الفهرس 
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Abstract
Summary
Bronchial asthma is a defined as a chronic inflammatory disease of airways that causes airway hyper-responsiveness, mucosal edema, and mucus production. This inflammation leads to varying degree of airways obstruction, which characterized by recurrent episodes of asthma symptoms such as cough, chest tightness, chest wheezing, and dyspnea. Patients with bronchial asthma are at risk for complications such as, respiratory failure which is a life-threatening condition affect their quality of life asthma. Treatment of patients with bronchial asthma can vary from anti-inflammatory and bronchodilator asthma inhalers to oral medications to drugs delivered in a nebulizer or breathing machine. Poor adherence with asthma therapy is a major challenge in the long term management of chronic asthma. So it is important to explain to the patients the importance and purpose of taking the long term therapy regularly and actively, participate in their own care, nurses are involved in both acute and long term management of patients with bronchial asthma; they are in a position to offer support and direction to help them to change their unhealthy behavior.
Aim of the Study:
This study aimed to develop, implement and evaluate the effect of self management program on knowledge, practice and self efficacy for patients’ with bronchial asthma.
Research Hypothesis:
It is hypothesized that the implementation of self management program will improve the knowledge, practice and self efficacy of patients with bronchial asthma.
Research design:
A quasi-experimental research design was used with pre-post & follow up assessment of outcomes.
Technical Design:
The technical design for the study include; setting of studied, subjects and tools for data collection.
A. Setting
This study was conducted at the chest outpatient clinic at El Kaser Al-Eini Hospital affiliated to Cairo University.
B. Subjects
Purposive samples of 130 patients with bronchial asthma, at the previous setting it will be one group (pre, post and follow up) on identified criteria were recruited for this study sample.
C. Tools of data collection
Data for this study were collected using the following tools:
I- Patients’ Sociodemographic characteristics and Clinical Data
Sheet: An Arabic questionnaire sheet based on criteria selection for subjects was filled in by patients and by the researcher if the subject is illiterate. It was designed by the researcher to assess:
Part (1): It deals with socio-demographic characteristics of the patient under study as regards; age, sex, level of education, social status, occupation, residence and family income and contain 10 items.
Part (2): It is related to patients past medical and family history related to bronchial asthma, duration of present illness, effect of current illness on patients’ work, and medications prescription and adherence, grade of disease, factors precipitating, sign and symptoms, diagnostic tests and contains 11 items.
Part (3): It includes data about patient’s environment and contains 17 items.
Part (4): It includes data about follow up and contains 4 items.
Part (5): It includes data about patient’s habits as smoking, sporting, nutrition, and contains 10 items.
II- Arabic questionnaire for patient’ knowledge developed by the researcher which includes assessment of patients’ knowledge related to definition of bronchial asthma, precipitating factors, diagnostic studies, clinical manifestation, complications, treatment and ways of control and prevention, action plan, importance of breathing exercise, and dietary instruction. The sheet constructed of (21) items in form of closed-ended, multiple choice questions. Patients’ responses to knowledge questionnaire were checked with model answered and given 1 point if correct and 0 if incorrect. The points were summed up and converted into a percent score. The items of this sheet were constructed, by the researcher based on review of literature under the guidance of the supervisors.
Scoring system of knowledge: For each area of knowledge the scores of the items were summed-up and the total divided by the number of the items, giving a mean score for the part. These scores were converted into a percent score, and then means and standard deviations were computed. Knowledge was considered satisfactory if the percent score was 60% or more.
III- Checklist to assess patients practices
These checklists aimed to assess patient’s practice regarding deep breathing: diaphragmatic, pursed lip breathing, how to use incentive spirometry, nebulizer and inhaler therapy. It was adopted from (Lewis, et al., 2004; Berman & Nosek, 2007). These checklists were used for program assessment and post program evaluation. It consists of 5 Performance assessment checklists covering the following areas:
Using a metered-dose inhaler, consists of 12 steps, scores 12 marks, using a dry powder inhaler , consists of 9 steps, 9 marks, administering nebulizer therapy, consists of 12 steps, 12 marks, performing breathing exercises, consists of 9 steps, 9 marks, how to use spirometer, consists of 10 steps, 10 marks.
Scoring system: Accordingly, subjects were given 1 point if the step was correctly done and zero if not done or incorrect. The points were summed up and converted into a percent score. A total score of 60% or higher was considered adequate practice.
IV- Self Efficacy Scale
It is adapted from Lorig et al. (2001) and modified by the researcher the scale constructed of 6 items.
Scoring system of Self Efficacy:
The Self Efficacy scale was scored on a continuous scale from ”1” or not at all confident to “10” or totally confident. The scores of the items were summed-up and the total divided by the number of the items, giving a mean score. These scores were expressed in means and standard deviations the higher the score, the improvement.
Results:
The important findings that were obtained from the study can be summarized as follows:
Socio-demographic characteristics of studied patients revealed the mean age of the studied sample was (39.2%). Concerning sex, slightly more than half (53%) of patients are females, and (62%) are married. As regards patients’ educational level, more than one third (37%) of the studied sample were educated secondary and university, slightly less than one third (31%) of patients are read and write, as for occupation more than one third (42%) of patients are manual workers. As regards residence, nearly two thirds (67%) of patients live in urban areas, the most (95%) of the sample has insufficient, regarding disease effect on work/school attendance nearly two third (65%) of study sample their work/ school attendance affected by BA disease.
There were a statistically significant differences between mean scores of the pre, post, and follow up tests of knowledge for the study groups (p<0.001).
There were a statistically significant differences between mean scores of the pre, post, and follow up of practices for the studied groups (p<0.001).
There were a statistically significant differences between mean scores of the pre, post, and follow up of self efficacy for the study groups (p<0.001).
There was a positive statistically significant relation between post program knowledge score and education level, age, urban residence, (p<0.001), which means that the educated patients lead to high score of knowledge, age, urban residence.
There was a positive statistically significant relation between post program practice score and education level, age, occupation, and residence, (p<0.001). Which means that the educated patients, age 40-50, manual worker, living in urban area has high score of high score of practice.
There was a positive statistically significant relation between post program self efficacy score and education level, age, occupation, and residence, (p<0.001). Which means that the educated patients, age 40-50, manual worker, living in urban area has high score of self efficacy.
There was a positive statistically significant correlation between total knowledge and total practice (r= 0.826, p<0.05), there were a positive statistically significant correlation between total knowledge and total self efficacy (r=-0.634 p<0.05) and there were a positive statistically significant correlation between total practice and total self efficacy (r=-0.589 p<0.05).
Conclusion:
Based on findings of the present study, it can be concluded that:
Overall, the study has indicated that there is highly statistically significant difference between total knowledge, total practice, and total self efficacy pre/post, and follow up self management program. Accordingly, the studied patients have a higher mean knowledge scores post self-management program, a higher mean practices scores and a higher mean self efficacy scores post self-management program.
Recommendations
Based on the result the main recommendation can be summarized as follows:
• Further studies have to be carried out in order to assess the effectiveness self management program on patients’ adherence to the prescribed therapeutic management.
• An illustrated instruction booklet in simple language concerning bronchial asthma self management is to be designed and distributed in chest outpatient clinics.
• Train and conduct support groups of patients with bronchial asthma and their families.
• Nursing staff acquire perceptive knowledge of self efficacy skills and supply the concept of self efficacy intervention in clinical practice to fulfill this essential nursing function.
• Replication of the study on a large sample is recommended to obtain more generalized finding in relation to effect SMEP