الفهرس 
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Abstract
Total knee replacement (TKR) is one of the most effective surgical interventions for pain relief and functional recovery in patients with advanced degenerative arthritis . Following total knee replacement surgery, patients frequently experience intense levels of pain, stress, depression, and anxiety that may reduce their postoperative recovery. It is clear that in order to improve the overall outcomes of patients after total knee arthroplasty, the nurse should have a better understanding of their patients in terms of their mental health and wellbeing, as this can certainly affect their outcomes. What is needed next is the development of a clinical screening tool to help identify patients at risk of having a poor outcome, including an assessment of their psychosocial profile to reduce the level of (depression, anxiety, fears and pain catastrophizing) and , can be used to improve the outcome for such patients so patients after surgery are in the need of psychosocial support. psychosocial needs considered an important aspect that are thought to affect the outcome of total knee replacement.
The Aim of This study was:
To assess psychosocial needs among patients with total knee replacement.
The Aim of This study was achieved through answering the following Research Questions:
3. What is the psychological needs among patients with total knee replacement?
4. What is the social needs among patients with total knee replacement?
Research setting:
The study was conducted at the orthopedic department and outpatients of Ain Shams University specialized Hospital.
Subjects of the study:
It was purposive sample. The subjects of the present study included 100 patients after total knee replacement surgery,above 40 years old, The actual fieldwork for the process of data collection has consumed seven months started at the beginning of November 2015 and was completed by Mid-May 2016. Data were collected in 3 days per week average. With 2 patients aday, the investigator conducted an interview during morning and afternoon shifts (morning at 11:00 am, afternoon at 5:00 pm), The study tools took about 15 to 20 minutes to complete.
Tools of data collection:
Data were collected using the following tools:
1- Interviewing Questionnaire:
This tool was designed by the investigator in a simple Arabic language based on review of related literature. It includes: socio-demographic data of patients such as age, sex, education, marital status, monthly income, working conditions, and first breadwinner.
2- Psychological needs Questionnaire (PNQ-23):
It was developed by the researcher. It was utilized to measure psychological needs for patients after total knee replacement surgery. The PNQ-23 consists of 23 “always”, “sometimes”, “rarely”, “never” statements, The minimum and maximum value range from 0 to 23, Thus a higher score suggests greater psychological needs and conversely a lower score on the (PNQ-23) indicates a lower psychological needs for patients after total knee replacement surgery.
3- Psychological needs related to body image Questionnaire (PNBIQ4):
It was developed by the researcher. It was utilized to measure psychological needs related to body image for patients after total knee replacement surgery. The PNBIQ-4 consists of 4 “always”, “sometimes”, “rarely”, “never” statements.
4- Social needs Questionnaire (SNQ-13):
It was developed by the researcher. It was utilized to measure social needs for patients after total knee replacement surgery.
The SNQ-13 consists of 13 “always”, “sometimes”, “rarely”, “never” statements, Thus a higher score suggests greater social needs and conversely a lower score on the (SNQ-13) indicates a lower social needs for patients after total knee replacement surgery.
5- Psychological needs related to work Questionnaire (PNWQ-6):
It was developed by the researcher. It was utilized to measure psychological needs related to work for patients after total knee replacement surgery. The PNWQ-6 consists of 6 “always”, “sometimes”, “rarely”, “never” statements.
6- Financial needs Questionnaire (FNQ-2):
It was developed by the researcher. It was utilized to measure financial needs for patients after total knee replacement surgery.
The FNQ-2 consists of 2 “always”, “sometimes”, “rarely”, “never” statements, The minimum and maximum value range from 0 to 2
Thus, a higher score suggests greater Financial needs and conversely a lower score on the (FNQ-2) indicates a lower financial needs for patients after total knee replacement surgery.
Pilot study:
The pilot study was conducted on ten patients from the hospital. They represent 10% of total sample to ensure the clarity of questions, applicability of the tools and the time needed to complete them. The necessary modifications were done as a result of pilot study; those patients were excluded from the actual study sample.
The main findings of this study revealed that:
• An analysis of socio-demographic characteristics showed that the mean age of patients was (60.4 ±5.7), approximately two thirds of patients (62%) aged older than 60 years old and the majority of them (62%) were females, and more than half of them (57%) were married, the majority of them(76%) had enough income, and slightly less than half of patients(45%) weren’t work, slightly less than half of them were the first breadwinner of the family.
• An analysis of psychological needs questionnaire showed that patients after total knee replacement in the need of psychological needs such as increasing self-efficacy, psychological support and health education to relief anxiety, depression and fears. psychological needs were affected by the age as(56%) of patients have (always) psychological needs, while (24%) of patients have (sometimes) psychological needs, while (20%) of patients (never) had psychological needs.
• An analysis of psychological related to body image questionnaire showed that patients after total knee replacement in the need of psychological needs such as increasing self-esteem , psychological support and health education to relief anxiety, depression and fears. Psychological needs were affected by the gender, (72%) of patients were female have (always) psychological needs.
• An analysis of social needs questionnaire showed that patients after total knee replacement in the need of social needs such as social support from health care team, family and friends and health education to relief anxiety, depression and fears. social needs were affected by the age especially the age above 60 years old represent (79.2%) of patients have (always) social needs after TKR surgery.
• An analysis of psychological needs related to work questionnaire showed that patients after total knee replacement in the need of psychological needs such as increasing self-efficacy, psychological support and health education about range of motion and exercise after the surgery to relief anxiety, depression and fears. psychological needs were affected by working conditions especially (handwork) patients represent (82.6%) of patients have (always) psychological needs.
• An analysis of financial needs questionnaire showed that patients after total knee replacement in the need of financial needs that affected psychological status, such as increasing self-efficacy, psychological support and health education about range of motion and exercise after the surgery to accelerate the recovery and relief anxiety, depression and fears. Financial needs were affected by the patients who are the first breadwinner of their families represent (70.2%) of patients have (always) psychological needs related to income.
• Regarding the relationship between time from the operation(in months) and different psychosocial needs, results show that patients have highest psychosocial needs at the period after surgery, while psychosocial needs decreased gradually by the time.
It is concluded that
The highest psychosocial needs appears in the age above 60 years old, and there were psychosocial needs between the female gender than male. patients who hadn’t enough income had highest psychosocial needs than patients had enough income, the patients who doesn’t work had highest psychosocial needs than patients who work. patients had highest psychosocial needs at the period after surgery, while psychosocial needs decreased gradually by the time. Patients who were the first breadwinner had highest psychosocial needs than others who weren’t, thus there are statistical significant differences between psychosocial needs among patients after total knee replacement, and the mean score of their socio-demographic data.
In the light of these findings it was recommended that:
o Psychological counseling should be provided for patients after total knee replacement surgery in facilities serving patients and should be delivered by psychiatric professionals.
o Elevate organizational awareness to explain procedure to the patients, encourage psychological preparation and caring experience of nurses working with patients before and after total knee replacement surgery. This include, administration could create programs/interventions to relief moral distress and negative attitudes to promote caring behavior.
o Construct stress management programs to nurses working on operative rooms (OR) and surgical unites.
o Construct workshops about anger management to nurses working on operative rooms(OR) and surgical unites.
o In-service education programs should be provided to nurses working with patients regarding the following topics:
• Proper use of communication skills with patients before and after the surgery.
• Provide an psychosocial support for patients before and after the surgery.
• Knowledge about total knee replacement care.
• Ensure patient rights for all patients.
• Educational programs for community in the shape of (booklet) should be ensured to increase their awareness of how to practice your daily life activities with the artificial knee joint and prevent it from dislocation or breakdown.