الفهرس 
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Abstract
Hemodialysis (HD) is a challenging process that requires frequent visits to dialysis facilities three times per week and alters the way patients live. According to estimates, 92% of HD patients experience a high symptom burden; majority of these symptoms is distressing and negatively impacts the patients’ quality of life. Additionally, HD is a time-consuming, expensive treatment that necessitates specific dietary and hydration restrictions (Greenberg & Choi, 2021).Technology is constantly affecting all domains of health care.Provision of health care remotely using telecommunication technologies improves health outcomes, health care quality, sustains health equity)Doyle et al., 2019). Tele-nursing is technology based intervention help continuity of care that is one of the important duties of nurses. Also,nurses can provide many services through tele-nursing including patient triage, symptom management, education, counseling and control of using care tools, monitor HD patients’ adherence to therapeutic regimen)Whitlow & Wallace, 2019).Purpose of the study:The purpose of this study was to examine effect of tele-nursing education intervention on self-efficacy, quality of life and adherence to therapeutic regimen of patients with hemodialysis.Research hypotheses: Knowledge level and mean score of the study group who will receive tele-nursing education intervention will be higher than the control group.Self-efficacy level and mean score of the study group who will receive tele-nursing education intervention will be higher than the control group. Quality of life level and mean score of the study group who willreceive tele-nursing education intervention will be higher than thecontrol group. Adherence to therapeutic regimen level and mean score of the study group who `will receive tele-nursing education intervention will behigher than the control group. Level of tele-nursing practice of the study group who will receivetele-nursing education intervention will be improved compared to the control group. Research design: A quasi experimental research design (study and control group)with pre and post- test was utilized to achieve the purpose of the study.Study setting:This study was conducted at two kidney dialysis units in AL Shuhada district, Menoufia Governorate, Egypt.Study sample:A purposive sample of 100 hemodialysis patients aged between 18 to <60 years and divided randomly into two equal groups (study group and control group, 50 subjects for each one) who attended kidney dialysisunit at EL Shuhada Central Hospital and kidney dialysis unit affiliated with the Association for the Preservation of the Holy Quran in ALShuhada district, Menoufia Governorate.Instruments of data collection:I. Structured interviewing questionnaire concerned with socio-demographic characteristic, medical history and clinical status of the study subjects.II. Bio-physiological measurements:- Including blood investigations as creatinine level, hemoglobin level, blood urea nitrogen, serum calcium and phosphorus level.III. Patients’ knowledge about kidney and chronic kidney diseases questionnaire:-This questionnaire consisted of 48 items about function of the kidney, risk factors for chronic kidney diseases, medications that impair kidney function, investigations to determine kidney function, signs and symptoms of chronic kidney diseases, complications of chronic kidney diseases, food and fluid restrictions for hemodialysis patients, weight gain between hemodialysis sessions and vascular access care.IV. Self- efficacy scale for hemodialysis patients:-This scale consisted of 25 items divided into four domains concerned with autonomy, self-integration, and problem solving and seeking social support.V. Kidney disease quality of life short-form (KDQOLSF):-It composed of 36 items and classified into five subscales concerned with physical component subscale, mental component subscale, burden of kidney disease subscale, symptoms and problem list subscale and effect of kidney disease subscale.VI. Adherence to therapeutic regimen for hemodialysis patients’questionnaire:-It consisted of eight items exploring --three dimensions of hemodialysis adherence concerned with medication adherence, attendance at hemodialysis session and diet and fluid restrictions.VII. Tele-nursing practice questionnaire:-This questionnaire used to assess tele-nursing practice of patients with hemodialysis.The main finding of the present study revealed the following:• There was a significant improvement in mean score and level of knowledge about kidney and chronic kidney diseases at post1 and post2 tele-nursing education intervention among the study group compared to the control group (P<0.0001).• There was a significant improvement in mean score and level of self–efficacy at post1 and post2 tele-nursing education intervention among the study group compared to the control group (P<0.0001).• There was a significant improvement in mean score and level of, quality of life at post1 and post2 tele-nursing education intervention among the study group compared to the control group(P<0.0001).• There was a significant improvement in mean score and level of adherence to therapeutic regimen at post1 and post2 tele-nursing education intervention among the study group compared to the control group (P<0.0001). Conclusion:-Based on the finding of the current study, it was concluded that: -Tele-nursing education intervention is an effective method to improve patients with hemodialysis knowledge, self-efficacy, quality of life and adherence to therapeutic regimen.Recommendations:Based on the previous finding of the current study, it was recommended that: -1. Integrating tele-nursing practice in providing continuous care and follow-up for HD patients.2. Providing patients with hemodialysis with necessary knowledge and skills to improve self-efficacy, quality of life and adherence to therapeutic regimen.