الفهرس 
Stages of chronic renal failureOnly 14 pages are availabe for public view
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Abstract
End stage renal disease is a worldwide health problem with significant increase in the number of affected patients and increased demands in financial costs. chronic renal failure is an illness for which long term management is required. A well-trained and experienced multi-disciplinary team and the availability of an integrated renal replacement therapy program are vital for providing proper help and support for ESRD (Galassi, Cupisti, Santoro, and Cozzolino). Self learning is activities done by the learner in order to develop behaviors, abilities and capabilities responsive to learner concerns in order to achieve personal development, integration and successful interaction with society by relying on him and trusts his abilities in the teaching and learning process (Longo et al., 2012). The aim of this study is to evaluate the impact of self learning module on compliance with therapeutic regimen for patients undergoing regular hemodialysis through the following:
1. Assess compliance and learning needs regarding therapeutic regimen for patients undergoing regular hemodialysis ,
2. Develop and implement self learning module for patients.
3. Evaluate impact of self learning module on Compliance with therapeutic regimen for patients undergoing regular hemodialysis .
Research design: A quasi experimental design was utilized to meet the aim of the study. Research setting: The study was conducted in 3 hemodialysis units at Ain Shams University Hospital. The hemodialysis units are contain 3 shifts, each sift contains 12 patients. Subjects: Purposive sample of (90) Patients under regular hemodialysis in the previously mentioned units and agree to participate were recruited in this study. Study tools:
I. Patient interview questionnaire: It was developed by the researcher, based on reviewing of recent literature. It consists of three parts:
1. 1st part was concerning with socio-demographic data.
2. 2nd part was concerning with medical history.
3. 3rd part was concerning with patients’ knowledge regarding their disease, hemodialysis and the therapeutic regimen.
II. Compliance sheet It was used to assess compliance with therapeutic regimen for patients undergoing hemodialysis . It was developed by the researcher based on reviewing of recent literature. II- Observational checklist to assess patient’s practice regarding vascular access care. This part was developed by the researcher based on reviewing of recent literature. Filed Work: Filed work included two phases:implementation phase & evaluation phase.
I. Implementation phase: This included:
The patients in hemodialysis units who met the study criteria were included in the study after explaining the purpose of the study and obtaining their consent before any data collection. Data collection started from the beginning of August 2013 to the end of February 2014 , it was done 3 days/wk for 8 hours from ( 9 am to 1 pm and from 3 pm to 7 pm ) for three weeks in the setting mentioned previously in morning and afternoon shifts . The researcher starting the interviewing process by filling observational checklist for patient’s practice regarding vascular access care which took 5 minutes then filling the patient interview questionaire
which took about 15- 20 minutes, lastly filling compliance sheet which took about 15- 20 minutes. II- Evaluation phase: Evaluation of the effect of self-learning module on compliance with therapeutic regimen for patients undergoing hemodialysis by comparing the results pre and post self learning module implementation (Immediately, 3 months & 6 months) by using the same data collection tools and is done three times. Results of this study showed that:
1. The mean age of patients under study was 34.59±8.24. As regard gender, (55.6 %) were males. Regarding educational level, (52.0%) of patients had secondary school and (28.0%) of them had bachelor degrees. In relation to occupation , (75.6%) had no work.
2. More than two fifths of patients (44.4%) their etiology of chronic renal failure was hypertension and (33.3%) was diabetes.
3. There was statistically significant difference between
total level of patients’ knowledge regarding therapeutic regimen pre & immediate, pre & post 3 months,
immediate & post 3 months and between immediate & 6 months post self learning module implementation.
4. There was statistically significant difference in satisfactory level of patients’ practice regarding caring of vascular access pre & immediate, pre & post 3 months, immediate & post 3 months and between immediate & 6 months post implementing self learning module .
5. There was statistically significant difference in total level of patients’ compliance pre & immediate, pre & post 3 months, immediate & post 3 months and between immediate & 6 months post implementing self learning module.
6. There was no statistically significant relation between total compliance and total knowledge pre implementation of self learning module, while there were highly statistically significant relation post implementations of self learning module.
The study concluded that:
Self-learning module had statistically significant positive effect on patients’ compliance with therapeutic regimen. There was improvement in total patients’ compliance with therapeutic regimen pre , immediate , post 3 months and post 6 months from self learning
module implementation, and there was statistically significant difference in satisfactory total level of patients’ compliance post implementing self learning module between pre & immediate, pre & post 3 months, immediate & post 3 months and between immediate & post 6 months . The study recommended that: 1. Developing education programs for patients undergoing regular hemodialysis for improving patients’ compliance with therapeutic regimen should be started from the first day of their admission to hemodialysis unit should be done periodically.
2. Design and implement an educational program for nurses to help them to provide nursing interventions to patients undergoing hemodialysis to improve their health-related issues.
3. Self learning module for patients undergoing regular hemodialysis should be available and applied in all hemodialysis units to be followed by all patients and should be up dated periodically.
4. Establish a multidisciplinary training unit Nephrologist, dialysis nurse and technician; include psychologist,
medical social worker and a dietician working together for better patient care.
5. Further studies should investigate the factors contributing to patients’ non-adherence to therapeutic regimen in order to develop interventions to overcome barriers. These factors include psychosocial , environmental determinants, and biological factors affecting adherence to therapeutic regimen.