الفهرس 
Introduction and aim of the workOnly 14 pages are availabe for public view
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Abstract
After open-heart surgery, patients experience many problems regarding the outcome of the surgery or rehabilitation including concerns about return to their previous life. Recovering from a cardiac surgery is a complex procedure that presents psychological and physical needs that continue after discharge from hospital (McPherson, et al, 2015)
Aim of the Study
This study aimed to:-
Identify factors related to complications among clients post open-heart surgery after discharge through:-
1) Assessing clients’ knowledge related to heart disease & OHS.
2) Determining clients’ practices according to their care after OHS.
3) Identifying factors (physical, psychological, level of dependence, social relationship, environmental, spiritual) related to cardiac complications among clients post open-heart surgery.
Research Question:-
1) Is there relation between client’s knowledge and their socio demographic status?
2) Is there relation between cardiac complications and clients’ practices?
3) Is there relation between clients’ knowledge and cardiac complications?
Subjects and method:-
Research design:-
A descriptive analytical design is used in this study.
Research setting:-
This study will be conducted at outpatient clinic affiliated to Nasser Institute Hospital for Research and Treatment, every Monday and Wednesday per week until obtaining 150 cases. This hospital was chosen because there is a high attendance rate of these cases.
Sampling:
Type: - Purposive sample
Size: - Will be selected from the pre-mentioned setting; the total number attending through 2012 /2013 -2013 /2014 was 1500. Sample size will be 10% from the total number attending equal 150 clients.
Tools of data collection:-
Data pertinent to the study variables will be collected through:-
First tool: - Interviewing Questionnaire.
The questionnaire consisted of:-
Part 1:- Socio demographic data (age, sex, education, occupation…)
Part 2:- clients’ Knowledge related to heart diseases, definitions, drugs, risk factors groups, causes, treatment etc…..
Part3:- factors related to cardiac complications: physically, psychologically, level of dependence, social relations, environmental, spiritual, etc…
Part 4:-Assessing clients’ practices related to their needs including diet, exercise, dressing, etc….
Second tool:-Medical Record investigation (Echo, PT. PTT., INR, …)
To: - collect data about clients’ health status.
Third tool: - ADL (Activities of Daily Living scale)
Modified from KATZ; (2010)
To: Assess clients’ dependency level
It includes 6 items (bathing, dressing, toileting, transferring, continence and feeding).
Fourth tool: - Home Environment checklist.
Modified from Stanphope (2011)
TO: assess the clients’ environmental conditions
It includes 10 items related to (noise, light, ventilation, cleanliness, water supply, sewage disposal, floors, furniture, toilet and bath).
Operational design:-
Pilot study:-
A pilot study will be conducted on 15 clients to test applicability, feasibility and clarity of the study tool, and then the necessary modification will be done as revealed from the pilot study.
Results:
The main finding of this study was summarized as follows:
• The total study sample from females was 50.7% and from males was 49.3%; 62 % of the sample aged from 40 to 60 years old; 40 % of the sample had intermediate education; 59.3 % of the sample were not working; 83.3 % were married; 97.3 % had sufficient monthly income; 77 % were living at ‘not crowding’ homes, and 34 % of the sample had their surgery and treatment at the expense of the government.
• The entire sample had abnormal coagulation profile; 99.3 % of the sample had abnormal cardiac enzymes and urine culture; 82.7 % of the sample had abnormal CT scan and 92 % had abnormal troponin test.
• The entire sample had normal cerebral dysfunction; 60 % of the sample had Mediastinitis; 47.3 % had low cardiac output and 22.7 % of the sample had Arrhythmias.
• 98.8 % of the study sample had satisfactory level of knowledge about signs & symptoms of heart diseases; 97.3% of the clients had satisfactory level of knowledge about normal range of blood pressure; 69.4% of the clients had satisfactory level of knowledge about the heart function, and all clients had satisfactory level of knowledge about the causes of heart diseases, but only 4 % of the clients had unsatisfactory level of knowledge about normal range of pulse.
• 99% of the study sample had satisfactory level of knowledge about permitted drinks post open-heart surgery; 98% of the clients had satisfactory level of knowledge about risk of CABG & VR and normal signs post-operative, and all of the clients had satisfactory level of knowledge of permitted food post-operative, but only 12% of the clients had unsatisfactory level of knowledge about time of healing of sternum.
• 86% of the study sample had satisfactory level of knowledge about heart diseases and open-heart surgery.
• 90 % of the study sample complied with their follow-up regimen; 78 % of the clients had correct dietary regimen, 46% were doing their physical activities correctly and 60% of the clients applied dressing on their wounds correctly. Whereas 43% of the clients were doing breathing exercise by using ”Tri-flow” correctly and 36% of the clients had adequate sleep & rest
• 58 % of the study sample had always score of spiritual factors; 45 % had always score of social factors and 35% of the study sample had always score of physically & level of dependence factors. While 17 % of the study sample had always score of economic factors and 14 % of the study sample had always score of psychological factors.
• 98.0% of clients had suitable stairs & pathways; 96% of clients had unsuitable bedside light during the night and 97.3% of clients had unsuitable presence of water.
• All clients (100%) urinated & defecated independently; 99.3% of clients used toilet, and had bathing and feeding independently; 2.7% of clients were partially dependent in transporting and wearing their clothes.
Conclusion:
The present study revealed that more than half of the studied clients were females and more than three quarters of the studied clients had a total satisfactory level of knowledge about heart diseases and open-heart surgery. The majority of the studied clients had correctly done practices. from factors related to post-operative complications, more than half of the clients had always score of spiritual factor. The majority of the clients had Mediastinitis and abnormal coagulation profile.
Moreover, the current result indicated that there was a significant relation between clients’ educational level and their knowledge about heart diseases and open-heart surgery. There was a significant relation between myocardial infarction and the clients’ practices. There was a significant relation between arrhythmias, psychological disturbance & intellectual dysfunction, decreased & elevated coagulation profile and clients’ knowledge, while there was no significant relation between clients’ knowledge about heart diseases & open-heart surgery and their practices post open-heart surgery.
Recommendations:
Based on the current study findings, the following recommendations are suggested:
• A need of a specific and accessible booklet for the clients post-operative, written in simple Arabic illustrating, with pictures, clients’ needs such as medication, exercise, diet & danger signs which require rapid management and knowledge of how to deal with them until reaching the hospital.
• There is a need for written & unique discharge planning for every client according to his/ her condition for provision of continuity home care using nursing process until the needs are met.
• For emergency situations, a hotline should be accessible for both clients and caregivers, rather than the dependence on the private telephone numbers of physicians which may be changed at any time.
• Further researches on extensive health education and health promotion programs are recommended to prevent heart diseases, complications and life style modifications.