الفهرس 
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Abstract
Hip replacement surgery is a procedure in which a doctor surgically removes a painful hip joint with arthritis and replaces it with an artificial joint often made from metal and plastic components. It usually is done when all other treatment options have failed to provide adequate pain relief. The procedure should relieve a painful hip joint, making walking easier (Fischer et al., 2021).
Hip joint replacement may suitable for elderly people with osteoarthritis. Osteoarthritis is one of the ten most disabling diseases in developed countries. Worldwide, estimates show that 10% of men and 18% of women aged over 60 years have symptomatic osteoarthritis, including moderate and severe forms. Age is the strongest predictor of the development and progression of osteoarthritis (WHO, 2018).
Activities of daily living (ADLs), often termed physical ADLs or basic ADLs, following areas: Feeding, Dressing and grooming, personal appearance, using toileting, Bathing, able to move from one body position to another (Zhang et al., 2021).
Aim of study
The aim of this study is to evaluate the effect of the nursing intervention for older adult Post hip joint replacement on their activity of daily living through:
1- Assessing the knowledge and practices of older adult related to hip joint replacement care.
2- Assessing activities of daily living related to hip joint replacement to detect patients’ health needs (pre the intervention).
3- Planning & implementing nursing intervention program based on patients health needs detecting in relation to activity of daily living of older adult.
4- Evaluating the effect of nursing intervention on knowledge, practices and activities of daily living of post the implementation of the intervention program that is related to hip joint replacement.
Research hypothesis:
Implementation of the nursing intervention will affect positively on knowledge, practice and activity of daily living of older adult with hip joint replacement surgery.
Subject and Methods
Research design:
A quasi – experimental design was used in this study with one group of subjects assessed pre/post the nursing intervention.
The setting:
The study was conducted was carried out at outpatient orthopedic clinics in El Helal Orthopedic hospital, which affiliated to the Ministry of Health and population. The hospital was selected because it is the one of only Government Specialized Hospital in the orthopedic surgeries. Moreover, the majority of the cases are mostly referred to it for follow up after surgery.
Sampling:
Purposive sample, sample size will be 126 patients to achieve power of 95%and a level of significance of 5% (tow sided), assuming improvement 30% (Rosner, 2016).
Inclusion criteria:
1. Older adult 60 years old and more
2. Perform period 1 to 3 monthes after hip replacement surgery
3. Free from mental disorder and able to communicate
Technical design:
Tools of Data Collection:
One tool was used for data collection.
- Structured Interviewing Questionnaire was developed by the investigator after reviewing the related literature in Arabic language. It was contain six main parts:
Part I:Socio demographic variables of the study subjects such as age, gender, residence, marital status, education level, occupation, daily work hours, income/month, family members, rooms number, crowding index, caregiver, change occupation and responsible for treatment expense.
Part II: Subjects medical history (past ¤t history).
Part III: older adults knowledge about factors leading to hip joint replacement such as meaning of hip replacement, Purpose of hip replacement, causes of operation, complication after operation, signs of wound infection, Signs indicated to DVT, instruction after operation, instruction for rest and safety, incorrect position effect on hip joint, correct body position, Pain relive methods, medications after operation benefits of medications, important of follow up and benefits of exercise.
Part IV: older adults reported practice; it consisted of 36 items which divided in to 7 parts such as:
• Daily living activity (sitting, walking, using stairs and sleeping (12 items).
• Healthy nutrition (4 items).
• Pain relieve methods (4 items).
• Drug administration precautions (3 items).
• Exercise (7 items).
• Hip joint protection (6 items).
Part V: Katz Index of Independence in Activities of Daily Living (ADL) (1983), it consists of two parts:
• Activities of Daily Living (ADLs): It consisted of 28 items which divided into 8 parts as the following (bathing, dressing, toileting, transferring, continence, feeding, walking and climbing stairs).
• Instrumental Activities of Daily Living (IADLs): It consisted of 30 items which divided into 8 parts as the following ability to use telephone, shopping, food Preparation, housekeeping, laundry, mode of transportation, responsibility for own medications and ability to handle finances.
Part VI: Home environment as reported by the elderly related to facilitation that helped patients with hip joint replacement such home general characteristics, lighting, ventilation, bathroom, furniture and floor and rugs.
Operational design
The study in order to be completed has passed through different phases as follows: the preparatory phase, pilot study phase and the field work phase.
Results:
The finding of the present study could be summarized as follows:
Less than half of the studied older adults were aged between 60 >65 years with, 58.7 % of them were male, 49.2 % of them were married, 31.7 % of them couldn’t read or write and 52.4 % of them worked less than 8 hours daily.
Two thirds of the studied older adults had diabetes mellitus, 60.3 % of them didn’t have previous hospitalization and 28.6 % of them had previous orthopedic operation and 38.8% of these operations were hip joint replacement.
57.1 % of the studied older adults were unable to mobile, majority of them diagnosed their disease through medical examination, 49.2% of them complained from Numbness & tingling of extremities, 50.8 % of them had wound infection as post-operative complication and 58.7 % of them were taken antibiotic drug.
Majority of the studied older adults had unsatisfactory level of total knowledge at pre-intervention program compared with, 60.3 % of them had satisfactory level of total knowledge at post-intervention program about hip joint replacement.
Moreover, there was a highly statistically significant difference in all items of the studied older adults’ reported practices about daily living activity pre and post intervention program (P, ≤ 0.001).
Nearly three quarters of the studied older adults had inadequate level regarding to total score level of reported practices post hip joint replacement at pre-intervention program, which improved to be 66.7 % of them had adequate level post-intervention program.
Moreover, there was a highly statistically significant difference in all parts of the studied older adults’ activity of daily living pre and post intervention program (P, ≤ 0.001).
Two thirds of the studied older adults had dependency regarding their total activity of daily living at pre-intervention program, which improved to be 57.1 % of them, had independency post-intervention program respectively.
61.9 % of the studied older adults had dependency regarding their total activities of daily living related to hip joint replacement at pre-intervention program, which improved to be 63.5 % of them had independency post-intervention program respectively.
Majority of the studied older adults didn’t have good stairs, most of them their light was not with good quality, 52.4 % of them didn’t have air conditioners, 65.1 % of them had bathroom without grip rails. Also, regarding the furniture most of the studied older adults had not arranged furniture and majority of them didn’t have mats on the floor.
There was highly a statistically significant relation between total older adults’ knowledge post hip replacement and their age, educational level and work hours at pre and post intervention program.
There was no statistically significant relation between total older adults’ knowledge post hip replacement and their sex & marital status at pre and post intervention program.
There was highly a statistically significant relation between total older adults’ reported practices post hip replacement and their age & educational level at pre and post intervention program.
There was a statistically significant relation between total older adults’ reported practices post hip replacement and their work hours at post intervention program.
There was no statistically significant relation between total older adults’ reported practices post hip replacement and their sex & marital status at pre and post intervention program.
There was highly a statistically significant relation between total older adults’ activity of daily living level post hip replacement and their age, educational level and work hours at pre and post intervention program.
CONCLUSION
In conclusion hip replacement surgery is most common among the older adults between rang 60-65 years. It is more prevalent among males more than females,
Implementation of the nursing intervention had positive effect on knowledge, practices and activity of