb fractures. Pain Manage Nurs. 2023;24(5):506–12. Dai Q, Peng M, Li C, Deng S, Huang P, Guo X, Yang Y. The factors associated with the caregiving burden among family caregivers of pediatric patients with fractures: A descriptive cross-sectional study. J Pediatr Nurs. 2024;79:126–32. Longo UG, Matarese, M., Arcangeli, V., Alciati, V., Candela, V., Facchinetti, G.,… Denaro, V. Family caregiver strain and challenges when caring for orthopedic patients:a systematic review. Journal of clinical medicine,. 2020; 9(5): 1497. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 09 Apr, 2026 Reviews received at journal 09 Mar, 2026 Reviewers agreed at journal 06 Mar, 2026 Reviews received at journal 05 Mar, 2026 Reviewers agreed at journal 05 Mar, 2026 Reviewers agreed at journal 01 Mar, 2026 Reviewers invited by journal 24 Feb, 2026 Editor invited by journal 30 Jan, 2026 Editor assigned by journal 29 Jan, 2026 Submission checks completed at journal 29 Jan, 2026 First submitted to journal 23 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8681721","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":596691789,"identity":"59ea2543-6106-46aa-a602-2d711110e26e","order_by":0,"name":"Rawia Abd El-ghany Mohamed","email":"","orcid":"","institution":"Benha University","correspondingAuthor":false,"prefix":"","firstName":"Rawia","middleName":"Abd El-ghany","lastName":"Mohamed","suffix":""},{"id":596691790,"identity":"f0f31c09-20a6-4321-87d0-575999d231b8","order_by":1,"name":"Nora Abd El-Alim Ebrahim","email":"data:image/png;base64,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","orcid":"","institution":"Benha University","correspondingAuthor":true,"prefix":"","firstName":"Nora","middleName":"Abd El-Alim","lastName":"Ebrahim","suffix":""},{"id":596691791,"identity":"7263a82b-81e7-45da-8b04-c635ab24b817","order_by":2,"name":"Hanan Elsayed Metwally","email":"","orcid":"","institution":"Benha University","correspondingAuthor":false,"prefix":"","firstName":"Hanan","middleName":"Elsayed","lastName":"Metwally","suffix":""}],"badges":[],"createdAt":"2026-01-23 18:08:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8681721/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8681721/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104399293,"identity":"6d475fd0-0b75-43ed-9ba0-c8d8e8baddda","added_by":"auto","created_at":"2026-03-11 12:05:25","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":186515,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eParents’ total reported practice regarding\u003c/strong\u003e \u003cstrong\u003ecare of their children after limb lengthening surgery pre, immediately post and after 3 months of nursing snippet-based intervention (n=55).\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8681721/v1/188a810672fde90dd8b2da70.png"},{"id":103589911,"identity":"7a5df04d-d9cf-4046-adcb-da9302404516","added_by":"auto","created_at":"2026-02-27 11:59:35","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":185509,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eParents' total level of self-efficacy regarding care for their children after limb lengthening surgery pre, immediately post and after 3 months of nursing snippet-based intervention (n=55).\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8681721/v1/09ff05e8b380eb786f2b0d3a.png"},{"id":104407540,"identity":"b63cbffd-7593-46bc-9140-f3d6624debb2","added_by":"auto","created_at":"2026-03-11 12:38:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3051821,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8681721/v1/2b6cc8f2-3140-442a-90dc-a88048035834.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of Nursing Snippet-Based Intervention on Parents' Burden and Self-Efficacy towards Caring for their Children undergoing Limb Lengthening Surgery ","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLimb lengthening surgery is one of the possible elongation procedures and represents a challenging pathway burdened by a high rate of complications. Additionally, this operation is still the only viable way for children with achondroplasia to restore body proportions more in line with the regular population and reach a stature comparable to the normal population range at maturity (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe functional and cosmetic consequences of limb deformity and shortening necessitate surgery. While more English-language publications support the practice of treating lower limb deformities and extending bones, fewer articles discuss upper extremity lengthening. Dick and Tietjen reported the first instance of humeral lengthening in 1978 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLimb length disparity, a condition where one limb is shorter than the other owing to congenital, developmental, or post-traumatic factors, can be corrected with limb lengthening, a crucial orthopedic operation. Children who have limb lengthening surgery might improve their psychological and emotional well-being while gaining more independence in everyday activities like sports, public transportation, and personal cleanliness (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLimb lengthening with external fixation can correct the lower extremity deformity (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). While, internal lengthening devices became more popular than external fixators. This was attributed to their effectiveness and lower complication rates (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe care of children undergoing surgery places a substantial burden on parents, both emotionally and in terms of practical caregiving responsibilities. The level of burden of care varies depending on the type, intensity and duration of the disease of the person receiving the care. Furthermore, giving care to a sick child, monitoring the treatment and medications used, meeting the child's nutrition and personal care needs, and hospitalizations affecting family integrity adversely affect parents\u0026rsquo; lifestyle and further deepen the difficulties they experience (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe suffering that a family member's primary caregiver experiences, including consequences for their health, psychological well-being, finances, and social life, is referred to as caregiver's load. In this context, a caregiver is someone who gives unpaid care to a sick child and who has a relationship with the child, either biologically or by friendship. Mothers, fathers, grandmothers, and aunts are typically considered caregivers (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFamily caregiver burden is a complicated reaction to the financial, social, emotional, psychological, and physical strains of providing care. The biological, psychological, sociological, ethnic, cultural, and religious facets of the life of formal caregivers are all impacted by this complex process (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Understanding the caring burden, stress, and personal resources of parents is crucial. The child's chronic illness affects both parents. In terms of personal requirements, mothers and fathers have disadvantages as compared to parents of healthy children (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e),(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSelf-efficacy describes how respond to stressful events in life and is only used in the care sector to explain how caregivers deal with persistent difficulties (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e In the context of pediatric surgery and long-term care, parents frequently take on the role of primary caregivers and bear heavy responsibilities in managing their child's recuperation and daily requirements. Additionally, improving parental understanding may boost parental efficacy and confidence. Therefore, nurses should be able to comprehend the emotional and psychological responses of the parents, as well as establish a great learning atmosphere and show crucial interest and support (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEducating families of children having surgery has been the subject of numerous research. Numerous techniques have been linked to lowering anxiety in children and their relatives. Strong interpersonal interactions between hospital staff and parents/children, emphasizing rapport, communication, and honesty, as well as education for parents/children. One method of preparing parents for the stress levels encountered during a preoperative period is through interventions (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe use of microlearning in education has been shown to improve learners' knowledge and self-assurance. Health professions educators support microlearning as a way to support parent education, training, and continuing education. Microlearning is the acquisition of knowledge or skills in the form of small units (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA nursing snippet-based intervention is a cutting-edge method of instruction that presents material in brief, targeted chunks, or \"snippets.\" When used in parent education, this approach improves learning outcomes and engagement by giving parents short, planned learning units that fit into their everyday schedules. The idea is based on micro-learning theory, which prioritizes brief, focused learning opportunities over lengthy class periods (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAdditionally, short modules and instructional films have been shown to be successful in enhancing parental scaffolding abilities and self-efficacy, allowing parents to better assist their children's learning and healing processes (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Thus, snippet-based instruction offers a productive, parent-centered framework that enhances the parent's role as an effective caregiver and educator, encourages active learning, and lessens cognitive overload (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e"},{"header":"Significance of the study","content":"\u003cp\u003eSurgery has been linked to anxiety and severe psychological reactions in children and parents due to concerns about anesthesia, fears of cancer or death, and anticipated pain and physical discomfort. Even in surgeries that doctors deem \"minor,\" these have been shown to negatively impact surgical procedures and the patient's recuperation. Given the evident yet crucial role parents play in managing children with surgical conditions, it would be pertinent to understand the caregiver burden (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eChildren's surgeries are known to be stressful experiences for both the child and the family. Expectations, views of the sickness, and the healing process all contribute to the high level of parental stress that persists during a child's hospital stay. Additionally, both children and their parents may have unpleasant and challenging experiences as a result of pediatric surgery. \"Burden of care\" refers to the negative effects of a caregiver's caregiving, including physiological, psychological, economic, social, and familial issues (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFor those with achondroplasia, the most prevalent skeletal dysplasia with an estimated prevalence of 1:22,000 live births and over 250,000 affected individuals globally, limb lengthening surgery is a controversial option. The combined prevalence of achondroplasia in Europe is 3.5 per 100,000 live births. Impaired endochondral bone formation is the outcome of a heterozygous pathogenic mutation in the Fibroblast Growth Factor Receptor 3 gene (FGFR3) (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRehabilitation and postoperative care are mostly the responsibility of the parents of children undergoing surgery. Research indicates that a high caregiver burden might have a detrimental effect on child outcomes by increasing parental stress and decreasing adherence to care routines. On the other hand, parental self-efficacy-boosting therapies greatly lessen load and promote the wellbeing of both parents and children (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eTheoretical framework\u003c/h2\u003e \u003cp\u003eThe theoretical framework of this study was developed to explain how a snippet-based teaching strategy can influence parents\u0026rsquo; burden and self-efficacy while caring for their children undergoing limb lengthening surgery. Parents of children who undergo this complex surgical procedure often experience high levels of physical, emotional, and psychological burden due to the long treatment period, intensive care requirements, and fear of complications. At the same time, their ability to cope and provide effective care depends largely on their level of knowledge, skills, and confidence.