الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 250 |  |  |
| | | from | 250 | | |
Abstract
Variceal bleeding is a common complication of cirrhosis and has high in-patient mortality (30-50%). Esophageal varices bleeding were found to be the commonest cause of upper gastrointestinal bleeding. In Egypt 70% of hepatic patients are suffering from variceal bleeding (Hosney, 2014). Re-bleeding is a major cause of death and occurs in 35% of patients at 6 weeks after the initial bleeding episode and 75% at 1 year. Therefore, strategies that improve survival by preventing re-bleeding in the early period are crucial to improve long-term survival. It, however, does not improve mortality and is associated with a greater risk of encephalopathy and is more costly than endoscopic procedures (Fitzpatrick, 2008).
Aim of the study:
This study was done to assess the effect of discharge planning for patients with esophageal varices on compliance to therapeutic regimen through:
1. Assessing patients’ needs and compliance of patients to therapeutic regimen.
2. Designing and implementing discharge planning for patients with esophageal varices.
3. Evaluating the effect of discharge planning on compliance of patients to therapeutic regimen.
To fulfill the aim of this study, one research hypothesis was formulated:
Hypothesis 1: The implementation of discharge planning will have positive effect on compliance to therapeutic regimen for patients with esophageal varices.
Research Design:
Quasi-Experimental design (pretest- post- test, and follow-up) was utilized to fulfill the aim of this study in order to determine whether the discharge plan has the intended effect on the study participants.
Subjects:
A purposive sample of 100 adult patients with esophageal varices was selected within the following inclusion criteria. The sample size was determined considering the total number of patients who underwent esophageal varices endoscopy at Benha university hospital at year 2011 were 334 patients, power analysis indicated that 100 patients would be enough to assess the effect of discharge planning on patients’ compliance to therapeutic regimen.
Inclusion criteria:
- Adult patients, from both gender
- Conscious, diagnosed with esophageal varices with previous attacks of bleeding
- Patients free from physical & mental handicapped, and able to communicate with others
- The exclusion criteria were patients with hepatocellular carcinoma or advanced liver cell failure.
Setting:
- The study was conducted at the GIT endoscopy unit and internal medicine units at Benha university hospital.
- Tools for data collection:
I) Interview questionnaire sheet to assess patients’ knowledge, which includes two parts:
1) Socio demographic characteristics of patients
2) Structured Knowledge Questionnaire which is divided into two sections 1- It was divided into two major sections:
Section (a): entails elements about esophageal varices, upper GIT endoscopy, therapeutic regimen, and follow-up
Section (b): Composed of questions to collect data about factors of non-compliance for patients with esophageal varices,
II) Compliance assessment sheet to assess compliance of patients with esophageal varices to therapeutic regimen.
A pilot study was carried out on (10) patients suffering from esophageal varices. Based on the result of pilot study and the revision of the tools by seven expertise in the medical surgical nursing specialty & internal medicine, the necessary modifications and changes on the tools were done.
The main results of the study:
- Concerning Socio demographic characteristics of patients, the majority (80%) of patients’ age was within age group of (40-50 years. Less than three quarters of them (71, 73, 72%) were males, illiterate, and their family number ranged from (6-11) members respectively. while, more than half (69, 66, 56%) working manual work, had supply of medication on their own cost, and were previous smokers respectively. All of them (100%) were married, and their income was insufficient. Whereas, the majority of them (82%) lived in rural areas.
- As regards to patients’ knowledge, results revealed that, all of patients had good knowledge after implementation of the educational program and also following-up the program three months later.
- Investigating factors affecting patients’ compliance to therapeutic regimen, the majority of the patients had many physical, psychological, social, and financial factors, and also health team related factors that affect their compliance to therapeutic regimen.
- Patients had high level of compliance after implementation of the educational program and also following-up the program three months later.
- There were highly statistically significant relation between patients’ sociodemographic characteristics and their total compliance to therapeutic regimen.
- There were highly statistically significant relations between sociodemographic characteristics and their total knowledge.
- Also, there were highly statistically significant positive correlations between patients’ total knowledge and their total compliance.
Based on the previous results, the following recommendations are suggested:
1. Periodic supervision should be provided for patients and their family members to prevent occurrence of complications and improve patients compliance regarding therapeutic regimen.
2. Further studies about patients’ compliance in GIT endoscopy units should be done on larger numbers of both nurses & patients.
3. Infection control programs should be provided to patients and their family members to prevent further complications.
4. Illustrating the need for improved communication and education for patients to improve their compliance.
5. Patient health related behaviors are better to be assessed through schedule of home visits to the patients by the public health nurse.
6. Conducting a study about knowledge assessment about how liver cirrhotic patients view and achieve their own compliance.