الفهرس 
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Abstract
Summary
M
ultiple system disorder also known as multiple organ dysfunction syndrome or multi-system dysfunction is defined as a syndrome characterized by the development of physiologic derangement in two or more organ systems such that organ function was inadequate to meet the needs of the host with-out exogenous support (Gourd& Nikitas, 2020).
A strict connection exists between cardiac and other organ functions. Cardiac dysfunction is a frequent complication in critically ill patients and contributes to organ hypo-perfusion and poor outcome mediated by hemodynamic, humeral, and immune mechanisms. Heart, lungs, kidneys and other splanchnic organs such as the gut and liver influence each other’s function in a bidirectional way this organ crosstalk must be regarded as a key aspect in multi-organ dysfunction (Cordina& Celermajer, 2024).
The Aim of the Study:
The study aims to assess the psychological problems and self-efficacy among patients with multiple system disorder through the following:
1- Assessing the psychological problems in terms of anxiety and depression levels among patients with multiple system disorder.
2- Assessing the levels of self-efficacy among patients with multiple system disorder.
Research Questions:
1- What are the levels of anxiety among patients with multiple system disorder?
2- What are the levels of depression among patients with multiple system disorder?
3- What are the levels of self-efficacy among patients with multiple system disorder?
4- Is there a relation between self-efficacy of patients with multiple system disorder and levels of anxiety and depression?
Operational definition:
Multiple system disorder among cardiac patients: this is a dysfunction syndrome characterized by the development of physiologic derangement in two or more organ systems, one of them cardiovascular system (Schwinger, 2021).
Research Design:
A descriptive research design was utilized to achieve the aim of this study.
Setting:
This study was conducted at cardiovascular outpatient clinics affiliated to Ain Shams University Hospital.
Subject:
A purposive sample of 100 patients with multiple system disorder has the following:
Inclusion criteria:
- Adult patients.
- Both sex.
- Primary diagnosed with cardiovascular disorder.
- Patients have two or more organ systems dysfunction.
- Patients able to communicate and follow therapeutic regimen.
Exclusion criteria:
- Patients with severe cognitive dysfunctions and disability.
- Completely irreversible organ failure.
Tools of Data Collection:
The data was collected through the following tools:
Tool I: Patient Interview Questionnaire: it was developed by the investigator in an Arabic language.
It was divided into two parts:
Part one: Socio-demographic characteristics of the patients such as sex, age, level of education, employment status, marital status, residence and presence of care givers.
Part two: Patient clinical health assessment includes information such as diagnosis, number of organ dysfunction, presenting symptoms and degree of pain mild-moderate-sever by numeric pain rating scale Pasero & McCaffery, (2010).Scoring system zero equal no pain, one to three equal mild pain, four to six equal moderate and seven to ten equal severe pain.
Tool II: Beck Anxiety Inventory (BAI):
This tool developed by Beck et al., (1988) and translated into Arabic by Al-Shatti, (2015) and adopted by investigator, was used to measure level of anxiety among patients with multiple system disorder. It includes twenty-one questions.And translated into Arabic language.
The scoring system:
It includes the 21 questions each answered by the patient through using four options, which were not at all equal zero, mild equal one, moderate equal two and severe equal three. The total score is calculated by finding the sum of the twenty-one items.
Score of 0-21=Mild anxiety.
Score of 22-35= Moderate anxiety.
Score of 36 and above= Severe of anxiety.
Tool III: Beck Depression Inventory (BDI):
This tool developed by Beck et al., (1987) and translated into Arabic by Nouf, (2000) adopted by investigator, was used to measure the severity of depression among patients with multiple system disorder. It includes 21 items distributed into 3 domains; affective, cognitive and somatic expression of depression. It included twenty-one questions by counting the number to the right of each question marked.
The scoring system:
Include the 21 questions each answered by the patient through items including four responses with specific criteria ranged as following no equal zero, mild equal one, moderate equal two or severe equal three to select the option that best represents them.
Score of 1-10 =Normal.
Score of 11-20 =Mild depression.
Score of 21-30 =Moderate depression.
Score of 31-40 =Severe depression.
Tool IV: Self-Efficacy for Managing chronic Disease (SEMCD):
This tool developed by Marconcin et al., (2021) adapted by investigator, was used to measure level of self-efficacy among patients with multiple system disorder.It includes six –Items Scale and translated into Arabic language.
The scoring system:
Include the 6 questions each answered by the patients through choose the number from one to ten that corresponds to confidence that can do the tasks regularly at the present time.The score for each item is the number circled. If two consecutive numbers are circled, code the lower number(less self-efficacy). If the numbers are not consecutive, do not score the item.the score for the scale is the mean of the six items. If more than two items are missing, do not score the scale. Higher number indicates higher self-efficacy where Low self–efficacy < 60% High self- efficacy ≥ 60 %. The researcher deducts the numbers for each item as following degerees.
1-4 Low degree
5-7 Moderate degree
8-10 High degree
Tools validity and reliability:
It was ascertained and tested through jury of five expert’s two professors and three assistant professor in the field of psychiatric mental health nursing- Faculty of Nursing, Ain Shams University who reviewed the content of the tools for comprehensiveness, accuracy, clarity and relevance was done accordingly.