\u003c/p\u003e \u003cp\u003eCurrent study is guided by Bandura\u0026rsquo;s Self-Efficacy Theory (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) supported by Lazarus and Folkman\u0026rsquo;s Stress and Coping Theory (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e),(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). According to the concept, parents perceived self-efficacy is a key factor in evaluating their capacity to manage the caring responsibilities related to limb lengthening surgery. Increased parental self-efficacy improves coping mechanisms and caregiving techniques, which lessens the perceived burden of parenting. On the other hand, parents' self-efficacy may be severely impacted and their burden may grow due to increased caregiving obligations and child-related clinical variables.\u003c/p\u003e \u003c/div\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n\u003ch2\u003eResearch design\u003c/h2\u003e\n\u003cp\u003eThe present study was carried out utilizing a quasi-experimental research design to evaluate the effect of nursing snippet-based intervention on parents' burden and self-efficacy towards caring for their children undergoing limb lengthening surgery. This study aimed to evaluate the following three research hypotheses:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eParents who participate in nursing snippet-based intervention are expected to have an improvement in their knowledge and practice score, toward caring of their children undergoing limb lengthening surgery\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eParents' burden level will be diminished after nursing snippet-based intervention, toward caring of their children undergoing limb lengthening surgery.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eParents' self-efficacy level will be improved after a snippet-based teaching strategy, toward caring of their children undergoing limb lengthening surgery.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003c/div\u003e\n\u003ch3\u003eSample\u003c/h3\u003e\n\u003cp\u003eA purposive sample of 55 parents accompanying their children undergoing limb lengthening surgery who attended the previously mentioned setting through two shifts (morning and afternoon shifts) for a period of six months.\u003c/p\u003e\n\u003cp\u003e- The sample size was calculated by the following formula: n\u0026thinsp;=\u0026thinsp;N/1\u0026thinsp;+\u0026thinsp;N(e)\u003csup\u003e2\u003c/sup\u003e (\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e) Where;\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003en\u0026thinsp;=\u0026thinsp;sample size\u0026thinsp;=\u003c/strong\u003e\u0026thinsp;55\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eN\u0026thinsp;=\u0026thinsp;Total population size\u0026thinsp;=\u003c/strong\u003e\u0026thinsp;64 parents\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003ee\u0026thinsp;=\u0026thinsp;Margin of error\u0026thinsp;=\u003c/strong\u003e\u0026thinsp;0.05\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eTherefore, \u003cstrong\u003esample size (n) =\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e64/ (1\u0026thinsp;+\u0026thinsp;64*0.0025)\u0026thinsp;=\u0026thinsp;55.1\u003c/strong\u003e.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThey were taken according to the following\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria for children\u003c/strong\u003e:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eFrom both genders.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eChildren who have already undergone limb lengthening surgery.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eAges ranged from 5\u0026ndash;12 years.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eFree from any other previous leg surgeries.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria for children\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003e-Children with cognitive or developmental delays that prevent understanding of instructions\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria for parents\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eWilling to participate in the snippet-based teaching strategy sessions.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eParents who own a smartphone and are able to access digital teaching materials.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria for parents\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003eParents with psychiatric or cognitive conditions that may interfere with participation\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch3\u003eSetting:\u003c/h3\u003e\n\u003cp\u003eThe current study was conducted at the inpatient pediatric surgical unit at Benha Specialized Pediatric Hospital affiliated to Ministry of Health in Benha City. It included two pediatric surgical departments that were located at Building B of the hospital on the second and third floors, each department comprises five rooms, each room contains four beds, and the recovery room contains two beds.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003eTools of data collection\u003c/h2\u003e\n\u003cp\u003eFive tools were used to obtain data relevant to the current study. It was prepared in simple Arabic language. Each parent was interviewed exclusively for filling the knowledge questionnaire sheet. These included the following tools:\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eTool (I): A structured interview questionnaire:\u003c/h3\u003e\n\u003cp\u003eThis tool was developed by the researchers after reviewing the scientific and relevant literature. That was written in an Arabic and consisted of two parts:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cstrong\u003ePart\u003c/strong\u003e (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParents\u0026rsquo; characteristics such as;\u003c/strong\u003e age, level of education, occupation, residence, consanguinity relation between parents and attendance of training courses regarding the care of their children undergoing limb lengthening surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePart\u003c/strong\u003e (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e): \u003cstrong\u003eParents' knowledge\u003c/strong\u003e regarding limb lengthening surgery. It was designed by the researchers in the light of related studies and researches (\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e), (\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e). It contained (31 questions) in the form of multiple choice and true/false, which included definition and purpose of limb lengthening (2 questions), risks/benefits of surgery(2 questions), types of devices used (1 question), importance of preoperative medical evaluation and investigations(3 questions), role of the parent in preparing the child physically and psychologically(4 questions), expected duration of the lengthening and consolidation phases (2 questions), postoperative Care (7 questions), signs of complications (1 questions), home care and follow-up (5 questions), and expected outcomes (4 questions).\u003c/p\u003e\n\u003cdiv class=\"Heading\"\u003e\u003cstrong\u003eScoring system\u003c/strong\u003e:\u003c/div\u003e\n\u003cp\u003eThe parents' knowledge was checked with the model answer after completing the interview questionnaire. The correct answers scored (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e), and the incorrect or do not know answers scored (0). The total degree ranges from 0\u0026ndash;31 (31 questions). The parents\u0026rsquo; total knowledge was classified as the following:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003e\u0026ge;60% was considered a satisfactory level of knowledge\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u0026lt;60% was considered an unsatisfactory level of knowledge.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003ch2\u003eTool (II): Child medical data:\u003c/h2\u003e\n\u003cp\u003eIt was developed by the researchers and consisted of two parts as the follow:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePart 1\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003e- Personal characteristics of the studied children, it included age, gender, and child rank.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePart 2\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003e- Medical history of children, it included medical diagnosis, complications that occurred as a result of limb lengthening surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTool (III): Parents' reported practices checklist\u003c/strong\u003e: It was adapted from(\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e), (\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e), (\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e) \u003cstrong\u003e\u0026amp;\u003c/strong\u003e (\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e) to assess parents' reported practice towards care of their children after limb lengthening surgery. It includes 11 main items and the total steps were 65 steps including; \u003cstrong\u003eimmediate post operative care\u003c/strong\u003e (6 steps), \u003cstrong\u003epain and analgesia management\u003c/strong\u003e (5 steps), \u003cstrong\u003eessential wound care/ daily cleaning of pin sites\u003c/strong\u003e (8 steps), \u003cstrong\u003eskin and personal hygiene management\u003c/strong\u003e (6 steps), \u003cstrong\u003eemotional/psychosocial support\u003c/strong\u003e (4 steps), \u003cstrong\u003eassist with mobility and safe transfers\u003c/strong\u003e (6 steps), \u003cstrong\u003ehome environment \u0026amp; equipment management\u003c/strong\u003e (7 steps), \u003cstrong\u003edevice/frame care \u0026amp; adjustments\u003c/strong\u003e (7 steps), \u003cstrong\u003ephysiotherapy / range-of-motion exercises\u003c/strong\u003e (5 steps), \u003cstrong\u003emonitoring for complications \u0026amp; early reporting\u003c/strong\u003e (7 steps), \u003cstrong\u003eadherence to follow-up schedule after surgery\u003c/strong\u003e (4 steps). Score (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e) was given to a correctly done step. Score (0) was given to incorrectly done or not done step. The total steps included 65 steps.