الفهرس 
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Abstract
Summary
Ureteral stents are a simple, minimally invasive method of maintaining ureteral drainage to assure renal function, treat pain caused by ureteral obstruction. Ureteral stenting is, however, associated with obvious side-effect, including irritation on voiding, pain and hematuria. Complications such as stent fracture, encrustation and clinically significant urinary tract infections are also regularly observed. Despite this, the possibilities of preventing and treating stent-associated morbidity are still limited. Self-care and good patient education can reduce symptoms caused by ureteral stents (Christodoulides et al., 2020; Li et al., 2021).
Finally, all the minor complications are generally well tolerated by patients and can be managed conservatively. Major complication if any can be dealt by stent removal/change. Double J stent should be kept for (3-6 months) short term period until problem is solved and should be removed when it is no longer needed. Patients should be counseled regarding the removal in time and to change periodically if required to be chronically indwelling (Polat et al., 2017).
Aim of the study:
The study aimed to assess self-care among patients with ureteric double J stent through the following:
1. Assessing patients’ knowledge regarding ureteric double J stent
2. Assessing patients’ self-care practice regarding ureteric double J stent.
3. Suggesting self-care guideline for patients based on needs assessment regarding ureteric double J stent placement.
Research Questions:
1. What is the level of knowledge regarding double J stent among patient with ureteric double J stent?
2. What is the self-care practice of patient with ureteric double J stent?
Technical research design:
A descriptive exploratory research design was used.
Research setting:
This study was conducted Fayoum University Hospital in Urosurgery Outpatient clinic.
Subjects:
Purposive sample include 70 male and female adult patients with ureteric double J stent who visited urosurgery outpatient clinic in EL-Fayoum University hospital within period of three months and met the inclusion criteria were recruited in the study sample.
Tool of data collection:-
Three tools was used for data collection
I: Structured interviewing questionnaire (Appendix I)
It was developed by investigator and written in Arabic language to accomplish the purpose of the study after reviewing relevant literatures (Koprowski et al., 2016; Raja, & Joshi, 2017; Baset et al., 2020). It consisted of two parts:
Part (1): concerned with patients’ demographic data include (age, gender, marital status, level of education, occupation and residence area).
Part (2): concerned with patients’ clinical data as following:-
a) Patients’ medical history included (Present medical history, past medical history, past surgical history, previous hospitalization, and history of urological disorders and family history, etc). It composed of 19 closed end questions.
b) Signs and symptoms assessment related ureteric double J stent:
It was developed by investigator and written in an Arabic language. It was used to assess signs and symptoms related double J stent. It composed of 21 closed end questions to assess ureteral-stent symptoms. It included: urinary tract symptoms (10 questions) and body pain or discomfort (11 questions).
II: Patients’ knowledge assessment questionnaire:
It was developed by investigator and written in an Arabic language based on related literatures (El-Nahas et al., 2014; Koprowski et al., 2016; Betschart et al., 2017; Lee et al., 2019 & Bansal et al., 2020) and used to assess patient’s knowledge regarding ureteric double J stent. It included 51 closed end questions. It included:
(A): It was concerned with urinary system anatomy and physiology. It composed two multiple choice questions.
(B): It was concerned with ureteric double J stent basic knowledge. It composed of 15 questions (4 multiple choice and 11 true or false).
(C): It was concerned with complications of ureteric double J stent. . It composed of 17 questions (one multiple choice and 16 true or false).
(D): It was concerned with self-care of ureteric double J stent. It composed of 17 questions.
III: Patients’ self-care practices tool.
It was developed by investigator based on related and literatures (Khalil & Abdalrahim, 2014; Michel-Ramírez et al., 2020; Baset et al., 2020) to assess patients’ self-care regarding ureteric double J stent. It was written in Arabic language after translation and back translation was done by investigator. It consisted of 90 statements as the following 12 subscales:
1- Nutrition: it included 11 statements.
2- Physical activities: it included 12 statements.
3- Rest and sleep: it included 4 statements.
