The finding of the present study revealed that more than half of the studied nurses (56.0%) their age ranged from (30 > 40) years, from the researcher point of view this result may be due to nearly two third of the studied nurses (66.0%) had bachelor of nursing. Supporting these findings by (Sitanggang et al., 2020) who conducted study about professional quality of nurses in palliative nursing services, and reported that two third of studied nurses (60.0%) their age from (< 28 – 42 years).
Regarding to gender, the current study illustrated that less than two thirds of the studied nurses (62.0%) were female, from the researcher point of view this result may suggest that there is a gender bias toward nursing profession in Egypt. This finding was in agreement with study by (Santos et al., 2020) who conducted study about "Development and validation a nursing care protocol with educational interventions for family caregivers of elderly people after stroke" and reported that more than two thirds of them were females.
Regarding to marital status, the present study showed that majority of the studied nurses (82.0%) were married, from the researcher point of view this result may be due to culture in our society that people married at young age so majority studied nurses are married. This result agreed with (Vahedian-Azimi et al., 2019) who carried out study regarding effects of stress on critical care nurses: a national cross-sectional study, and found that most of the studied nurses (89.0%) were married.
The result of the present study revealed that majority of the studied nurses (84.0%) were village resident, from the researcher point of view this result may be due to agricultural nature of the sample setting (El Gharbia governorate). This result contraindicated with Mohamed Morsy, 2020) who carried out study about effect of educational interventions for nurses about pre and post-operative care on clinical outcomes of patients undergoing ureteral stent surgery, and found that (71.0%) of the studied nurses living in urban area.
Regarding to qualification, the present study represented that nearly two third of the studied nurses have bachelor of nursing (66.0%), from the researcher point of view this result may be due to newly assigned nurses with bachelor of nursing who distributed in critical care departments in the hospital rather than general departments. This result supported with (Sok, 2020) who represented that less than three quarters of participants (73.0%) graduated university in their study about burn out and related factors of nurses caring for DRN patients in intensive care units, South Korea.
Regarding to occupation, the present study revealed that nearly two third of the studied nurses (68.0%) were bedside nurses, from the researcher point of view this result may be due to job description distribution in the hospital as bedside nurses responsible for providing care to patients in all hospital departments. This result goes in the same line with (Hisaka et al., 2021) in their study about nurses’ awareness and actual nursing practice situation of stroke care in acute stroke units: a Japanese cross-sectional web-based questionnaire survey, who found that majority of all participants (90.5%) were staff nurses.
Regarding to the experience years in profession, the present study showed that more than three quarters of the studied nurses (76.0%) had more than 5 to 10 years of experience, from the researcher point of view this result may be due to more than half of the studied nurses (56.0%) their age ranged from (30 > 40) years. This result accepted with (Saramago, 2020) who carried out study regarding stress in nurses’ caring for stroke patients and families: a mixed – method study, and found that (75.0%) of respondents had a minimum 3 years’ experience.
The result of the present study revealed that nearly two third of the studied nurses (66.0%) had experience years in neurology from 5 to 10 years’ experience, from the researcher point of view this result may be due to more than three quarters of the studied nurses (76.0%) had more than 5 to 10 years of experience in nursing profession. This result in disagreement with (Ram, 2019) who carried out study about effectiveness of supplementary training on knowledge and attitude regarding comprehensive care of acute ischemic patients among nursing staff, and represented that almost half of nursing staff (42.5%) were having less than 1 year experience in caring stroke patients.
Regarding to the training courses, the present study showed that more than half of the studied nurses (52.0%) haven’t received any previous training courses; while, more than one third of them had received training courses as ICU & emergency (34.0%) followed by first aid (30.0%). From the researcher point of view this result may be due to lack of in service training programs that may be determined by cost or number of staff in every shift because staff shortage made it difficult to undertake training, also; duration of training, skills deficit and knowledge acquisition required by medical and nursing staff factors that contribute to lack of training courses that reflect on quality of patient care, job performance, care burden and care providers’ quality of life.