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n\u003ch2\u003e\u003cstrong\u003eScoring system for parents\u0026rsquo; reported practice\u003c/strong\u003e:\u003c/h2\u003e\n\u003cp\u003eTotal scores were ranged from (0\u0026ndash;65). Accordingly, parents' reported practices were classified as the following:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eLess than 85% was considered incompetent practice level\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eEqual to or more than 85% was considered competent practice level\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eTool IV: Caregiver Self-Efficacy Scale (CSES)\u003c/strong\u003e adopted from (\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e). It was written in an Arabic language and consisted of 15 items measuring confidence in managing caregiving tasks and obtaining respite, within 3 subscales (self-efficacy for obtaining respite /support, self-efficacy for responding to child\u0026rsquo;s distress/disruptive behaviors, and self-efficacy for controlling upsetting caregiving-related thoughts).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n\u003ch2\u003eScoring system for Caregiver Self-Efficacy Scale:\u003c/h2\u003e\n\u003cp\u003e0\u0026ndash;100 confidence rating scale, classified as 0-33.3% considered Low self-efficacy, 33.4%-66.6% considered Moderate self-efficacy, and 66.7%-100% considered High self-efficacy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTool V: Burden interviewing questionnaire\u003c/strong\u003e: Modified version of Zarit Burden Interviewing questionnaire (ZBI) developed by (\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e). This tool was used to measure the extent of family caregiver have physical, social and psychological burden. The ZBI questionnaire consisted of 22 items Burden in the relationship 6 items, Emotional wellbeing 7 items, Social and family life 4 items, Finances 1 items, and Loss of control over one's life 4 items.\u003c/p\u003e\n\u003cp\u003eCategorized in three main sections: 3-point Likert scale of response for each statement indicates how often the caregiver feels that way: (0) never, (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e) rarely, (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e) sometimes, (\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e) quiet frequently, nearly always (\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e). The scale scoring system: The burden level was rated from (0\u0026ndash;20) little burden, (\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e40\u003c/span\u003e) mild burden, from (41\u0026ndash;60) moderate burden, from (61\u0026ndash;88) high burden.\u003c/p\u003e\n\u003cp\u003eIt aims to assess the level of burden experienced by the principal caregivers of older persons with dementia and disabled persons. The ZBI provides an assessment of subjective burden, that is, the appraisals caregivers make of the impact that providing care has on their lives. Subjective appraisals are a fundamental dimension in understanding the stress process. Measures of the patients\u0026rsquo; symptoms or problems in functioning and behavior provide a context in which burden is experienced, but caregivers\u0026rsquo; subjective experiences of the impact of problems on their lives can vary considerably. Subjective burden as measured by the ZBI is a critical dimension, because caregivers\u0026rsquo; perceptions of the impact of providing care on their lives will affect their actions and the decisions they make, such as about seeking help or continuing in the care role.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n\u003ch2\u003ePreparatory phase:\u003c/h2\u003e\n\u003cp\u003eIn order to become more familiar with the various parts of the study, this phase involved reviewing pertinent local and worldwide literature as well as recent studies. It also involved constructing the study's tools using journals, scientific books, magazines, and evidence-based articles.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n\u003ch2\u003eTools validity and reliability:\u003c/h2\u003e\n\u003cp\u003eA panel of three pediatric nursing specialists from Benha University's Faculty of Nursing evaluated the study tools' validity in order to assess the items' clarity, relevance, and applicability. The changes were made to guarantee their accuracy and applicability. The Cronbach's alpha test was used to determine the measures' internal consistency. It was 0.85 for practice and 0.78 for knowledge.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n\u003ch2\u003e\u003cstrong\u003ePilot study\u003c/strong\u003e:\u003c/h2\u003e\n\u003cp\u003eIt was carried out on six parents, or 10% of the study participants, in order to assess the study tools' applicability and calculate the time needed to finish them. No significant changes were made to the study instruments in light of the pilot study's findings. As a result, the study sample was expanded to include the parents from the pilot study.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n\u003ch2\u003eProcedure for data collection:\u003c/h2\u003e\n\u003cp\u003eThe researchers were found in the study setting by using rotation two days per week (Saturday and Wednesday) during the morning shift to gather data using the previously mentioned tools. The fieldwork was completed over a six-months period.\u003c/p\u003e\n\u003cp\u003eThe following phases were carried out to achieve the aim of the current study; assessment, planning, implementation and evaluation phases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssessment phase\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ethe researchers interviewed each parent individually; the aim and duration of the study were explained. Oral and written consents to participates in the study before data collection obtained.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n\u003ch2\u003ePlanning phase:\u003c/h2\u003e\n\u003cp\u003eThe researchers developed the nursing snippet-based intervention after reviewing the related literature and determined the needs in the assessment phase. The nursing snippet-based intervention utilized in the current study included three methods as following:\u003c/p\u003e\n\u003cp\u003e1- \u003cstrong\u003eSnippet videos\u003c/strong\u003e: Snippet videos are short, focused, and easily digestible video segments that deliver essential information in a concise and engaging way. They are particularly useful for educating parents about child care, medical procedures, rehabilitation, and health promotion.\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003e- The duration of video Typically 5\u0026ndash;7 minutes per video, focused on one topic or skill at a time, visual demonstrations (e.g., physiotherapy exercises, wound care). Also, videos can be accessed anytime, often via mobile device.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e- Snippet had a great importance for parents through enhancing understanding because parents can focus on one concept at a time. Moreover, short videos are easier to remember than long lectures. Also, snippet videos increase engagement because videos with visuals and animations grab attention better than text.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e- Parents can pause, replay, or share videos, allowing flexible learning. Furthermore, it supports practical skills and demonstrates procedures like bandage changing, physiotherapy exercises, or limb-lengthening care. Helps parents gain confidence in applying care techniques at home and feel less anxious when guided visually\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e2-\u003cstrong\u003eSnippet Infographics\u003c/strong\u003e are visual representations of information, or instructions that combine graphics, icons, charts, and brief text to make complex content easy to understand. Focus on a single concept or procedure per infographic, can be printed or shared digitally\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eImportance of Infographics for Parents\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e- It simplifies complex information by showing step-by-step instructions visually (e.g., limb care after surgery). Also, parents can keep a printed or digital copy for fast guidance at home.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3-Snippet Single-Focus Modules\u003c/strong\u003e are short, focused teaching units that cover one specific skill or concept at a time using brief text explanations. It covers one topic per module, easy to share digitally or use in print, and supports better adherence to care instructions it was applied by using the following steps:\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eOne Skill per Snippet\u003c/strong\u003e \u0026ndash; Focus on a single task.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eShow Then Explain\u003c/strong\u003e \u0026ndash; Demonstrate first, then give 1\u0026ndash;3 sentences summarizing steps.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eUse Simple Language\u003c/strong\u003e \u0026ndash; Parent-friendly, avoid jargon.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eUse printed colored cards\u003c/strong\u003e summarizing critical steps (such as pain management, pin-site care, and danger signs) were also provided during hospital discharge\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eHighlight Key Points\u003c/strong\u003e \u0026ndash; Emphasize warnings or critical steps.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eShare Accessibly\u003c/strong\u003e \u0026ndash;WhatsApp, or printed handouts.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ol\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n\u003ch2\u003eImplementation phase:\u003c/h2\u003e\n\u003cp\u003eThe nursing snippet-based intervention was applied through short, focused instructional segments that covered essential aspects of their child\u0026rsquo;s limb lengthening care. These snippets were presented sequentially and reinforced through direct guidance. The researchers ensured consistent delivery, clarified questions, and supported parents\u0026rsquo; skill development throughout the snippet teaching strategy implementation considering the appropriate level of Arabic language for the parents' education.\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003e- Session\u0026rsquo;s implementation schedule was established to suit parents including date, time, place, topics, and duration of all snippet sessions.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e- There were eight meetings in all, lasting 40 to 50 minutes over the course of four months. Moreover, eight sessions containing the study objectives and carried out through (3 session for the theoretical as showed in Table A and 5 sessions for the practical part as showed in Table B) using different snippet teaching strategies. Ten groups of parents were created, with five to six parents in each group.