الفهرس 
Anatomy and Physiology of Respiratory TractOnly 14 pages are availabe for public view
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Abstract
COPD is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. COPD is an important public health challenge as it could be preventable and/or treatable. COPD is a major cause of chronic morbidity and mortality all over the world and die from it or its complications. The main cause of COPD in developed countries is tobacco smoking, long-term exposure to irritating gases or particulate matter, most often from cigarette smoke.
Symptoms include breathing difficulty, cough, mucus (sputum) production and wheezing. Pharmacological therapy for COPD is used to reduce symptoms, as well the frequency and severity of exacerbations, and improve exercise tolerance and health status. Self‐efficacy is described as a cognitive process, as the individuals learn through environmental and social influence, new behaviors that affect their abilities to improve future events. Promoting self‐efficacy can improve the outcomes and quality of life for patients living with chronic diseases.
Aim of the study
1- Assessing of patient’s level of knowledge regarded chronic obstructive pulmonary disease.
2- Assessing level of self-efficacy among patients with chronic obstructive pulmonary disease.
Research question:
This study is based on answering the following questions:
- What are the level of knowledge of patients regarding chronic obstructive pulmonary disease?
- What are the level of self-efficacy among Patients with chronic obstructive pulmonary disease?
- What are the factors that affect the level of Self-Efficacy among patients with chronic obstructive pulmonary disease?
Subjects and Methods
Research Design:
A descriptive design will be used to achieve the aim of this study.
Research setting:
This study will be conducted in the chest department and outpatient clinic at chest hospital at Zagazig, (the hospital affiliated to Ministry of Health).
Subject:
A convenient study sample included 108 patients in chest department from the previously mentioned setting, the sample size represents about 15% of admitted patients with chronic obstructive pulmonary disease during the year 2017 (603 patients) calculated by Cochran formula
(n=Z2P(1−P)/d2 ).
Tools of data collection:
Data collection was obtained using two tools, they were developed by the investigator based on the relevant and most recent literatures and reviewed by a panel of experts in critical care nursing; they consisted of the following:
Tool 1: Patient’s interview ’questionnaire:
It is developed by the researcher after reviewing recent and related literatures. It is consisted of the following parts:
• Demographic characteristics: It includes: (age, gender, level of education and social status) of the study subjects
• Medical history, it includes: past and present history of the subjects and their families.
• Patient’s level of knowledge: It is concerned with the assessment of patient level of knowledge regarding chronic obstructive pulmonary disease .Including; definition, causes, risk factors, signs and symptoms, diagnostic tests, medication , side effects, complications , self care of patient with COPD regarding to nutrition , daily activities, warning signs and instructions to prevent exacerbation )
• Less than 60% (>48 grade) = Unsatisfactory level of knowledge.
• More than 60% (>48 grade) = Satisfactory level of knowledge.
Tool 2: Self-Efficacy Scale
It is standardized scale developed by (Wigal,1991), it was translated to Arabic and retranslated into English language. It includes: (Physical exertion, intense emotional arousal, negative affect, weather / environmental and behavioral risk factors.
• More than 60 % (102 grade) = High self-efficacy.
• Less than 60% (68 grade) = Low self-efficacy.
• Factors that affect the level of Self-Efficacy among patients with chronic obstructive pulmonary disease it was consisted of three categories physical factor which represented by dyspnea severity (BORG scale , psychological factor which was assessed by Beck depression scale and social factor which was assessed by MOS-SSS survey
Tool 3: Modified Borg Dyspnea Scale
It starts at number 0 where patient breathing is causing him no difficulty at all and progresses through to number 10 where patient breathing is difficulty to the maximal level. that answer to the question
How much difficulty is patient breathing causing him right now?
- Mild severity of dypsnea score (from 0 to2)
- Moderate severity of dypsnea score (from 3 to 6)
- Sever severity of dypsnea score (from 7 to 10)
Tool 4: Beck’s Depression Inventory,
It evaluates depression level of patients. It was composed of 20 items to indicate symptoms related to depression.