4- Personal hygiene: it included 10 statements.
5- Daily assessment of intake and output: it included 6 statements.
6- Elimination: it included 6 statements.
7- Adherence to the prescribed medication: It included 7 statements.
8- Prevention of ureteric double J stent complications: it included 8 statements.
9- Prevention of infection: It included 7 statements.
10- Sexual relation: It included 6 statements.
11- Psychological domain: It included 4 statements.
12- Social interaction and work performance: It included 9 statements.
Results: the result of the study showed that:
- Regarding demographic characteristics of studied patients revealed that 42.9% of patients their age ranged from 35- 45 years, 72.9%, of them were male and 44.3% of patients were unemployed.
- Regarding present history, it was found that 74.3% of studied patients had initial diagnosis by stones. While 37.2% of the studied patients had DJS inserted since more than 6 months.
- Regarding past history, it was found that 35.7% of the studied patients had diabetes mellitus. In addition to 71.4% of the studied patients had previous hospitalization due to ureteral obstruction.
- Regarding family history, it was found that 50.0% of the studied patients had family history of ureteral obstruction and 85.7% of them were 1st degree relationship.
- As regard to ureteric stent symptoms, it was found that 60.0% of the studied patients had frequency of urination every 3hr during the day and 100% of them had urgency. In addition to 77.1% of the studied patients had incontinence before toileting.
- Regarding body pain, it was found that 100% of the studied patients had body pain related to stent.
- Regarding total knowledge among the studied patients, it was found that, 100% of the studied patients had unsatisfactory level of knowledge regarding complications of ureteric double J stent while, 31.3% of them had satisfactory level of knowledge regarding self-care.
- Regarding to adequate level of self-care practices, it was found that, 60.0%, 77.1% - 62.9%, 64.3% and 84.3% of the studied patients had adequate self-care practices regarding personal hygiene, rest and sleep, compliance with treatment, infection prevention and sexual relation respectively.
- Regarding to inadequate level of self-care practices, it was found that, 100% of the studied patients had inadequate level of self-care practices regarding physical activity, elimination and social and work domain.
- There were a statistically significance difference between patients’ gender and their total self-care practice (p-value 0.014).
- There were a statistically significance difference between patients’ level of education and their total self-care practice (p-value 0.034).
- There were statistically significant difference between complications of ureteric double J stent stated that, forgotten stent and encrustation and total self-care practice at (p-value 0.019 and 0.023) respectively.
- There were highly statistically significant difference between complications of ureteric double J stent regarding stent obstruction and total self-care practice at (p-value 0.000).
- There was a highly statistically significant relation between patient’s total knowledge score and their educational level and their residence area at (p- value <0.001**)
- There were a highly statistically significant positive correlation between total knowledge and total self-care practice among patients with ureteric double J stent (p-value <0.001**).
Conclusion
Based on the findings of the current study, it can be concluded that:
Overall, this study concluded that, all of the studied patients had unsatisfactory total level of knowledge regarding ureteric double J stent. In addition to, all of the studied patients had inadequate level of self-care practices regarding physical activity, social and work domain and most of the studied patients had inadequate level of self-care practices regarding psychological domain. This study recommended with implementing self-care practices educational program regarding ureteric double J stent in outpatient clinics and the urology departments.
Based on the findings of the present study, the following are recommended:
Recommendation related patients:
3) Implementing self-care practice educational program regarding ureteric double J stent in outpatient clinics and the urology departments.
4) Simple booklet written in simple Arabic language is
recommended to developed, and be available for all
patients with ureteric double J stent included all informations about ureteric double J stent, complications and its self-care.
Recommendation related research:
3) A similar study can be done on a large sample to
generalize the findings.
4) Future researches should be conducted to assess the effect of educational guideline on patients’ knowledge and self-care regarding double J stent.
Recommendation related health institution:
3) Hospital should deal with patients by phone to remember them about removing or replacing of double J stent.
4) Provide posters and simple illustrations about ureteral stent complications management should be available in every surgical department.