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eTable A: A nursing snippet-based intervention for theoretical part\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Taba\" border=\"1\"\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTheoretical part\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSnippet Video\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eInfographic / Visual\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSnippet Single-Focus Modules (Brief Text Explanation)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDefinition and Purpose of Limb Lengthening\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eShort animation explaining the concept of bone lengthening and how new bone forms.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDiagram showing bone segments, external fixator/device, and distraction process.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eClear text module defining limb lengthening, goals, and indications in simple language.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eRisks and Benefits of Surgery\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVideo summarizing common risks (infection, pain, nerve irritation) and expected benefits (corrected deformity, improved function).\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRisk\u0026ndash;benefit comparison chart with icons.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBrief text listing major risks and benefits, with emphasis on parental understanding and early reporting.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTypes of Devices Used\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDemonstration video showing external fixators and internal lengthening nails.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDevice comparison chart with labelled diagrams.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStep-by-step explanation of each device, its purpose, and how it works.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eImportance of Preoperative Evaluation \u0026amp; Investigations\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVideo explaining required investigations (X-ray, blood work, anesthesia assessment).\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFlowchart of preoperative assessment steps.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eModule explaining why each investigation is needed and what parents should expect.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eRole of the Parent in Preparing the Child Physically \u0026amp; Psychologically\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVideo showing parent\u0026ndash;child interaction, preparation routines, and communication tips.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChecklist visual for psychological and physical preparation.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eShort text guiding parents on how to reduce anxiety, encourage cooperation, and prepare physically (nutrition, hygiene, rest).\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eExpected Duration of Lengthening \u0026amp; Consolidation Phases\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVisual timeline video showing each phase week by week.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTimeline graphic from surgery \u0026rarr; distraction \u0026rarr; consolidation \u0026rarr; full healing.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eExplanation of typical timeframes and what happens during each phase.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePostoperative Care (General)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVideo on positioning, monitoring, and early home care.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePostoperative care flow diagram.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSimple instructions describing daily tasks parents must perform.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSigns of Complications\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eScenario-based video showing early signs of infection or device issues.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRed-flag warning poster with visual icons.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFocused text describing when to seek emergency help.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eHome Care \u0026amp; Follow-Up\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHome-setting demonstration of daily routines, mobility support, and device care.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHome care checklist.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eClear explanation of home care responsibilities and follow-up visit schedule.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eExpected Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMotivational video showing recovery progress and typical long-term outcomes.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBefore/after visual comparison of expected limb improvement.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eText module outlining realistic outcomes and factors influencing success.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable B: A nursing snippet-based intervention for Practical part\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tabb\" border=\"1\"\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePractical Task / Skill\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSnippet Video\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eInfographic / Visual\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSnippet Single-Focus Modules (Brief Text Explanation)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eImmediate Postoperative Care\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDemonstration video showing positioning, monitoring vital signs, limb elevation, and maintaining a safe environment.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStep-by-step flowchart for immediate postoperative care.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBrief text describing the essential steps of immediate postoperative care clearly and sequentially.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePain and Analgesia Management\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVideo showing clear explanation of pain recognition, medication timing, monitoring effectiveness, and comfort measures. how to assess pain in children, administer prescribed analgesics, and document response.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInfographic showing step by step analgesia management.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e''Give pain medications as prescribed. Keep child comfortable and in recommended position.\u0026rdquo;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEssential Wound Care\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVideo of step-by-step dressing removal \u0026amp; application\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLabeled diagram of wound care steps \u0026amp; warnings\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ldquo;Wear gloves, remove old dressing carefully, clean area, apply new dressing gently. Watch for redness or discharge.\u0026rdquo;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDaily Pin Site Cleaning\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVideo demonstrating aseptic pin-site cleaning using real equipment.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVisual guide with steps for pin-site care.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e''Check screws and pins gently; do not force. Call doctor if pins feel loose or cause pain.\u0026rdquo;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eHand Hygiene\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u0026ndash;2 min video showing proper handwashing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStepwise diagram of handwashing steps\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ldquo;Wash hands with soap for 20 sec before care. Dry with a clean towel.\u0026rdquo;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSkin and Personal Hygiene Management\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVideo of safe bathing, skin inspection, and maintaining hygiene around device.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHygiene checklist with essential tasks.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ldquo;Keep the skin clean and dry, bathe carefully around the device, and check for irritation or injury.\u0026rdquo;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEmotional / Psychosocial Support\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVideo demonstrating comforting techniques, parent\u0026ndash;child communication, reassurance, and coping strategies after surgery.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInfographic showing emotional support tips parents should perform.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e''Offer praise, calm voice, gentle touch. Encourage child to express feelings.\u0026rdquo;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAssist with Mobility \u0026amp; Safe Transfers\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVideo demonstration of safe bed-to-chair transfers, walking with aids, and protecting the operated limb.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMobility infographic with safety rules.\u003c/p\u003e\n\u003cp\u003e-Diagram of safe walking techniques\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e''Use assistive devices as instructed. Ensure clear floor and maintain balance.\u0026rdquo;.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eHome Environment \u0026amp; Equipment Management\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eShort video illustrating safe space, removing hazards, and equipment placement.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDiagram of safe home layout\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ldquo;Remove obstacles, keep floor dry, provide stable furniture to prevent falls.\u0026rdquo;.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDevice / Frame Care \u0026amp; Adjustments\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStep-by-step video demonstrating daily inspection and safe frame adjustments.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDiagram of device care with labeled parts.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ldquo;Clean and inspect\u003c/p\u003e\n\u003cp\u003edevice daily ''\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePhysiotherapy / Range-of-Motion Exercises\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePhysiotherapist-led demonstration of Range-of-Motion exercises, stretching, and strengthening.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eExercise infographic with Range-of-Motion steps.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e''Lift child\u0026rsquo;s leg slowly, bend knee gently, repeat 5 times per session, twice daily. Stop if painful.\u0026rdquo;.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMonitoring for Complications \u0026amp; Early Reporting\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eScenario-based video showing early signs of infection, hardware problems, or neurovascular issues.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRed-flag infographic with warning signs requiring immediate reporting.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ldquo;Check for redness, swelling, pus, or fever. Contact doctor immediately if any appear.