This finding matched with (Nagep, 2021) who conducted study about "Assessment of Nurses’ Performance Regarding Care for Elderly Stroke Patients" and showed that less than half of the studied nurses haven’t received any previous training courses.
Concerning on total knowledge level among the studied nurses, the result of current study displayed that there was a statistically significant difference has occurred in knowledge during implementation of the educational program as P= (0.000) and the total level of knowledge was improved immediately and after two months of implementation of the educational program as majority of the studied nurses had high knowledge (96% –90.0%) respectively and the remaining had moderate knowledge (4% –10.0%) respectively.
This improvement of nurses’ knowledge immediately post implementation of designed educational program may be due to their exposure to stroke competency program where they are provided with an Arabic educational booklet, motivated and reinforced and also; it is the first time for the studied nurses to attend educational sessions about cerebrovascular stroke.
This finding consistent with study by (Rababah, 2021) who conducted study about " Effectiveness of an educational program on improving healthcare providers’ knowledge of acute stroke" and showed that there was statistically significant mean differences among the study nurses on level of knowledge about stroke as P value <0.05*.
Related to total stress level among the studied nurses throughout periods of intervention, the present study illustrated that there was a statistically significant reduction has occurred in stress scale during implementation of the educational program as P= (0.000) and immediately and after two months of implementation of the educational program frequently stressed percentage changed from (60.0% to 20.0%) and extremely stressed percentage decreased to (0.0%).
From the researcher point of view this result may be due to the effectiveness of the educational program in significantly reducing studied nurses’ stress by applying positive coping mechanisms to be able to face challenges and obstacles during their work, services and life.
This result supported with study by (Jiang, 2020) who conducted study about "Psychological impact and coping strategies of frontline medical staff in Hunan between January and March 2020 during the outbreak of Coronavirus Disease 2019 (COVID 19) in Hubei", and showed that more than half of studied nurses had moderate level of total nursing stress scale. Also, more than one quarter of them had severe level. Mean SD score of studied nurses regarding to total nursing stress scale was 99.47 ± 10.671, so that; recommended perform program to reduce stress among studied nurses.
Regarding total level of using coping ways among the studied nurses throughout periods of intervention, the current study showed that there was a statistically significant difference has occurred related to using of coping ways during implementation of the educational program as P= (0.000), and increase using of coping ways immediately and after two months of implementation in a great deal (44.0%). From the researcher point of view this result may be due to improvement of the studied nurses’ knowledge & skills and consequently improved their using of coping ways as they become more aware of their role in reducing burden of care and improving quality of their life.
This result matched with study by (Madian, 2019) who conducted study about "Level of stress and coping strategies among nursing students at Damanhour University, Egypt" and showed that more than half of the studied nurses had fair of coping ways and recommended that stress management programs and the provision of suitable support.
As regards to nurses regarding their quality of life level throughout periods of intervention, the present study illustrated that a statistically significant reduction has occurred in disability level as P= (0.001) and increase quality of life immediately and after two months of implementation of the educational program among the studied nurses as low disability represented (72.0%). From the researcher point of view this result may be due to the effectiveness of the educational program that reflect on improvement in studied nurses’ knowledge and the effectiveness of coping strategies training in reducing burden of care and reducing disability then hence improving their quality of life post program.
This result matched with study by (Babapour et al., 2022) who conducted study about "Nurses’ job stress and its impact on quality of life and caring behaviors" and concluded that provision of educational programs to the studied nurses improve their quality of life.
Regarding the correlation between levels of knowledge, stress, coping ways, and quality of life of the studied nurses throughout periods of intervention. It showed that there is statistically significance difference between coping ways and quality of life only pre intervention P = (0.045) and positive correlation between coping ways and quality of life immediately after the implementation of the educational program r = (0.318), P = (0.024).
This finding was in contrast with (Al-Ruzzieh & Ayaad, 2021) who conducted a study entitled "Work Stress, Coping Strategies, and Health-Related Quality of Life among Nurses at an International Specialized Cancer Center" and found that there is no significant correlation between the total mean value of the coping strategy scale and the health-related quality of life scale r = (0121), P = (>0.05).
