الفهرس 
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Abstract
Lower limb amputation is both a life –saving procedure and a life–changing event that is likely to pose considerable challenges in the definition of psychological and social adjustment. Limb amputation can lead to not only permanent physical loss, but it also lead to influence all life domains. It can lead to significant psychosocial dysfunction among some persons. Person response to lower limb amputation are varied from one to one according to personal, social, environmental and physical factors (Bosse et al, 2017).
The biopsychosocial method in the health care emphasizes the importance of understanding the human health. The biological, psychological and social factors very important in understanding health, illness and access to health care. In addition, psychosocial factors should be understood as significant to the patient’s disease prognosis and ability to provide care (Meyr et al, 2017).
The Indications for amputation are related to the degree of tissue necrosis or viability, and it is performable in either a single operation or a staged manner (amputation followed by reconstruction). The decision to take on either approach depends largely on the clinical status of the patient and the quality of the soft tissues at the desired level of amputation with the primary goal being to excise the non-viable and infected tissue. In general, soft tissue quality and the ability to obtain bone coverage will guide the adequacy of the level of amputation. It is important to note that skin grafts are an acceptable option for patients where adequate muscle coverage is obtainable, where skin coverage is not possible (Heijink et al, 2016).
The care of the patient involves an interprofessional approach in which nursing staff plays a key role. Monitoring in the post-operative setting includes obtaining and recording vital signs, pain scores, and laboratory values. Serial wound assessments allow for early detection of post-operative bleeding and will also allow the nurse to perform temporizing maneuvers (digital pressure, dressing reinforcement) while a medical provider is alerted. Pain scores are diligently obtained to titrate the patients’ pain medication accordingly and provide the best condition for early mobilization. Close communication between the medical providers and nursing staff is necessary to provide the patient with individualized care based on their needs (Popescu et al, 2017).
Aim of the study:
The present study was conducted to assess Biopsychosocial needs among patients with lower limbs amputation. This aim was achieved through:
1-Assessing patient′s knowledge regarding caring of his \her amputated lower limb.
2-Assessing patient′s ability to perform allowed exercise after lower limb amputation.
3-Assessing patient related factors as physical, psychosocial and social factors that affect patient status after lower limb amputation.
Research Questions:
This study was conducted to answer the following research questions:
1- What are Biopsychosocial needs among patients with lower limbs amputation?
2- What are the factors affecting the Biopsychosocial needs among patients with lower limbs amputation?
Research Design:
A descriptive exploratory research design was used to achieve the aim of the study. It is a design used when the investigator want to describe a specific behavior as it occurs in the environment without influencing manipulating the variables in any way ((Smith et al, 2019).
Research Setting:
The study was conducted in the surgical department and in the out patients clinics at El. Demerdash Hospital affiliated to Ain Shams University. The surgical department contain two wards for male and female patients and its capacity 30 beds for male patients and 15 for female patients. Stay average period from 2 to 3 days. The number of attendees in the hospital is about 48 thousand patients annually, the number of patients attending outpatient clinics is 102 patients and the average number of admissions is 36 thousand patients annually.
Subjects:
A purposive sample of 50 patient post lower limb amputation surgery admitted in the surgical department and the out patients clinics at El. Demerdash Hospital affiliated to Ain Shams University according to inclusion and exclusion criteria.
Inclusion Criteria:
Patients who had the following criteria:
1- Adult patients from both gender.
2- Accepting to participate in the study.
3- Age from 20 to 60 years.
4- The patients’ with unilateral or bilateral lower-limb amputation within 1-4 weeks to ensure that the patient able to communicate and hemodynamically stable.
5- The post-operative patients.
Exclusion criteria:
1- Patients with cognitive or mental impairment.
2- Subjects refuse participation in the study.
Tools for data collection:
Two tools were developed by the investigator to collect data of this study, these tools were:
Tool I: Patient’s interviewing questionnaire:
It was developed by the investigator in simple Arabic language after reviewing the relevant recent related literature (Tosun et al, 2017).The questionnaire included three parts as follow:
Part I: socio-demographic data: this part was used to assess patients′ demographic data as age, gender, level of education, occupation, marital status, smoking habit, exercise and monthly income.
Part II: Patient’s medical data: this part was used to assess present history that includes the main cause of amputation surgery, level of amputation, presence of pain postoperative and the severity of stump pain. The past health history was such as previous Surgeries, presence of chronic disease, significant Allergies, also assess medical management and the Family history about lower limb amputation.
Part III: patient′s knowledge level: this part was used to assess patients’ level of knowledge regarding lower limb amputation surgery, exercises availability, physical activity postoperative, rehabilitation postoperative and follow up. It was consisted of 11 MCQs.