\u0026rdquo;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAdherence to Follow-Up Schedule After Surgery\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVideo explaining importance of regular clinic visits, X-rays, and frame adjustments.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCalendar-style visual showing follow-up timeline.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ldquo;Keep calendar of appointments. Attend all follow-ups to check progress and adjust care.\u0026rdquo;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eEvaluation Phase (Post nursing snippet-based intervention)\u003c/strong\u003e: The parents' burden, self-efficacy, knowledge and practice were immediately evaluated after a nursing snippet-based intervention and after 3 months of nursing snippet-based intervention. The same pretest collection tools were used to conduct the post-tests.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\n\u003ch2\u003eData analysis\u003c/h2\u003e\n\u003cp\u003eUsing (SPSS version 22), the data was coded and converted into a specifically created format for computer entry. Frequency, percentages, mean, and standard deviation were used as descriptive statistics. Additionally, chi-square was used to assess the study's premise. At p-value\u0026thinsp;\u0026le;\u0026thinsp;0.001, a highly significant difference was found; at p-value p\u0026thinsp;\u0026le;\u0026thinsp;0.05, a statistical difference was found; and at p-value P\u0026thinsp;\u0026gt;\u0026thinsp;0.05, no statistical difference was found.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e reveals the parents' characteristics; it was found that, the mean age of the studied parents was 35.94\u0026thinsp;\u0026plusmn;\u0026thinsp;3.52 years and the majority (87.3%) of them were mothers. According to parents' educational level more than two thirds (69.1%) of them had university education. Additionally, it was noticed that, slightly less than two thirds (61.8%) of parents not occupied and more than two thirds (67.3%) of them from rural area. Moreover, less than three quarters (70.9%) of the studied parent had no consanguinity relation and all (100%) of them not attended any previous training courses regarding limb lengthening surgery.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows children\u0026rsquo;s personal characteristics; it was observed that, the mean age of the studied children was 8.32\u0026thinsp;\u0026plusmn;\u0026thinsp;2.53. As regards gender it was found that slightly less than two thirds (65.5%) of children were females. Additionally, it was noticed that, two fifth (40.0%) of the studied children was the first child in order.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e explains children's medical history; it was found that less than half (45.3%) of them diagnosed with congenital short femur. Additionally, more than one quarter (29.3%) of children had complications as a result of limb lengthening surgery and less than half (45.5%) of children who had complications were complicated with joint stiffness.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e describes parents' total knowledge regarding limb lengthening surgery pre, immediately post and after 3 months of a snippet-based teaching strategy implementation. It was found that, the majority (83.6%) of the studied parents had unsatisfactory knowledge pre- nursing snippet-based intervention. While, (87.3% \u0026amp; 78.2%) of them had satisfactory total level of knowledge immediately post and after 3 months of nursing snippet-based intervention, respectively.\u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e portrays parents' total reported practice regarding care of their children after limb lengthening surgery at pre, post and after 3 months of nursing snippet-based intervention implementation. It was found that, more than three quarters (78.2%) of the studied parent had incompetent reported practices pre- nursing snippet-based intervention. In contrast, the majority (89.1% \u0026amp;81.8%) of them had competent total reported practice immediately post and after 3 months of nursing snippet-based intervention respectively.\u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows Parents' total level of self-efficacy regarding care for their children after limb lengthening surgery pre, immediately post and after 3 months of nursing snippet-based intervention. It was found that, less than two thirds (62.5%) of the studied parent had low self-efficacy pre- nursing snippet-based intervention. In contrast, (41.7% \u0026amp;35.5%) of them had high self-efficacy immediately post and after 3 months of nursing snippet-based intervention, respectively.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e displays parents\u0026rsquo; total burden levels at pre, immediately post and after 3 months of nursing snippet-based intervention; it was observed that (16.4% \u0026amp; 38.2%) had high and moderate burden level pre- nursing snippet-based intervention respectively. While, (40.0% \u0026amp; 36.4%) of them had low burden level immediately post and after 3 months of nursing snippet-based intervention respectively.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e reveals correlation between total knowledge score, total reported practice score and total parents' self-efficacy level of the studied parent pre, immediately post and after 3 months of nursing snippet-based intervention. It was found that there was highly statistical positive correlation between the studied parents' total level of knowledge, total reported practices and their total self-efficacy level at pre, immediately post and after 3 months of nursing snippet-based intervention.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePercentage distribution of the studied parents according to their personal characteristics (n\u0026thinsp;=\u0026thinsp;55).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParents' characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eAge in years\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20-\u0026gt;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30-\u0026gt;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e50.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e29.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e35.94\u0026thinsp;\u0026plusmn;\u0026thinsp;3.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eConsanguinity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFathers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMothers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducational level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntermediate education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e69.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost graduate education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e10.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e38.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e61.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e67.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e32.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eConsanguinity relation between parents\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e29.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e70.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAttendance of training courses regarding limb lengthening surgery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePercentage distribution of the studied children according to their personal characteristics (n\u0026thinsp;=\u0026thinsp;55).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eChildren's personal characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;55)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge in years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5-\u0026gt; 9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9-\u0026ge; 12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ex̅\u0026plusmn;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e8.32\u0026thinsp;\u0026plusmn;\u0026thinsp;2.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRanking of the child\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecond\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThird\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFourth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePercentage distribution of the studied children according to their medical history (n\u0026thinsp;=\u0026thinsp;55).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eChildren's medical history\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;55)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eMedical diagnosis of children under limb lengthening surgery\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCongenital short femur\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e45.3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAchondroplasia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRotational deformity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost traumatic damage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComplications that occurred as a result of limb lengthening surgery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e29.3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIf yes, the complications are (n\u0026thinsp;=\u0026thinsp;22)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePin- site infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuscle contractures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJoint stiffness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e45.5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeep venous thrombosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePercentage distribution of the studied parents\u0026rsquo; total knowledge regarding limb lengthening surgery pre, immediately post and after 3 months of nursing snippet-based intervention (n\u0026thinsp;=\u0026thinsp;55).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePre a snippet-based teaching strategy implementation (n\u0026thinsp;=\u0026thinsp;55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eImmediately post a snippet-based teaching strategy implementation (n\u0026thinsp;=\u0026thinsp;55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eAfter 3 months of a snippet-based teaching strategy implementation (n\u0026thinsp;=\u0026thinsp;55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eX2(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eX2(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal knowledge level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e28.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eP\u0026thinsp;\u0026gt;\u0026thinsp;0.05 ns\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSatisfactory (\u0026ge;\u0026thinsp;60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e87.3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e78.2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnsatisfactory (\u0026lt;\u0026thinsp;60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e83.6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e21.