الفهرس 
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Abstract
This section provides an overview of the study and its significant findings and presents the research recommendations based on the current study findings.
Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation of the synovial tissues in multiple joints, leading to joint destruction. The cause of this disease is unknown, but genetic, environmental, and hormonal factors may initiate the immune response (Tsukuda et al., 2012).
Clinical onset of RA may be variable; it generally begins with symmetrical involvement of the small joints, pain, morning stiffness, and limitation of movement for more than 1 hour. Although the meta-carpophalangeal (MCP) joints, the proximal interphalangeal (PIP) joints, the wrists, the metatarsophalangeal (MTP) joints and the knee joints are the most frequently involved joints, RA may also involve other ones (Almeida et al., 2014).
Rheumatoid arthritis is a chronic often disabling form of inflammatory arthritis. The impact of RA is reduction of patients’ daily activities. As RA follows patients for their entire lives, a severe condition leads to disability and eventually affects patients’ education, work, family life and social activity. Thus, the disease is not only affects patients’ quality of life, but also increases the cost of care, resulting in a financial burden for society and the patient’s family .Management of RA involves treatment from a range of healthcare providers over many years as well as self-management by the person affected (Brand et al., 2010 & Lee et al., 2010).
Objectives of the study:
1- Assess health needs for rheumatoid arthritis patients.
2- Assess self efficacy for rheumatoid arthritis patients.
This descriptive study was carried out at rheumatology outpatient clinics at Port-Said general hospital and Port-Fouad general hospital which are affiliated to the Ministry of Health in Port-Said governorate. The sample was comprised of 50 adult RA patients. Data collection started from the beginning of October 2015 extended to the end of March 2016. Data were collected through using structured interview sheet for health needs and Arthritis Self-Efficacy Scale (ASES).
The main findings of the present study are:
• 90% of patients are females; 28% of them were from 40 to less than 50 years old; 36% graduated from secondary school; 64% and 82% of patients, respectively, were housewives and married; all of them (100%) live in urban area; 66% have insufficient income; and 40% pay treatment costs on their own expense.
• 48% of patients have RA for more than five years; 96% of them detected the disease by suffering from symptoms; 64% suffer from other chronic diseases, predominantly hypertension; 86% take prescribed medications for treatment of RA and are adherent to them; 78% do not have family history of disease and for those with it, 36.4% of them have second degree relatives with the same disease and with a good disease prognosis. Moreover , all of patients (100%) report joints pain as the most predominant articular manifestation; regarding extra-articular manifestations, 84% have difficulty in performing activities of daily living; and for medications’ side effects, 50% experience heart burn.
• 58% of study patients have health needs. the highest needs are in relation to psychological needs, whereas they always experience mood swings which represent in anxiety, fear and sadness and the latter is considered an indicator for depression, as well as they sometimes feel distress without reason; then physical needs especially in areas of holding and gripping ”hand activities” and exercise; and then educational needs as regards disease follow up, medications, treatment options, clinical manifestations and complications of disease. The lowest needs are in relation to social and spiritual needs.
• 84% of study patients have high self-efficacy.
• There is statistically significant relation between health needs of the study patients and their socio-demographic characteristics in area of age.
• There is statistically significant relation between health needs of the study patients and their medical history regarding adherence to medications, articular manifestations (joints deformity), as well as extra - articular manifestation (chronic muscle ache, difficulty in performing activities of daily living, and fatigue with minimum effort).
• There is statistically significant relation between self-efficacy of the study patients and their socio-demographic characteristics in areas of gender and job.
• There is statistically significant relation between self-efficacy of the study patients and their medical history regarding adherence to medications, family history of disease, articular manifestations (joints deformity), extra - articular manifestations (chronic muscle ache, fatigue with minimum effort, and dyspnea).
• There is highly statistically significant relation between health needs of the study patients and their self-efficacy in areas of physical and social needs.
• There is highly statistically significant negative correlation between health needs of the study patients and their self efficacy.
The study concludes that:
More than half of RA patients have health needs, although most of them have high self-efficacy. The highest needs are in relation to psychological needs, then physical needs, then educational needs, while the lowest needs are in relation to social and spiritual needs. Also, there is highly statistically significant negative correlation between health needs of RA patients and their self-efficacy.
The study recommendations are the following:
Nurses should:
• Enhance the patient education provided to RA patients, including proper pain management strategies and techniques for overcoming physical limitations to help patients feel more in control of their pain and improve their physical functions, thereby reducing psychosocial distress.
• Strongly encourage family involvement in patient education so that family members can better empathize and provide active support for the patients throughout their illness experience.
• Redesign patient education materials to present more comprehensive information, including causes of RA, triggers of flare-ups, medication use and their side effects, as well self-management strategies.
• Actively screen for patients at risk of psychological distress or depression and providing appropriate support for these patients such as empathic listening and validating their suffering, instead of focusing only on physical symptoms, to maintain their psychological health.
• Conduct support groups for RA patients so that the latter can share their experiences and coping strategies, and gain confidence and self-efficacy from meeting other RA patients who are successfully coping with everyday life.
Ministry of health should:
• Look into ways to enhance the healthcare services to better suit RA patients’ health needs, such as improving processes for continuity of care and enhancing access to medical professional in times of flare.
Further study:
• Assessment of factors influencing health needs and self-efficacy of RA patients.
• Delivery of an effective nursing interventions program tailored for health needs and self-efficacy of RA patients.