الفهرس 
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Abstract
Hepatic encephalopathy is one of the most debilitating complications of cirrhosis and severely affects the lives of patients and their caregivers. It is a spectrum of reversible neuropsychiatric abnormalities, seen in patients with liver dysfunction and /or portosystemic shunting. It is also associated with increased morbidity and mortality as well as significant utilization of health care resources.
Compliance and medication management in people with decompensated cirrhosis have been associated with prevention of substantial potentially-preventable harm. Reinforcement of compliance with treatment had beneficial effect on the prevention of recurrent hepatic encephalopathy.
Quasi – experimental research design was utilized to conduct this study. This study was carried out in the Tropical Medicine and Gastroenterology department at El - Rajhi liver Hospital in Assuit University hospital. To test research hypothesis; sixty adult patients (both sexes) and diagnosed with liver cirrhosis child B or C were included. There are divided equally into two groups (study group and control group).
The study group of patients assessed by (tool I) then received the contents of nursing instructions booklet in the form of small session. Then they evaluated for their level of knowledge (immediately post and after three months from application of nursing instructions) , also they assessed through a period of three months (every month) using (tool II) for compliance with these instructions and evaluated for hepatic encephalopathy using (tool III) while control group assessed using (tool I) and received routine hospital instructions then assessed after that through a period of three months (every month) for hepatic encephalopathy using (tool III).
The following tools were utilized for data collection: Tool I ”Structured interview patient questionnaire ”, Tool II ”Compliance assessment questionnaire” and Tool III ”West Haven criteria scale”. Data was collected and analyzed using necessary statistical manipulation.
The main findings of the present study were:-
According to socio-demographic characteristics of patients, the majority of both study and control group were male, married, illiterate, from rural areas, and their age ranged from 60 to ≤ 65 years old. As regarding to occupation it was found that nearly half of study group (46.7%) were housewives while half of control group were non-workers.
As regarding medical data; hepatitis C virus was the main cause of cirrhosis in the highest percentage of study and control group (80.0 %, 63.3 %). As regarding medical co-morbidities diabetes mellitus, hypertension and cancer were documented in (40.0%, 26.7%, 23.3%) for study group and (16.7%. 20.0%, 10.0%) for control group. While all the study and control group hadn’t renal disease.
More than half (53.3%) of study group and more than one third (37.9%) of control group had gastrointestinal bleeding half of them had both hematemesis and melena. More than half (51.7%) of study group and nearly one fourth (23.3%) of control group had oesophageal varices and the highest percentage of study group and all of control group had performed endoscopic band ligation. The majority (80.0%) of both study and control group had ascites more than one third (37.5%) of them in the study group had marked ascites while half of control group had moderate ascites. The highest percentage in both study and control group (63.3%, 70.0%) respectively had jaundice.
There was no statistical significant difference in medications prescribed for study and control groups of patients.
There was no statistical significant difference between both groups regarding their laboratory investigations pre application of nursing instructions.
The highest percentage of patients (96.7%) had low level of knowledge pre application of nursing instructions, while all of them had a good level of knowledge immediately post application of nursing instructions and the highest percentage (90.0%) of studied patients also had a good level of knowledge after three months from application of nursing instructions with highly statistical significant difference (p< 0.001).
The highest percentage of patients had a high compliance with nursing instructions in the first, second and third month (93.3%, 90.0%, 86.7%) respectively. Also, there was no statistically significant difference between patients compliance through three months.
There was a significant difference as regarding forgetting taking medications, forgetting medications whilst travelling and feeling a hassled in sticking to the pharmacotherapy of the disease as the percentage of patients who reported that increased in the third month than first and second month.
Highest percentage of patients had a medium compliance with medication in the first, second and third month (80.0%, 80.0%, 63.3%) respectively.
The highest percentage of patients had high compliance with total nursing instructions in the first, second and third month (93.3%, 90.0%, 90.0%) respectively.
In the first and second month there was a statistically significant difference between study and control group as regarding severity of hepatic encephalopathy while in the third month there was no statistically significant difference between study and control group.
Nearly one fourth of patients exposed to hepatic encephalopathy in the three months.
There was highly statistical difference between study and control group who exposed to hepatic encephalopathy in the three months with P value < 0.001.
There was a significant statistical relation between patient’s knowledge and gender, residence, education and occupation pre application of nursing instructions, knowledge and the educational level immediately post and between knowledge and marital status and occupation post three months.
There was no statistically significant relation between patient’s knowledge and occurrence of hepatic encephalopathy, GIT bleeding and ascites after three months from application of nursing instructions.
There was no statistically significant relation between patients mean compliance and their sociodemographic characteristics.
There was no statistical significant relation between patient’s compliance and their medical data.
In the first and second month there was a highly statistical significant relation between patient’s compliance with nursing instructions and hepatic encephalopathy. In the third month there was no statistical relation between patient’s compliance and hepatic encephalopathy.