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003e**Highly statistical significant difference at p value\u0026thinsp;\u0026le;\u0026thinsp;0.001\u003c/h2\u003e \u003cp\u003e \u003csup\u003e \u003cb\u003ens\u003c/b\u003e \u003c/sup\u003e \u003cb\u003eNo statistical significant difference at p value P\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/b\u003e\u003c/p\u003e \u003cp\u003eX2(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Difference between pre-test and post-test\u003c/p\u003e \u003cp\u003eX2(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Difference between post-test and follow-up test.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePercentage distribution of parents\u0026rsquo; total burden levels at pre, immediately post and after 3 months of nursing snippet-based intervention (n\u0026thinsp;=\u0026thinsp;55).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePre a snippet-based teaching strategy implementation (n\u0026thinsp;=\u0026thinsp;55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eImmediately post a snippet-based teaching strategy implementation (n\u0026thinsp;=\u0026thinsp;55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eAfter 3 months of a snippet-based teaching strategy implementation (n\u0026thinsp;=\u0026thinsp;55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eX2(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eX2(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParents\u0026rsquo; total burden levels\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e15.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eP\u0026thinsp;\u0026gt;\u0026thinsp;0.927 ns\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLittle burden\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e36.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild burden\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e32.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate burden\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh burden\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003e**Highly statistical significant difference at p value\u0026thinsp;\u0026le;\u0026thinsp;0.001\u003c/h2\u003e \u003cp\u003e \u003csup\u003e \u003cb\u003ens\u003c/b\u003e \u003c/sup\u003e \u003cb\u003eNo statistical significant difference at p value P\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/b\u003e\u003c/p\u003e \u003cp\u003eX2(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Difference between pre-test and immediately post-test\u003c/p\u003e \u003cp\u003eX2(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Difference between immediately post-test and follow-up test\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation between total knowledge score, total reported practice score and total parents' self-efficacy level of the studied parents pre, immediately post and after 3 months of nursing snippet-based intervention (n\u0026thinsp;=\u0026thinsp;55).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTotal knowledge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eTotal reported practices\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eTotal parents' self-efficacy level\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePre\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eImmediately post\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eAfter 3 months\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal knowledge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.621\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.538\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal reported practices\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.452\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.579\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal parents' self-efficacy level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.385\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.005*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.551\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003e**A highly statistical significant difference (p\u0026thinsp;\u0026le;\u0026thinsp;0.001)\u003c/h2\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003e*A statistical significant difference (p\u0026thinsp;\u0026le;\u0026thinsp;0.05)\u003c/h2\u003e \u003cdiv id=\"Sec26\" class=\"Section4\"\u003e \u003ch2\u003er- Pearson Correlation Coefficient\u003c/h2\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eDue to their vulnerability, children and parents require close monitoring during the entire perioperative period. These findings highlight the importance of preoperative psychosocial assessment and continuous emotional support throughout healing and recovery. The best method for orthopedic surgeons to enhance children's physical health and quality of life is to incorporate a parent's self-efficacy oriented strategy into treatment plans (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eParents are important participants and practitioners in pediatric postoperative limb surgery (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).Therefore, they should be able to provide extensive information to nurses on behalf of their children and provide timely feedback on the effectiveness of clinical interventions.\u003c/p\u003e \u003cp\u003eA nursing snippet-based intervention support parents were able to better understand caregiving processes without feeling overburdened by the information presented in brief, focused portions. This method probably lessened anxiety and cognitive overload, which are frequently experienced by parents of children with complicated medical or surgical demands (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRegarding parents' characteristics; it was found that, the mean age of the studied parents was 35.94\u0026thinsp;\u0026plusmn;\u0026thinsp;3.52 years, the majority of them were mothers and according to parents' educational level more than two thirds of them had university education. This result was in the same line with (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) whose study entitled \" Swedish parents' experiences of their role in treatment for children with congenital limb reduction deficiency: Decision-making and treatment support\" and founded that, the mean age of the studied parents was 40 years, less than three quarter of them 70.5% were mothers and according to parents' educational level more than two thirds 64.7% of them had university education. The researchers reflect these results to the fact that mothers are first care giver to their children who provide all attention to improve their health status and their education level help researchers to use a nursing snippet-based intervention effectively.\u003c/p\u003e \u003cp\u003eAccording to attendance of training courses regarding limb lengthening surgery, all parents' not attending training courses. From the researchers' point of view the limb lengthening surgery is a complex procedure cause parents' burden and effect self-efficacy which reflect importance of study.\u003c/p\u003e \u003cp\u003eThe current study showed that, mean age of children need limb lengthening surgery was 8.32\u0026thinsp;\u0026plusmn;\u0026thinsp;2.53 year which inconsistent with the previous studies conducted by (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e), (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e), whose studies entitled \"Quality of life evaluation following limb lengthening surgery in patients with achondroplasia\" \u0026amp; \"Comparison between upper and lower limb lengthening in patients with achondroplasia: A retrospective study.\", respectively and reported that, 12 children had received upper-and lower-limb lengthening; mean age at initial surgery 11.8 years with achondroplasia. The researchers reflect this as a result of differ sample size and setting of study.\u003c/p\u003e \u003cp\u003eRelated to complications that occurred as a result of limb lengthening surgery it was founded that, more than one quarter had complications and less than half of them had joint stiffness. This result was agreed with (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e) whose study entitled \"calcaneal lengthening for correction of symptomatic flexible flat foot in children.\" and founded complications were reported in 17.5% on children. On the other hand, current study disagreed with (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e) Whose study entitled \" Results and complications of bilateral limb lengthening in achondroplasia: a retrospective analysis.\" and demonstrated that a 4.7% increase in the risk of developing complications. Additionally, current study inconsistent with (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e),(\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). Whose study entitled \"Limb lengthening in achondroplasia\" \u0026amp; \"Bilateral double level tibial lengthening in dwarfism\" and founded that, the complications were 33 out of 36 lengthened segments (92%), 28 out of 28 lengthened segments (100%), respectively. Also, in contrast, in the study by (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). Whose study entitled \"Femoral lengthening in achondroplasia: magnitude of lengthening in relation to patterns of callus, stiffness of adjacent joints and fracture.\" all 20 patients reported temporary joint stiffness and fractures of bone regenerate occurred in 15% of cases. From the researchers' point of view, there were high chance of complications after limb surgery but with cooperating care from parents and health care providers which provided with impower parents with knowledge and share in care plan can easily minimize risks and prevent complications. This was accomplished with the nursing snippet-based intervention in current study.\u003c/p\u003e \u003cp\u003eAs founded, parents' total knowledge regarding limb lengthening surgery pre, immediately post and after 3 months of nursing snippet-based intervention. It was found that, the majority of the studied parents had unsatisfactory knowledge pre- nursing snippet-based intervention. This result compatible with (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e) whose study \"Parental postoperative pain management perceptions, attitudes, and practices in pediatric limb fractures\" and founded that, parents had insufficient knowledge about limb surgery, pain assessment tools, analgesics and causes of pain in children. This could be mainly attributed to negligence by health care professionals, unavailability of assessment tools, and inadequate limb surgery and pain related education.\u003c/p\u003e \u003cp\u003eThe present study mentioned that, the majority of parents had competent total reported practice immediately post and after 3 months of nursing snippet-based intervention. This result competent with (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) which highlight the complex nature of the parental role of being a treatment supporter for a child with limb surgery, and founded that, the majority of parents performed a number of duties to support the treatment process. Unexpectedly from the parents' point of view, they were given the role of an \u0026lsquo;extended arm\u0026rsquo; of the healthcare team, in which they carried out direct and indirect treatment duties that were crucial to the treatment outcomes. From the researchers' point of view, the snippet-teaching strategy provided parents with step-by-step, achievable learning units, enabling them to gain confidence in managing caregiving activities such as medication administration, wound care, and monitoring warning signs.