الفهرس 
• Aim of the study and research hypotheses…………….Only 14 pages are availabe for public view
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Abstract
Alternate nostril breathing (ANB) is an effective breathing exercise with therapeutic benefits on cardiorespiratory functions for healthy and diseased individuals as heart failure and renal failure. It also relieved stress, fatigue, pain, enhanced cognitive function; improve quality of sleep and refined metabolism. The ANB produces consistent positive physiological changes and has a sound scientific basis for their beneficial human body outcomes. It causes positive effects on heart rate, blood pressure, and respiratory rate. Heart Failure (HF) is a growing national and global health problem impacting 26 million people worldwide with increase in economic costs for patients’ treatment, also renal failure affects between 8% and 16% of the population worldwide (Jahan, et al., 2021).
Aim of the study
The aim of this study was to evaluate the effect of alternate nostril breathing exercise on heart failure and renal failure patients’ outcomes.
Research Hypotheses:
The following research hypotheses have been put in place to achieve the aim of the study
H1: Patients’ physiological parameters could be significantly improved after intervention of the alternate nostril breathing exercise than before.
H2: Patients’ fatigue pattern could be significantly decreased after intervention of the alternate nostril breathing exercise than before.
H3: Patients’ quality of sleep could be significantly improved after intervention of the alternate nostril breathing exercise than before.
H4: Patients’ pain could be significantly decreased after intervention of the alternate nostril breathing exercise than before.
Subjects and method
Study design:
Quasi-experimental comparative design was utilized to achieve the aim of this study.
Study setting:
This study was conducted in cardiac care unit (CCU) and hemodialysis Unit at Benha University Hospital, Qalyubia Governorate, Egypt.
Subjects:
Purposive sample of 70 HF & 70 RF conscious adult patients; their age ranged from 20- 60 years old from both sexes during the time of data collection (6 months) who are able to communicate and agree to participate in this study.
The inclusion criteria:
Patients that able to implement the alternate nostril breathing exercise.
Free from mental illness
Free from neuromuscular diseases
Free from serious lung problems as pulmonary fibrosis
Free from severe asthma attack
The exclusion criteria:
Patients with severe systemic disorders
Patients with communication disorders
Patients with nasal pathology
Chronic smokers
Patients with malignant hypertension
Patients with vertebral deformities.
Tools for data collection: (Appendix I)
Five tools were used to collect data for this study.
Tool I: Patients’ interview questionnaire: This questionnaire was designed by the researcher in simple Arabic structure items after reviewing recent relevant literatures and scientific references adapted from (Karadag & Baglama, 2019) ,(Suhardjono, et al., 2019) & (Pretto, et al., 2020).
It aimed to assess personal and medical data. It included two parts as the following:
• Part one: Personal data of patients; included age, sex, marital status, level of education, occupation and residence.. It contains (6 questions).
• Part two: Patients’ medical data; included diagnosis, complain, length of the disease, family history, patients’ present and past medical & surgical history. It includes (8 questions).
Tool II: Physiologic parameters assessment: It included patients’ physical parameters such as heart rate, respiratory rate, systolic blood pressure and diastolic blood pressure, adopted from (Jayawardena, et al., 2020). It includes (4 items).
Tool III: - Sleep Quality Scale: This scale was used to assess patients’ quality of sleep in the adults, adapted from (Lin, et al., 2019). The patients completed the questionnaire by themselves with the assistance of researcher. It includes (11 questions).
Tool IV: Fatigue Assessment Scale: It was used to assess patients’ fatigue and to evaluate the ability of the patient to cope in different activities, adopted from (Hamed & Mohamed Abdel Aziz, 2020). It contains (10 questions).
Tool V: Visual Analogue Pain Scale: It was used to assess patients’ degree of pain, adopted from (Mar, 2020). It includes (6 items).
Educational booklet regarding alternate nostril breathing exercise: (Appendix II)
The general objective of the patients’ booklet was improving patients’ information and practices regarding alternate nostril breathing exercise. It was included two parts: 1-Theoritical part: It included knowledge related to ANB such as definition benefits, indications, precautions and contra-indications of ANB. 2- Practical part: It contained demonstration of steps of ANB application.
Results:
The main results of the present study were:
- Regarding the personal data for heart failure and renal failure patients, 51.4% of heart failure patients were females and 61.4% of renal failure patients respectively were males, 68.6% and 64.3% of them respectively were married, 52.9% and 51.4% of them attained an intermediate education, 47.1% and 38.6% of them respectively didn’t work. In addition, 70% and 64.3% of them lived in village respectively.
- As regard to patients’ current health status and medical data for heart failure and renal failure patients, 72.9% & 42.9% of the heart failure and renal failure patients had the disease for more than 2 years, 60% & 72.9% of them respectively had other diseases, from those 78.6% & 80% respectively had a surgical history. In addition 70% & 78.6% of heart failure and renal failure patients respectively hadn’t a family history to the disease.
- In relation to studied patients’ physiologic parameters measurement, sleep quality, fatigue level and patients’ pain level, there were highly statistical differences between pre ANB intervention as compared to after 1 month and 3 months intervention in both HF & RF patients.
- With regards to correlation between total pain level and total sleep quality as well as total fatigue level among the studied patients, there was high significant statistical positive correlation between total pain level and total fatigue level among patients pre ANB intervention, after 1 month and after 3 month of ANB intervention and there was no significant statistical correlation between total pain level and total sleep quality among patients after 3 month of ANB intervention.
- Concerning predictor for pain level, sleep quality, and fatigue level among the studied patients after three months of ANB intervention which assessed by physiologic parameters assessment, sleep quality scale, fatigue assessment scale & visual analogue pain scale the present study revealed that it was best predicted by length of disease (p= 0.001*, 0.022*, & 0.021*, respectively), among studies patients with heart failure accounting for (0 .349 %, 0.046 % & 0.465% respectively). (p= 0.015*, 0.009*, & 0.046* respectively) among studies patients with renal failure accounting for (0.102%, 0.022 %, & 0.255% respectively) through the follow-up phase
Conclusion
According to the results of present study, it might be concluded that
Applying of alternate nostril breathing exercise was very effective on improving heart failure and renal failure patients’ physiological parameters, quality of sleep, fatigue and reducing pain level (patients’ outcomes) as compared to pre alternate nostril breathing exercise intervention which supports the study hypotheses, while have been shown higher improvement among renal failure patients compared to heart failure patients.
Recommendations
In the light of the findings obtained from the current study the following recommendations can be suggested:
• Alternate nostril breathing exercise recommended being involved as a nursing role for patients with heart failure and renal failure in the early course of the disease, so that patients can experience the maximum benefit.
• Replication of the study using a larger probability sample from different geographical areas to attain more generalizable results.
• Further studies may be needed to assess effect of using different non-pharmacological methods on improvement of HF & RF patients’ outcomes.
• Hospitals are recommended to implement the alternate-nostril breathing exercise alongside other treatments to improve heart failure & renal failure patients’ outcomes as well as, for other patients with chronic illness.
• Designing guidelines about ANB intervention for patients to be distributed in heart and renal failure departments.