Regards to socio-demographic characteristics among the studied family care providers, the present study illustrated that about one quarter of them (25.7%) their age; from (20 to < 30) and (40 to < 50) years. Moreover, more than half of them (57.1%) were females, and more than one quarter of them (28.6%) were life partner, less than three quarters of them (72.9%) were married, as well as less than two thirds (61.4%) were village residents. These findings was in agreement with study by (Achilike et al., 2020) who conducted study about "Caregiver burden and associated factors among informal caregivers of stroke survivors" and revealed that most of the studied caregivers female, married and provide care for their partner.
From the researcher point of view, this result may be due to women are the primary care providers in family setting as they seem to see it as amoral obligation. As well as spousal care providers emphasized that marital responsibility and a sense of obligation promoted them to become the main care providers and this obligation can has negative influence on family care providers because they wish to provide the best possible for their parents or spouses which can lead to increase burden of care.
The result of the present study revealed that more than one third of the studied family care providers (40.0%) were average qualification. From the researcher point of view, this result may be due to the fact that education in Egypt is free for all and obligatory by law until the end of middle school period. This result in agreement with (Ahmed, 2021) who conducted study about " burden and coping mechanisms among caregivers for old adult with advanced illness" , and found that the high proportion of participants was nearly half of the caregivers had a secondary education, about one third had a primary education and more than one fifth had a higher education.
The result of the present study showed that more than half of the studied family care providers (58.6%) were having monthly income not enough. From the researcher point of view, this result may be due to low socioeconomic status of people in our society, increase cost of living and requirements of individuals and family, as well as expensive costs of therapy. This result in supported with (Costa et al., 2020) who carried out study about "burden on caregivers of patients with sequelae of cerebrovascular accident", and represented that more than half of the studied caregivers had insufficient income.
Regarding the role of family care providers in care, the result of the present study revealed that more than half of the studied family care providers (54.3%) not being the only care providers for patients due to culture in our society that connected people with family and relatives from birth to death, more than half of them (55.7%) reported 1 week to 3 months duration of care as more than half of the studied patients (55.7%) had stroke duration ranging from 1 week to 3 months, as well as less than two third of the studied family care providers (64.3%) provided daily care.
This result in accepted with (Nalini, 2016) who conducted study about " assess the role burden and attitude of caregivers towards post stroke rehabilitation in selected hospitals, Chennal " , and found that majority of participant (58.3%) being caregivers for duration of 10 – 4 weeks and majority of them (80.0%) spent > 5 hours on patient care every day.
According to aspects where care providers need help, the result of the present study showed that majority of the studied family care providers need more information regarding the disease, insurance, support groups, and home safety. From the researcher point of view, this result might be due to lack of information and training to care providers and adequate educational media and personnel in hospital. As well as lack of attention from health professionals resulting in facing infinite number of unmet needs which commonly affects all aspects of care providers’ life.
This result harmony with study by (Riffin, 2021) who conducted study about "Assessing and addressing family caregivers' needs and risks in primary care" and stated that most of the studied caregivers need more information regarding the disease, insurance, and support.
Concerning on total knowledge level among the studied family care providers, the present study showed that there was a statistically significant difference has occurred in knowledge during implementation of the educational program as P= (0.000) and the total level of knowledge was improved immediately and after two months of implementation of the educational program as majority of the studied family care providers had high knowledge (91.4% –78.6%) respectively and the remaining had moderate knowledge (8.6% –21.4%) respectively.
From the researcher point of view, this result may be due to improvement of family care providers’ knowledge immediately after implementation of designed educational program as the family care provider's desire to know more information about stroke as they previously rely on their personal and non-scientific information about stroke patients’ caring and some chronic complications in patients are caused by non-scientific care.
This finding accordance with study by (Gurjar, 2019) who conducted study about "Effectiveness of educational program on knowledge and competence of home care of stroke patients among care givers" and displayed that in pretest about three quarters of caregivers had an inadequate knowledge, about one fifth of them had moderate knowledge and very few of them had adequate knowledge regarding home care of stroke patients. Whereas in posttest, more than half of them had an adequate knowledge, two fifths had moderate knowledge and very few of them had inadequate knowledge regarding home care of stroke patients. So that there was a statistically significant difference has occurred in knowledge P = (0.000).