Tool II: Assessment of patient′s Biopsychosocial needs (Appendix II):
It was developed and modified by the investigator and adapted from (Abeysekera &Dawson, 2015). It was used to assess biopsychosocial needs (physical, psychological, social, and spiritual) among patients with lower limb amputation. It was included four sections as follow:
Section 1: Physical needs in patients with the lower limb amputation:
This section included 10 MCQ concerned with activities of daily living and pain. The activities of daily living were included six items (bathing, dressing, transferring, toileting, continence and feeding).
Section 2: Psychological needs in patients with lower limb amputation
This section included 15 MCQ concerned with sleeping disturbances, fear from complication of the surgery, the shaming in front of people, effects on your body image, suffering from phantom pain, psychological effect of the treatment, communication with people, boring from the life, the depression, dealing with all people like before the surgery, decreasing of self-esteem, feeling that the character become complicated, feeling toward the amputated part, feeing despaired.
Section 3: Social needs in patients with lower limb amputation
This section was included 15 MCQ. It was concerned with problems may be facing in the work due to the surgery, the effects of the surgery on the marital relationship, social events and the family, the effects of the surgery on the communication with others, the effects of the surgery when go out for shopping or travelling and professional life how it become after the surgery.
Section 4: Spiritual needs in patients with lower limb amputation
This section was included 10 MCQ. It was concerned with feeling that the physical condition causes stress, meaning or value of life now, the way for enjoying the in the life, the internal conflicts toward the future, the difficulty to cope with the new condition, the goals in the life and the satisfaction feeling in the new life.
Results:
The important findings that obtained from this study can be summarized as follow:
• Demographic characteristics of patients showed that the mean age of the studied patients was 45.60, and 58% of them were from not working, while marital status 70% of them were married and 52% of them were live with their family and 52% of them were from urban, with about 46% of them their income not enough for the cost of treatment and 54% of them were smokers, while 84 of them had not practice sport regularly and 68% of the studied subjects were male and 32% of the studied subjects were female. 20% of the studied subjects were illiterate, 32% of them were had primary education, 20% of them were had secondary education and 28% were highly educated.
• The results illustrated that 84%, 74% of the studied subjects had diabetes mellitus and hypertension, while 60% of subjects had amputation before knee and 56% of them had family history for amputation.
• The results showed that 42% of the studied subjects had average knowledge about meaning of amputation, 46% were had good knowledge about antibiotic importance, 44%of them had poor knowledge about dangerous of diabetes mellitus, 42% of them had average knowledge about rehabilitation according to post-operative type,46% of them had poor knowledge about importance of rehabilitation post-operative, 44% of them had poor knowledge about the danger signs of infection.30% of the studied subjects had poor level of knowledge regarding lower limb amputation, 44% of them had average level of knowledge and 26% of them had good level of knowledge.
• The current results illustrated that 42%of subjects ’physical needs had independent regarding bathing, 48% of them had need assistance regarding dressing and 36% of them had totally dependent regarding dressing. 74% of subjects had onset of the pain suddenly, 40% of them had duration of pain >15 minute, 46% of them had mild pain and 38% of them had tightening pattern of pain.
• The results showed that 40% of studied subjects′ psychological needs had never depressed or worried about future life, 64%of them had sometimes shyness in front of people and 36% of them had always feeling frustrated. 36% of the studied subjects′ social needs who had the surgery never causes problems in their job, 62% of them sometimes had handicapped to go out for shopping and buying their needs and 40 % of them always face problems when use public transport.38% of the studied subjects′ spiritual needs never had goals in their life to fight for it and missing the satisfaction feeling in their life, 54% of them sometimes had difficulty to cope with their condition and 30% of them hadn’t opinion toward their future life.
• There was a statistically significant relation between the studied subjects level of knowledge and their age (years), educational level, marital status, with whom you live, residence, own income enough for the costs of treatment and practice any sport regularly at p-value p<0.05.
• There was a highly statistically significant relation between the studied subjects level of physical needs and their age (years), educational level, while there was a statistically significant relation regarding their marital status, with whom you live, residence, own income enough for the costs of treatment and Practice any sport regularly at p-value (p<0.05).
• There was a statistically significant relation between the studied subjects level of psychological needs and their age (years), while there was a highly statistically significant relation regarding their education level, with whom they live, residence and practice any sport regularly, at p-value <0.001.
• There was a highly statistically significant relation between the studied subjects′ level of social needs and their age (years), educational level, while there was a statistically significant relation regarding with whom you live, Residence, own income enough for the costs of treatment and Practice any sport regularly, at p-value <0.05.
• There was a highly statistically significant relation between the studied subjects′ level of social needs and their age (years), educational level, while there was a statistically significant relation regarding with whom you live, Residence, own income enough for the costs of treatment and Practice any sport regularly, at p-value <0.05.
• There was a statistically significant relation between the studied subjects′ level of knowledge and their biopsychosocial needs and Level of spiritual needs, at p-value <0.001.