الفهرس 
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Abstract
Women experiencing breast cancer are confronted with a life-threatening disease and face changes that restricts their life psychologically, physically and socially. Moreover, it influence the health needs and self efficacy. Nurses play a pivotal role in the psychosocial care of women throughout their journey. They see them at their worst and best; from diagnosis, through treatment, to cure or palliative and end of life care. It is a long journey which is shared between women and health care practitioner. There are two important issues in the delivery of psychosocial care to those women: recognition of needs and the available health resources (Büchi, 2010).
Aim of the study
The aim of this study is to evaluate the effect of educational guidelines on self efficacy and meeting health needs of women undergoing modified radical mastectomy through the following:
• Assessment of the self efficacy of women undergoing modified radical mastectomy.
• Assessment of the health needs of women undergoing modified radical mastectomy.
• Develop and implement educational guidelines for mastectomy women and evaluate its’ effect on self efficacy and meeting their health needs.
Hypothesis:
- It will be hypothesized that the educational guidelines had a positive effect on improving the self efficacy, added to meeting the health needs of women undergoing modified radical mastectomy.
Methodology
Design
A quasi experimental research design has been conducted to achieve the aim of this study.
The study was conducted in the surgical departments and outpatient`s clinics of breast surgery in El-Demerdash Hospital and Radiotherapy and Nuclear Medicine Department, affiliated to Ain Shams University Hospitals.
Subjects:
A purposive sample of 60 women during six months period from the above mentioned setting with different ages undergoing modified radical mastectomy. They were selected according to the sensitive analysis in relation to the number of women undergoing to modified radical mastectomy within the year 2014 in Ain Shams University Hospitals according to the statistical department. They were taken according to the following criteria:
Inclusion Criteria:
• Women undergoing modified radical mastectomy.
• Women who will agree to participate in the study.
• Conscious women with non co – morbid conditions.
Tools of Data Collection:
Tool (1):
A structured interview questionnaire sheet (pre /post and follow up tests) (Appendix I): This tool was developed by the researcher in a simple Arabic language to assess the needs of women undergoing modified radical mastectomy. It was developed after reviewing the most recent and relevant literature from (Smeltzer and Bare, 2013) and included the following parts:
• Sociodemographic characteristics:
It covers women’s characteristics which includes (age, level of education, marital status, occupation, place of residence and financial support).
• Medical Reports:
It was used to cover (past, present medical and family history).
• Patients` health needs which includes:
- Physical needs such as: Activities of daily living, pain, general assessment, fatigue, lymphedema and hormonal changes that can cause menopausal symptoms.
- Psychological needs such as: Reducing anxiety from pain and complications, fear of loss of control, fear of recurrence, depression, uncertainty about the future, changes in body image and emotional health lifestyle instructions.
- Social needs such as: Patient’s social activities, work, integration of the cancer experience into their life and social support.
- Spiritual needs such as: Self esteem, relation with God and motivation.
- Educational needs such as: Information about breast cancer, treatment, prognosis, mastectomy surgery, wound care, breast self examination, arm exercises, chemoradiotherapy and its side effects, activities of daily living, body image changes and follow up visits.
Tool (II)
An observational checklist (pre/post and follow up tests) (Appendix II): It was developed based on the recent review related literatures from Altman & Buchsel (2009) and Craven & Hirnle (2009). It was filled by the researcher to evaluate practices of women under the study regarding: wound care, arms exercises, oral care, hand washing and breast self examination.
Scoring System:
Each item was observed, categorized and scored into the following:
Done correctly = 2 degree,
Done incorrectly=1 degree and
Not done = zero.
Total scores for all items were graded as follows: Satisfactory level of practice (70% and more), while unsatisfactory level was considered from (less than 70%).
Tool (III)
Psychometric assessment: It was completed by interviewing of the studied patients to determine their pain level.
Numerical pain scale (Appendix III):
It was developed by Compbell (1995) in Mohasseb et al. (2004) to measure pain severity among women undergoing modified radical mastectomy. It was consisted of a line divided by numbered points from (0-10). Patients’ responses were categorized and adapted as follows: no pain (zero), mild pain (0 - less than 4), moderate pain (4-less than 7) and severe pain (7 - 10).
Tool (IV):
General Self-Efficacy Scale (Appendix IV)
The scale was developed in 1979 by Ralf Schwarzer and Matthias Jerusalem to assess a general sense of perceived self-efficacy with the aim in mind to predict coping with daily hassles as well as adaptation after experiencing all kinds of stressful life events among women undergoing modified radical mastectomy
Results:
• About two thirds of the study sample was aged ≥ 40 years and the majority of them were married. Moreover, one third of them were illiterate.
• About two thirds of the studied women were from urban area, did not have enough income, had sudden and moderate pain one month post educational guidelines
• One quarter of them use analgesics to control pain.
• There was a statistical significant difference between women’s physical, psychological, social, spiritual and educational needs pre / post educational guidelines, whereas the improvement was indicated post guidelines.
• There was a statistical significant difference between pre / post guidelines among the studied women’s self efficacy and practices levels, whereas more improvement was indicated post guidelines.
• There was a statistical significant relation between women with less than 40 yrs and more than 40 yrs as regards their needs (physical, social and educational). Mean while, insignificant relation was indicated as regards (psychological & spiritual needs).
• There was a statistically significant relation between women’s marital status (married & unmarried) as regard their needs (physical & social needs. Meanwhile insignificant relation was indicated as regards psychological, spiritual and educational needs.
• There was a statistical significant relation between women’s educational levels (illiterate, essential, secondary and university) as regards their needs (physical, psychological and educational). Meanwhile insignificant relation was indicated as regards social and spiritual needs.
• There was a statistically significant relation between self- efficacy level (high and low) among the studied women as regards their characteristics and needs.
• There was a statistical significant relation between total practices level (satisfactory and unsatisfactory) among the studied women as regards their characteristics and needs.
Conclusion
On light of the current study results, it can be concluded that, majority of the studied women had physical, psychological, social, spiritual