Regarding to total burden level among the studied family care providers throughout periods of intervention, the present study revealed that there was a statistically significance reduction has occurred in burden of care during implementation of the educational program as P= (0.000) and immediately and after two months of implementation of the educational program moderate to severe burden percentage changed from (42.9% to 24.3%) and severe burden percentage decreased from (14.3% to 0.0%).
From the researcher point of view, high percentage of burden among the studied family care providers might be due to variety factors including: family care providers are responsible for caring of patients when they return to the community, impact of caring for elderly patients and overlapping or conflicting roles in family, lack of coping mechanisms among care providers that help them cope effectively with stresses of advanced disease with little support from community health services. While, reduction in the burden of family care providers occurred after the nursing interventions that provided a break for care providers in the provision of care activities.
This finding in same line with study by (Kazemi et al., 2021) who conducted study about "Caregiver burden and coping strategies in caregivers of older patients with stroke" and showed that more than half of the studied caregivers had mild burden of care. Moreover, this outcome matched with (Deyhoul et al., 2020) who conducted study about "The effect of family-centered empowerment program on the family caregiver burden and the activities of daily living of Iranian patients with stroke" and founded that there was a statistically significant difference has occurred in burden of care at p <0.001**.
Regarding total level of using coping ways among the studied family care providers’ throughout periods of intervention, the current study demonstrated that there was a statistically significant difference has occurred in using of coping ways during implementation of the educational program as P= (0.000), and increase using of coping ways immediately and after two months of implementation of the educational program in a great deal (35.7%).
This result congruent with the study was done by (Cheng, 2018) who conducted study about "Effectiveness of a strength-oriented psychoeducation on caregiving competence, problem-solving abilities, psychosocial outcomes and physical health among family caregiver of stroke survivors" and illustrated that most of the studied caregivers used quite a bit preprogram, while, after psycho education program about half of them used a great deal and there was a statistically significance difference has occurred related to ways of coping among the studied family caregivers after implementation of the educational program regarding coping ways as P<0.001**.
Concerning on quality of life level among the studied family care providers throughout periods of intervention, the present study illustrated that a statistically significant reduction has occurred in disability level as P= (0.001) and increase quality of life immediately and after two months of implementation of the educational program among the studied family care providers as low disability represented (54.30%). From the researcher point of view this result may be due to the effectiveness of the educational program that reflect on improvement in family care providers’ knowledge and the effectiveness of coping strategies training in reducing burden of care and reducing disability then hence improving their quality of life post program.
This result in agreement with study by (Baykal & Tulek , 2022) who conducted study about "The effect of discharge training on quality of life, self-efficacy and reintegration to normal living in stroke patients and their informal caregivers" and showed that the program improved total quality of life in caregivers and there was a statistically significance as P value <0.05*.
Regarding the correlation between levels of knowledge, burden of care, coping ways, and quality of life of the studied family care providers throughout periods of intervention. It showed that there is statistically significance difference between knowledge and quality of life only post intervention P = (0.016) and between burden of care and quality of life during the implementation of the educational program P = (0.000 – 0.008 – 0.008) respectively.
There is high statistically significance and positive correlations between knowledge and quality of life r = (0.346 – 0.394 – 0.496) respectively, P = (0.003 – 0.001 – 0.000) ** respectively; as well as coping ways and quality of life r = (0.319 – 0.330 – 0.330) respectively, P = (0.007 – 0.005 – 0.005) ** respectively throughout periods of intervention of the educational program. While negative correlations between burden of care and quality of life r = (-0.520, -0.518, -0.518) respectively, P = (0.000 – 0.000 – 0.000) ** respectively throughout periods of intervention of the educational program.
These findings matched with study by (Chan et al., 2022) entitled "A review on family caregiving challenges in Malaysia" and concluded that there is statistically significance difference pre and post intervention between levels of knowledge, burden of care, coping ways and quality of life among the family caregivers pre and post intervention at P<0.05*.