Reliability: The tools were measured to ensure that an assessment tool produces stable with consistent result overtimes. The reliability coefficient for the study tools were calculated using the correlation coefficient Cronbach’s alpha test as:
Tool No of questions Cronbach’s Alpha
Beck Anxiety Inventory (BAI) 21 0.92
Beck Depression Inventory (BAI) 21 0.90
Self-Efficacy for Managing chronic Disease 6 0.91
Pilot Study:
¬It was carried out on ten patients (10% of the total number of patients) after developing the tool and before starting the data collection to evaluate the clarity, applicability and to estimate the needed time to fill out of the study tools. No necessary modifications were done. Therefore, the pilot study samples were included in the total sample.
Field work:
• The investigator reviewed the current, recent and relevant related literature concerning psychological problems and self-efficacy among patients with multiple system disorder by using books, articles, periodicals, journals and internet databases in order to prepare the tools of data collection.
• The investigator was approved ethically by the ethical committee, Faculty of Nursing, Ain Shams University before initiating the study work (April, 2023).
• Permission for data collection and implementation of the study were obtained from the director at cardiovascular outpatient clinics affiliated to Ain Shams University Hospital.
• The investigator started data collection by introducing herself to the patients and ex-plain the aim of the study and takes, their approval to participate in the study prior to any data collection.
• The sample of the study was recruited according to the inclusion and exclusion criteria.
• The investigator assesses patient’s levels of anxiety with multiple system disorder.
• The investigator assesses patient’s levels of depression with multiple system disorder.
• The investigator assesses patient’s levels of self-efficacy with multiple system disorder.
• The investigator distributed the questionnaire to the patients, took about 20-30 minutes for each patient to complete the questionnaire.
• Data collection was done 3 days every week (Sunday, Tuesday and Thursday); it took about 6 hours from (8 am to 2 pm), it took six months starting from the first of August 2023 up to the end of January 2024.
Administrative design:
An approval to carry out this study was obtained from director of outpatient clinics affiliated Ain Shams University Hospital. An Issued litter from the dean of Faculty of Nursing at Ain-Shams University.
Ethical considerations:
The ethical research considerations in this study included the following:
The research approval was obtained from the Scientific Research Ethical Committee Ain shams university faculty of nursing before starting the study, oral consent was obtained from the patients under study after clarifying the aim of the study to them. The researcher assured maintaining anonymity and confidentiality of the study subject/data in addition, patients were informed that participation is voluntary..
Statistical Design:
All Data were collected, tabulated and subjected to statistical analysis. Statistical analysis is performed by SPSS in general (version 20), while Microsoft office Excel is used for data handling and graphical presentation. Quantitative variables are described by the Mean and Standard Deviation (SD).Qualitative categorical variables are described by frequencies and Percentages. Chi-squared test and Fisher exact tests are used for contingency tables.Pearson correlation coefficient is used for correlation analysis. Significance level is considered at P < 0.05 (S); while for P < 0.01 is highly significant (HS). Two Tailed tests are assumed through out the analysis for all statistical tests.
Results:
• Less than three quarter (73.0%) of the studied patients their age ranged between 45<65 years with mean and standard deviation age 47.55 ± 8.8years, more than half (59.0%) of them were females, more than half (58.0%) of them were married. Regarding educational level, half (50.0%) of studied patients had secondary school. Also, more than three quarters (82.0%) of the studied patients didn’t have work, less than three quarters (73.0%) of the studied patient were living near to hospital and less than three quarters (73.0%) of studied patients had care givers.
• Less than one quarter (23.0%) of studied patients were diagnosed with cardiovascular disease and pulmonary disease, followed by cardiovascular disease and kidney disease one fifth (18%) and cardiovascular disease, kidney disease and abdominal disease with the same percentage. Regarding number of organ dysfunction, less than three quarters (72.0%) of studied patients had two organs dysfunction and half of them (51.0%) of studied patients were presented with tachycardia.
• Illustrates total levels of anxiety, (70.0%) of the studied patients had severe anxiety, followed by (21.0%) of them had moderate anxiety and (9.0%) of them had mild anxiety.
• Illustrates total levels of depression, (46.0%) of the studied patients had moderate depression, (27.0%) of them had severe depression and (20.0%) of them had mild depression.
• Illustrates total levels of self-efficacy, (60.0%) of the studied patients had high self-efficacy and (40.0%) of them had low self-efficacy.
• The current study revealed that, there was a statistically highly significant relation between anxiety, depression with number of organ dysfunction when P < 0.01. While, there was a statistically non-significant relation between self-efficacy with number of organ dysfunction when P > 0.05.
• The current study revealed that, there was a moderate negative correlation statistically between self-efficacy with anxiety (r = -0.7, p-v = 0.00).
• The current study revealed that, there was a strong negative correlation statistically between self-efficacy with depression (r =-0.8, p-v = 0.00).
Conclusion:
Less than three quarter of studied patients had severe anxiety, less than half of studied patients had moderate depression and more than half of studied patients had high self-efficacy. Also, there was negative correlation between self-efficacy with levels of anxiety and depression. It was concluded that there was highly statistically significant relation between anxiety and depression with number of organ dysfunction.
Recommendations:
In the light of the result of the present study, the following recommendations are suggested:
• Design an educational program to patients with multiple system disorder about disease process to enhance life style.
• Psychosocial counseling should be provided by specialist for patients to facilitate dealing with anxiety, depression, improve mental health and self-efficacy.
• Multiple system disorder patients are in need of a comprehensive booklet (How to apply self-efficacy to manage disease).
• Further research studies on multiple system disorder or multi-organ dysfunctions to assess factors that increase anxiety and depression for the patient and problems that cause disease.