Assessment of Nurses' Knowledge toward Alternative Communication Strategies for Children with Autism Spectrum Disorder at the Autism Centers in Dhi Qar Governorate

: Background: Alternative communication is a form of communication that can be offered to some people who do not have the ability to speak and helps in developing the child's verbal abilities and the ability to express their feelings, emotions and needs. Aims :

Methods: A descriptive study is conducted for the periods of December 26 th 2020 to Jun 1 st 2021.
The study is carried out at the Autism Centers in Dhi Qar Governorate. A non-probability purposive sample selected for (25) nurses working at the Autism centers in Dhi Qar Governorate.
A content validity were achieved through a panel of experts and reliability were achieved through a pilot study. The data collection process uses the self-administrating technique in which the nurse fills the questionnaire form by themselves. Through the descriptive statistic, data were analyzed.

Results
: Findings indicate that nurses were unsatisfactory knowledge towards concept of autism spectrum disorder at mean equal 1.64. This results come because low level of nurses. As well as, findings indicate that nurses were poor knowledge towards alternative communication strategies of autism spectrum disorder at mean equal 1.67.

INTRODUCTION:
The acronym "autism spectrum disorder" (ASD) refers to a category of diverse brain growth disorders, "Autism" is derived from the Greek word "autos" which means "self" it applies to circumstances in which a person's "isolated self " is present, ASD is characterized by difficulties in social interaction, as well as verbal, nonverbal and repetitive motor interaction, It can also be followed by learning disability and physical health issues such as sleep and digestive problems [1] .
The World Health Organization has defined autism spectrum disorder (ASD) as a growing global public health issue that can pose some of the largest disease burden in children and adolescents [2] .
Autism Spectrum Disorder (ASD) is a broad term for a disease that affects around one in every 68 school-aged children. It affects boys 4.5 times more often than girls [4] .
Autism is an enigmatic condition, with no knowledge about its origins, the only statement that may be used to describe autism was "there is no idea" and we now know that there is no particular explanation for autism and that there are many forms of autism ,and fortunately experts have recently begun to provide answers [5] .
The autism spectrum disorders (ASD) are a category of neurodevelopmental abnormalities that have long-term consequences. Autism is increasing at an alarming rate for unknown causes, whether it is due to an increase in the illnesses itself or to more advanced testing and classification methods. As the number of people diagnosed with ASD continues to rise, it is critical for nurses to be sufficiently equipped to fulfill the healthcare needs of this unique group [6] .
According to estimates, a primary care physician (PCP) could see "as many as 11 children with an ASD for every 1,000 children in his or her practice," implying that a nurse would see at least this number, also, because most PCPs have an office nurse on staff, this does not apply to adults with ASD. These folks will be interacted with by nurses in a variety of nursing practice areas [7] .
Nurses are responsible for educating children's with autism spectrum disorder on various aspects and keeping them up to date, various teaching strategies are used to enhance knowledge, such as teaching, demonstration, discussion and self-education, these methods of self-education have an advantage over others, as the learner can educate himself at his own pace and also stress the importance of rereading [8] .

AIMS OF THE STUDY:
To asses assess nurses ' knowledge toward alternative communication strategies for children with autism spectrum disorder.

METHODOLOGY
-Design of the study: To investigate the knowledge among nurses toward, this descriptive study is conducted for the periods of December 26 th 2020 to Jun 1 st 2021.

-Setting of the Study:
The study is carried out at the Autism Centers in Dhi Qar Governorate (Dhi Qar Autism Center-Autism Center in Shatrah). This Centers provide health care to children with autism spectrum disorder. Attending to the Autism centers for receiving treatment ,care, and doing full investigations. The services provides for the patient freely.
-Sample of the Study: A non-probability purposive sample selected from nurses who were working at the Autism centers in Dhi Qar Governorate.

-Study instruments:
A questionnaire consists of the following parts including: Part 1: Socio-demographic data of nurses includes gender, age, level of education, social status, years of experience in general nurses and years of experience inside Autism Center, did you participate courses related to (ASD).

Part 2:
Nurses' knowledge of the concept of (ASD): Which composed of (20 items).