\u003c/p\u003e \u003cp\u003eAs regards parents' total level of self-efficacy regarding care for their children after limb lengthening surgery, there were founded that, the majority of parents had high level of self- efficacy immediately post and after 3 months of nursing snippet-based intervention this result congruent with (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e) whose study \"Core psychosocial issues for children and adolescents in the context of limb lengthening and reconstruction surgery treatment\" and showed, the majority of parents were weighted toward limb lengthening surgery and in the same time feel high self-efficacy after empowered with information about surgery. From researchers' point of view, parents' self-efficacy depends on understanding full picture about their children case.\u003c/p\u003e \u003cp\u003eAccording total parents' burden levels, the current study founded that, more than half of parents had moderate and high burden level pre- nursing snippet-based intervention implementation which congruent with (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e) Whose study entitled \"The factors associated with the caregiving burden among family caregivers of pediatric patients with fractures: A descriptive cross-sectional study\" and founded that, most family caregivers were mothers comprising 56% of the total and 81.5% of caregivers had moderate or severe burden. From researchers' point of view, this finding reflects that most participants were mothers, who are generally more emotionally responsive and more closely engaged in their children\u0026rsquo;s care. Also, increase parents' burden linked to the lengthy course of limb lengthening therapy, which frequently entails numerous surgeries, multiple hospital stays, intense home care and ongoing condition monitoring. The simplicity, clarity, and accessibility of the nursing snippet-based intervention may be responsible for the decrease in parental burden seen in the current study.\u003c/p\u003e \u003cp\u003eRegarding correlation between parents' total level of knowledge, total reported practices and their total self-efficacy level, there were highly statistical positive correlation between the studied parents' total level of knowledge, total reported practices and their total self-efficacy level at pre, immediately post and after 3 months of a nursing snippet-based intervention. These results were consistent with (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). Whose study entitled \"Family caregiver strain and challenges when caring for orthopedic patients: a systematic review\" and founded, Orthopedic caregivers without enough information had less security in dealing with the children\u0026rsquo; disease than those who received an appropriate education from health care team members: this is a finding that was consistent with the stress, self- efficacy and coping model of caregiving. This finding aligns with Bandura\u0026rsquo;s self-efficacy theory, which highlights how people's perceived capacity to successfully carry out caregiving responsibilities can be diminished by a lack of knowledge and skills (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eImplications of the study\u003c/h2\u003e \u003cp\u003e The findings of the study suggest that using simple and attractive methods for teaching as A nursing snippet-based intervention can significantly increase parents\u0026rsquo; self-efficacy, compliance with care plan and decreases parents' burden. These improvements can directly influence child health.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003eConclusion of the study\u003c/h2\u003e \u003cp\u003eThe current study findings were used to validate the research hypotheses. In conclusion, nursing snippet-based intervention reinforces the critical role of improve parents' knowledge, practice, self- efficacy and decreases parents' burden toward caring of their children undergoing limb lengthening surgery.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eRecommendations:\u003c/h3\u003e\n\u003cp\u003eThe current study recommended that future research validate and build upon these findings utilizing longitudinal designs and larger, more varied samples in other contexts. Additionally, establish training programs for clinical staff to optimize fidelity and effectiveness of nursing snippet-based intervention.\u003c/p\u003e \u003cdiv id=\"Sec31\" class=\"Section2\"\u003e \u003ch2\u003eLimitations of the study\u003c/h2\u003e \u003cp\u003eThere are a number of limitations to this study. First, the study was carried out in a single Egyptian public hospital, which would restrict the findings' applicability to other facilities. Second, the study might be biased because it only included people with smartphones and access to digital instructional resources. Third, social desirability bias or inaccurate parental perceptions may have affected the data acquired via questionnaire sheets. Furthermore, although the study found important correlations between knowledge, practices, self-efficacy, and parents' burden, other variables like clinical experience and personal motivation were not evaluated and may have affected the results.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCSES\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCaregiver Self-Efficacy Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eFGFR3\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFibroblast Growth Factor Receptor 3 gene\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eZBI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eZarit Burden Interviewing\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eClinical trial number\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e \u003cp\u003e In accordance with the Declaration of Scientific Research Ethics Committee, Faculty of Nursing Benha University, Egypt, the approval was obtained; code REC-PN-P79 prior to beginning the actual work. The submission of an official letter from the hospital manager and the supervisors of the surgical unit was done. The objectives, aim, and benefits of the study were adequately explained to each parent. Each parent gave written informed consent before participating in the study. The researchers made it clear that parents' involvement in the study was completely voluntary and that they might withdraw at any time without experiencing any repercussions. Confidentiality was further ensured by coding the data.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests\u003c/strong\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eAuthor details\u003c/h2\u003e \u003cp\u003e \u003csup\u003e1,2,3\u003c/sup\u003ePediatric Nursing, Faculty of Nursing, Benha University, Benha, Egypt.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eOpen access funding provided by The Science, Technology \u0026amp; Innovation Funding Authority (STDF) in cooperation with The Egyptian Knowledge Bank (EKB). Open access funding was provided by the Science, Technology \u0026amp; Innovation Funding Authority (STDF) in cooperation with the Egyptian Knowledge Bank (EKB).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eA. Every author contributed to the development of the research topic, goal, and plan. B. Gathering and presenting the research's scientific foundation. C. Taking part in the creation of instruments for gathering data. D. Taking part in choosing the research sample's size and methodology. E. Research applied practically. F. Taking part in statistical analysis and reporting the findings of the study. G. Taking part in producing recommendations, conclusions, and indexing the research's references.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eThe authors thank and appreciate all the study subjects who were involved in this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data and resources utilized in the current study cannot be made publicly available due to confidentiality considerations. On reasonable request, they can be obtained from the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGiorgino R, Cornacchini J, Sillmann YM, Kostyra D, Berkane Y, Peretti GM, et al. Aesthetic lower limb lengthening techniques: a systematic review of efficacy, complications, and patient satisfaction. J Orthop Surg Res. 2025;20(1):415.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl-Hamid A, Ahmed M, Hosny AG, A Anter M. Humeral lengthening: Systematic Review and Meta Analysis. Benha J Appl Sci Benha Univ. 2023;8(3):151\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXi F, Xue X, Ji E, Zhang Q, Zhao S, Li K, et al. Relationship between leg length discrepancy and functional scoliosis in children and adolescents. BMC Musculoskelet Disord. 2025;26(1):428.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu C, Huang P, Mo Y, Wang D, Ning B. How do lesions affect limb lengthening in children with Ollier\u0026rsquo;s disease? BMC Musculoskelet Disord. 2025;26(1):13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYoussef AR, Gumaa M, Hosny GA. Are internal lengthening devices effective and associated with less complications compared to other lengthening devices? A systematic review and meta-analysis. J Pediatr Orthop B. 2022;31(2):e219\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaraarslan D, \u0026Ccedil;elik NK, Ergin D. Relationship between the care need levels of patients hospitalized in the pediatric surgery service and the caregiving burden of their parents: A cross-sectional study. Enfermer\u0026iacute;a Cl\u0026iacute;nica (English Edition). 2025:502210.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElebute OA, Campbell EA, Ademuyiwa AO, Ihediwa CG, Bode CO. Psychological burden of care in parents/caregivers of children with surgical conditions\u0026ndash;A local experience. J Clin Sci. 2023;20(1):8\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoursi HA, Sabry SS. Effect of educational guidelines for family caregivers of elderly cancer patients regarding burden of care. Assiut Sci Nurs J. 2022;10(28):94\u0026ndash;109.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCohn LN, Pechlivanoglou P, Lee Y, Mahant S, Orkin J, Marson A, et al. Health outcomes of parents of children with chronic illness: a systematic review and meta-analysis. J Pediatr. 2020;218:166\u0026ndash;77. e2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee S, Seo S, Choi H, Choi DJ. A Qualitative Study on the Caregiving Experiences of Parents of Young Adults with Mental Disorders. J Korean Acad psychiatric Mental Health Nurs. 2024;33(4):404\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAzar RMZ, Maedeh B, Hamideh AL. Relationship between self-efficacy and perceived burden among schizophrenic patients\u0026rsquo; caregivers. J Nurs Midwifery Sci. 2019;6(2):91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTork HM, Mansour HEM, Mohamed E-g, Abd R. Effect of empowerment program on parents' self competence regarding care of their children with cochlear implantation. Int J health Sci. 2022;6(S9):2852\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBatsalya ALR, Kanak K, Hiramani P, Rakshya S. Communication is the key: Does strategic perioperative counseling decrease anxiety in parents of the pediatric patient undergoing surgery? Birat J Health Sci. 2024;8:2174\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDe Gagne JC, Park HK, Hall K, Woodward A, Yamane S, Kim SS. Microlearning in health professions education: scoping review. JMIR Med Educ. 2019;5(2):e13997.