الفهرس 
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Abstract
Cirrhosis is the final common pathway for the majority of liver diseases, and is a complex chronic condition which causes population mortality rates of approximately 5-10/100,000 person-years worldwide.Cirrhosis patients lack the knowledge required to effectively manage their disease. A simple educational intervention may improve patient knowledge (Volk, Fisher and Fontana, 2013). The present study aimed to examine the effect of a designed nursing intervention on knowledge and outcomes among patients with
liver cirrhosis.A quasi-experimental (pre and post) research design was carried out to achieve the aim of the study. The study was conducted in outpatient clinic in Hepatology and Gastrointrodology Department,
National Liver Institute in Menoufia University, Shebin Elkom city, Egypt. A purposive sample of 80 patients with liver cirrhosis was included in the study. Study Instruments Data was collected using the following instruments:Instrument 1: A structured interviewing questionnaire prepared by the researchers which included:Part one: Socio-demographic data of the patients such as age, sex, level of education, occupational, income, place of residence, telephone number, marital state and family members. Part two:- Medical data such as; diagnosis of cirrhosis according to child Pugh calcification, duration and detection of the disease, frequency of previous hospitalization and causes of hospitalization. Physiological. measurement such as; weight, abdominal circumference, degree of ascites and skin condition and laboratory investigations related to liver cirrhosis patients such as; bilirubin total and direct, albumin, liver function test, kidney function test, brothrombin concentration, complete blood count, hepatitis C virus and hepatitis B virus. Instrument II: Knowledge Assessment Questionnaire: It was constructed by the researchers based on related literature (Taha et al.,2015 & Atya et al., 2019) to evaluate gain of knowledge after implementation of the nursing intervention. It included 20 questions for assessing patient’s knowledge about liver cirrhosis, causes, symptoms, complications and disease management. Instrument III: Duke Health Profile Index (Parkerson, 2002) The Duke Health Profile (DUKE) is intended as a brief and practical measure to evaluate patient reported functional health status in primary care settings. The DUKE is a 17-item generic health status profile from which six scales measure function: physical, mental, and social health, general health, perceived health, and self-esteem. Regarding assessing the cirrhotic patients about Duck Health Profile (DHP), the researcher follow Copyright(1994-2017) by the Department of Community and Family Medicine, Duke University Medical Center, Durham, N.C., U.S.A. Instrument IV: chronic Liver Disease Questionnaire: (Younossi,2016) It is designed to measure the chronic liver disease symptoms related to liver cirrhosis. The CLDQ included 29 items in the following six domains: (abdominal symptoms, fatigue, systemic symptoms, activity, emotional function and worry). It was modified by the researcher to 11 items. Each domain including items: abdominal symptoms included 3. items, systemic symptoms included 5 items and activity symptom included 3 items.Instrument V: Fatigue impact scale (FIS) (Fisk et al., 2010) to measure fatigue related liver cirrhosis symptoms. This instrument provides an assessment of the effects of fatigue in terms of physical,cognitive, and psychosocial functioning. The full-length MFIS consists of 21 items. Main study Findings Approximately half of studied cirrhotic patients (45%) aged between 50 - 60 years with mean of 52.1 ± 8.3 years, 42.5% was illiterate and 20% of them were read and write. The majority of studied patients (75%) were Grade A Child- Pugh classification of cirrhosis. There but there was no significant difference between all items o laboratory data pre and post intervention. A highly significant improvement in the different aspects of knowledge post intervention. The post intervention good knowledge responses increased from 16.3% pre intervention to 43.7% for post intervention (P<0.0001). Post intervention results revealed a highly significant improvementin the different health scales items (Duke Health Profile Index (DHPI). In addition, Total score of Duke Health profile increased from 19.5± 3.2 with a range of 14 28 pre intervention to 22.2 ± 3.6 with range of 14 32 post intervention. A highly significant improvement (p<0.000) in the fatigue categories after nursing intervention was appeared. Post intervention revealed a significant improvement (p<0.000) in the different symptoms of chronic liver disease than that of the pre intervention. Conclusion In the light of the present study findings, it can be concluded that: A designed nursing intervention has a significant role in improving knowledge related liver cirrhosis and enhancing patient health outcomes including lowering fatigue and symptoms severity and improving health profile scores among studied patients with chronic liver cirrhosis. Recommendations Based on the results of the present study, it can be suggested that: Activate periodic checkup for the public especially adults regarding liver investigation and laboratory data to guarantee healthy liver.Providing continuous education programs about self-care for liver cirrhotic patients in hepatology units to overcome symptoms and complication of the disease. Conducting periodic surveys and medical campaigns under supervision of Ministry of health and Ministry of higher education, including universities to discover new cases of hepatitis B, C viruses to control infection and before occurrence of complications. Offering simplified booklet self-care for the patients. Further studies are needed to determine whether more educational interventions can effectively carried out to improve outcomes in patients with cirrhosis particularly those that involve patient self- management for symptom related- liver cirrhosis.