• Mild depression; from 1-16.
• Moderate depression: from 17-30.
• Sever depression :< 30.
Tool 5: The Medical Outcomes Study (MOS) Social Support Survey (SSS)
Is a self-administered questionnaire that includes 15 items. Developed for the Medical Outcome Study (Sherbourne & Stewart, 1991), the MOS-SSS Social Support Scale aims to evaluate the degree to which an individual relies upon the support of others to cope with different life situations.
• Mild social support dysfunction 15 -> 30.
• Moderate social support dysfunction 30 -> 60.
• Severe social support dysfunction 60 – 75.
Results
The current study shows that 37% of the studied patients were from 45 to 60 years old, 72.2% of the studied patients were male, 60.1% of the studied patients are basic education, 65.7% of the studied patients are married, 57.4% of the studied patients had manual work, 73.1% of the studied patients their income insufficient to cover the expenses of treatment as their perception and 54.6% of the studied patients were from rural areas.
Shows that 71.3% of the studied patients haven’t family history of COPD, 52.8% of the studied patients have < 4 members in their family. Also 25%, 23.1%, 18.5% and 20.4% of the studied patients had past history of diabetes mellitus, hypertension, heart disease and thyroid disorders respectively, 22.2%, 23.1% and 64.8% of the studied patients receiving antidiabetic, antihypertensive, and corticosteroids drugs respectively,75.0% of the studied patients were admitted to hospital due to COPD and 72.2% of the studied patients are smokers , 48.1% of the studied patients had history of COPD since five or more 5 years, 53.7% of the studied patients had difficulty breathing at admission, 46.3% of the studied patients had difficulty breathing, and 75% of the studied patients is receiving bronchodilators as maintenant drugs for COPD.
Shows that 65.7% of the studied patients had unsatisfactory level of knowledge about COPD regarding definition, causes and diagnostic tests and 70% of the studied patients had unsatisfactory level of knowledge about COPD regarding complications. While, 39.8% of studied patients had satisfactory level regarding symptom and signs, drugs therapy and their side effects, 64.8% of the studied patients had unsatisfactory level o .Also 67.6% of studied patients got unsatisfactory level regarding warning signs, 63% of studied patients had unsatisfactory level regarding patients instructions to prevent COPD exacerbation.
Concerning total level of knowledge, the current study shows that 55.6% of the studied patients had unsatisfactory level of knowledge about COPD, while 44.4% of the studied patients had satisfactory level knowledge. According to total level of self efficacy of studied patients, 59.3% of studied patients had low self efficacy among patients with COPD and 40.7% of them had high self efficacy regarding COPD.
The study shows that 39.8% of the studied patients had mild dyspnea, while 35.2 % of the studied patients had severe dyspnea, 52.8 % of the studied patients had mild depression while 8.3 % of the studied patients had severe depression, 19.4% of the studied patients had mild social support dysfunction, while 62.1% of them had moderate social dysfunction.
The findings shows that there were high positive statistically significant correlations between studied patient’s level of self-efficacy and their satisfactory level of knowledge. While there were highly negative statistical significant correlations between studied patient’s level of self-efficacy and their dyspnea severity. Also, there was negative statistical significant correlations between patient’s level of self-efficacy and their social support dysfunction (p<0.05).
Conclusion
Based on the findings of the current study, it could be concluded that half of studied patients had unsatisfactory knowledge regarding COPD, more than half of the studied patients had low level of self-efficacy regarding chronic obstructive pulmonary disease, more than one third of the studied patients had slight difficulty of breathing. Also about half of the studied patients had a mild level of depression, while two third of the studied patients had moderate social support dysfunction. Therefore it could be concluded that the physical, psychological and social factors affecting self efficacy level among the studied patients with COPD.