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEmara EAE-HM. Using Authentic Video Snippets for Developing Non-Major Students' EFL Listening Skills and Growth Language Mindset. J Fac Educ Benha Univ. 2024;35(1393):31\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeyva AZVS, Steiner L, Carley-Rizzuto K. A Parental Involvement Program: Facilitating parental scaffolding with literacy strategies to support students\u0026rsquo; mathematical skills. Discover Education (2025).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDella Porta SL, Sukmantari P, Howe N, Farhat F, Ross HS. Naturalistic parent teaching in the home environment during early childhood. Front Psychol. 2022;13:810400.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eForman DA, Forman GN, Avila-Mireles EJ, Mugnosso M, Zenzeri J, Murphy B, et al. Characterizing forearm muscle activity in university-aged males during dynamic radial-ulnar deviation of the wrist using a wrist robot. J Biomech. 2020;108:109897.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaghnie M, Semler O, Guillen-Navarro E, Selicorni A, Heath KE, Haeusler G, et al. Lifetime impact of achondroplasia study in Europe (LIAISE): findings from a multinational observational study. Orphanet J Rare Dis. 2023;18(1):56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBandura A. Social foundations of thought and action. Englewood Cliffs NJ. 1986;1986:23\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBandura A. Self-efficacy: The exercise of control. Freeman; 1997.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLazarus RS, Folkman S. Stress, appraisal, and coping. Springer publishing company; 1984.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFolkman S. Stress: appraisal and coping. Encyclopedia of behavioral medicine. Springer; 2013. pp. 1913\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSlovin E. Slovin\u0026rsquo;s formula for sampling technique. Retrieved July 21, 2021. 1960.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRingn\u0026eacute;r A, Ljung M, Rullander A-C. Parents' and nurses\u0026rsquo; experiences when children undergo limb lengthening treatment. Int J Orthop Trauma Nurs. 2025;57:101176.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeger C, Alves I, Carl-Innig P, Sessa M, Mohnike K, Cheung MS. Limb lengthening in individuals with achondroplasia: Analysis of an international survey. Bone. 2025;195:117462.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalimi M, Sarallah R, Javanshir S, Mirghaderi SP, Salimi A, Khanzadeh S. Complication of lengthening and the role of post-operative care, physical and psychological rehabilitation among fibula hemimelia. World J Clin Cases. 2022;10(24):8482.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTrofimchuk V, Dossanov B, Lozovoy V, Khmyzov S, Dossanova A, Angelov A, et al. Quality of Life in Children With Achondroplasia Undergoing Paired Limb Lengthening With an External Fixator and Modified Distraction Control: Observational Nonrandomized Study. JMIR Rehabilitation Assist Technol. 2024;11(1):e49261.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRadler C, Calder P, Eidelman M, Horn J, Kold S, Langend\u0026ouml;rfer M, et al. What\u0026rsquo;s new in pediatric lower limb reconstruction? J Child Orthop. 2024;18(4):349\u0026ndash;59.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCatena N, Arrigoni C, Carvalho M, Matic I, Farr S. External fixators and lengthening systems in pediatric upper limb. J Child Orthop. 2025;19(2):139\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSteffen AM, McKibbin C, Zeiss AM, Gallagher-Thompson D, Bandura A. The revised scale for caregiving self-efficacy: reliability and validity studies. Journals Gerontol Ser B: Psychol Sci social Sci. 2002;57(1):P74\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZarit S. ZBI-Zarit Burden Interview Version 1.0: Scaling and Scoring. Lyon: Mapi Research Trust; 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHamilton AA, Mehta R, Sue Epstein B, Fabricant PD, Fragomen AT, Robert Rozbruch S. Core psychosocial issues for children and adolescents in the context of limb lengthening and reconstruction surgery treatment. J Child Orthop. 2021;15(2):122\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeltramini A, Milojevic K, Pateron D. Pain assessment in newborns, infants, and children. Pediatr Ann. 2017;46(10):e387\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNeri HG. Disparities in the Lanterman Developmental Disabilities Services Act. Walden University; 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSj\u0026ouml;berg L, Hermansson L, Lindner H, Fredriksson C. Swedish parents' experiences of their role in treatment for children with congenital limb reduction deficiency: Decision-making and treatment support. Child: Care,. Health and Development, 2020;46(6):723\u0026thinsp;\u0026ndash;\u0026thinsp;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBatıbay SG, Balcı, H. İ., Bayram, S., Chodza, M., G\u0026ouml;ksoy, Ş., H\u0026uuml;rmeydan, \u0026Ouml;. M., \u0026hellip;Kocaoğlu, M. Quality of life evaluation following limb lengthening surgery in patients with achondroplasia. Indian Journal of Orthopaedics, 2020; 54(Suppl 1):39\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim SJ, Agashe MV, Song SH, Choi HJ, Lee H, Song HR. Comparison between upper and lower limb lengthening in patients with achondroplasia: a retrospective study. J Bone Joint Surg Br Volume. 2012;94(1):128\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHegazy M, Bassiouni H, Al-Ashhab. M. calcaneal lengthening for correction of symptomatic flexible flat foot in children. Benha Med J Benha Univ. 2020;36(3):98\u0026ndash;106.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVerdoni FGR, Virgilio C, Nannini A, Vigan\u0026ograve; M, Curci D, Peretti GM, Mangiavini L. Results and complications of bilateral limb lengthening in achondroplasia: a retrospective analysis. Front Pead.2023; 11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChilbule SK, Dutt V, Madhuri V. Limb lengthening in achondroplasia. Indian J Orthop. 2016;50(4):397\u0026ndash;405.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBurghardt RDYK, Kashiwagi N, Yoshino S, Bhave A, Paley D, et al. Bilateral double level tibial lengthening in dwarfism. J Orthop. 2015;12(242):7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVenkatesh KPMH, Devmurari K, Yoon JY, Anupama BR, Song HR. Femoral lengthening in achondroplasia: magnitude of lengthening in relation to patterns of callus, stiffness of adjacent joints and fracture. J Bone Joint Surg Br. 2009;91(1612):7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang SM, Chan YY, Lai LL, Liang PR, Lin M. Parental postoperative pain management perceptions, attitudes, and practices in pediatric limb fractures. Pain Manage Nurs. 2023;24(5):506\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDai Q, Peng M, Li C, Deng S, Huang P, Guo X, Yang Y. The factors associated with the caregiving burden among family caregivers of pediatric patients with fractures: A descriptive cross-sectional study. J Pediatr Nurs. 2024;79:126\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLongo UG, Matarese, M., Arcangeli, V., Alciati, V., Candela, V., Facchinetti, G.,\u0026hellip; Denaro, V. Family caregiver strain and challenges when caring for orthopedic patients:a systematic review. Journal of clinical medicine,. 2020; 9(5): 1497.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Children, Limb lengthening surgery, Nursing Snippet-Based Intervention, Parents' burden, Self-efficacy","lastPublishedDoi":"10.21203/rs.3.rs-8681721/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8681721/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Parents frequently experience severe anxiety when their child has surgery, which can have a detrimental effect on their emotional health and possibly affect the child's recuperation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim: \u003c/strong\u003eTo\u003cstrong\u003e \u003c/strong\u003eevaluate the effect of nursing snippet-based intervention on parents' burden and self-efficacy towards caring for their children undergoing limb lengthening surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThe present study was carried out utilizing a quasi-experimental research design.\u003cstrong\u003e \u003c/strong\u003eSetting:\u003cstrong\u003e \u003c/strong\u003eThe present study was conducted at the inpatient pediatric surgical department, at Benha Specialized Pediatric Hospital in Benha city.\u003cstrong\u003e \u003c/strong\u003eStudy sample: A purposive sample of 55 parents accompanying their children undergoing limb lengthening surgery. Study tools:\u003cstrong\u003e \u003c/strong\u003eFive tools were used for data collection,\u003cstrong\u003e \u003c/strong\u003eTool I: A structured interviewing questionnaire. Tool II: Child medical data. Tool III: Parents' reported practices checklist. Tool IV: Caregiver Self-Efficacy Scale. Tool V: Burden interviewing questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The majority of the studied parents had satisfactory level of total knowledge and competent level of total practice immediately post nursing snippet-based teaching intervention. Also, less than half of them had high self-efficacy level and little burden immediately post nursing snippet-based teaching intervention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e A nursing snippet-based intervention had a positive effect on improvement of parents' self-efficacy and diminished burden level.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendation:\u003c/strong\u003e\u003cem\u003e \u003c/em\u003eEstablish training programs for clinical staff to optimize fidelity and effectiveness of nursing snippet-based interventions.\u003c/p\u003e","manuscriptTitle":"Effect of Nursing Snippet-Based Intervention on Parents' Burden and Self-Efficacy towards Caring for their Children undergoing Limb Lengthening Surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-27 11:59:30","doi":"10.21203/rs.3.rs-8681721/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-09T14:10:26+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-09T06:39:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"50019087638865863068330403638055276322","date":"2026-03-06T07:31:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-05T06:19:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"72014373151887201112205210873755142790","date":"2026-03-05T05:59:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"224875236083450626436775566782226534747","date":"2026-03-01T18:23:28+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-24T10:58:12+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-30T08:30:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-29T05:39:15+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-29T05:35:32+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2026-01-23T17:49:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"424ab87e-eb73-40fd-bbbd-aef597e0c90d","owner":[],"postedDate":"February 27th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-28T20:53:25+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-27 11:59:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8681721","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8681721","identity":"rs-8681721","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}