Part 3:
Nurses' knowledge of alternative communication strategies: Which composed of (21 items).
-Validity and reliability of study questionnaire: A content validity were achieved through a (15) panel of experts and reliability were achieved through a pilot study. It conducted on (10) were selected among nurses concerning with Children Autism Centers in Dhi Qar. Cronbach's Alpha= 85 which indicate a pass questionnaire items.
-Data collection: The data collection process uses the self-administrating technique in which the nurse fills the questionnaire form by themselves. Through the descriptive statistic, data were analyzed.    Using sign with children on the autism spectrum as an alternative system in the event that speech and speech fail to grow and develop, and it is a system to help the development of language and speech The sense of touch for many children with autism is the most effective senses, and therefore letters can be taught to them by accustoming them to touching letters made of plastic

Discussion: Part I: Discussion of Nurses' Socio-Demographic Characteristics
The sample included (50) nurses who accepted to participate in the study (25 in the study and 25 in the control group). Nurses' ages ranged from (20) to (41) years and above, (40%) of them aged between (31) to (35) years . This result in line with study who stated that their sample included (25) nurse [9] . Also, other findings confirmed that the mean age of nurses in their sample was (33) years old [10] .
Regarding nurses' gender and educational level, (66%) of them were females and (50%) of them were having a diploma degree as academic achievement. This result similar findings indicate that the sample included (117) (92.9 %), female nurses [11] . Also, findings mentioned that nearly (60%) of nurses in their sample were having a diploma degree as academic achievement [12] .
Concerning years of services in the nursing field and the autism center, nearly (35%) of nurses having (6) to (10) years of services in the nursing field and (44%) of them were having (4) to (6) years of services in the autism center. This result close to that indicate who stated that (77%) of nurses having experience dealing with autistic children [13] .
Apropos of nurses' marital status, (68%) of them were married and only (32%) percent of them were single. This result similar to that stated that nearly (70%) of nurses in their sample were married [14] .
Respecting the participation and number of previous courses of autism for nurses, (66%) of them participated in courses/ workshops and (62%) of them had previously participated in one course/ workshop. This result agrees with findings stated that (50%) of nurses in their sample have participated in previous courses/ workshops regarding autism [15] .

Part II: Discussion the Nurses Knowledge related to alternative communication strategies
Findings indicate that nurses were poor knowledge towards concept of (ASD) at mean equal 1.64. This results come because low level of nurses. As well as, findings indicate that nurses were poor knowledge towards alternative communication strategies of (ASD) at mean equal 1.67, due to nurses were limitation of attending training sessions. The current gap has been highlighted as nurses' lack of knowledge on autism spectrum disorders. Nurses must be equipped with the information and resources necessary to be informed of and confident in their abilities to communicate with people who have ASD. A minimal amount of ASD information is taught within the program for a Bachelor of Science in Nursing curriculum, according to Giarelli et al. (2012), despite the usefulness of giving such content to nurses within their study field [16] .
It observed comparable outcomes in their study, indicating the necessity for ASD information for nurses to be included. Nurses must be knowledgeable about ASD since they are frequently the ones who begin referrals to specialists [16] .
Individuals with ASD will be more likely to receive the same safe, high-quality, competent care as the rest of society, which they are both morally and ethically entitled to, if nurses are appropriately trained with the required skills and information around ASD [17] .
In the light of poor knowledge, it is emphasized the need of nurses, along with doctors, being members of multidisciplinary teams when working with people with ASD. This emphasizes the fact that all nurses, regardless of their practice setting, must be educated about ASD [13] .
Nurses who are appropriately equipped with knowledge about ASD and how to deal with people with ASD will feel more at ease, which will improve their capacity to interact with and care for people with ASD. Nurses require greater training and experience in this area, as well as health resources in the workplace to improve their knowledge and capacity to deal with ASD [18] .

Conclusion:
The nurses were unsatisfactory knowledge. more years of experience in Autism Centers and training the by local officials help raising professionals' nurses. Provide the health resources and exploiting young energies of nurses which indeed helps to develop their knowledge.
Ethical Clearance: All experimental protocol was approved under the College of Nursing, University of Bagdad, Iraq and all experiments were carried out in accordance with approved guidelines.