الفهرس 
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Abstract
Women with urinary incontinence suffering from marital problems that can affect social, psychological, familial occupational, physical and sexual aspects on women’s lives (Riss and Kargl, 2015). Therefore, this disease, as a social problems, prevents employment and education leads to shame and causes rejection from society (Basak, Uzuan and Arslan, 2018).
There are many marital problems caused by urinary incontinence, effects on the women such as embarrassment, fears of being seen as old, wet or bad smelly, even though their symptoms may severely restrict their lifestyle and fear with it’s relation with her spouse. The result can be isolation, depression, feelings of shame and guilt, as well as problems with marital and wider family relationship, it threatens self-esteem and leads to loss of personal control (Coyne et al., 2016).
Women with urinary incontinence has been found to be significantly has a great impact on sexual health associated with decreased libido, vaginal dryness, decreased interest, worries about costal incontinence and unsatisfying somatic health (Nilsson, Lalos, 2016).
Aim of the study
The aim of this study is to evaluate the effect of nursing guidelines for reducing marital problems among women suffering from urinary incontinence.
This aim will be achieved through:
1. Assessing knowledge among women with urinary incontinence.
2. Designing and implementing nursing guidelines for reducing marital problems from urinary incontinence.
3. Evaluate the effect of guidelines for reducing marital problems among women with urinary incontinence.
Research hypothesis:
Implementation of nursing guidelines will expected to reduce marital problems among women suffering from urinary incontinence.
Subjects and methods:
Subjects and method for this study were portrayed under the four main designs as follow:
1- Technical design.
2- Operational design.
3- Administrative design.
4- Statistical design.
Technical design:
The technical design for the study included: research design, setting subjects and tools for data collection.
A. Research design:
A quasi experimental study design was used to evaluate the effect of nursing guidelines for reducing marital problems among women suffering from urinary incontinence.
B. Setting:
The study was conducted at Ain Shams Maternity University Hospital in uro-gynecology Unit which consists of three rooms: Room for the director, clinical room and urodynamic room.
C. Subjects:
Sample size:
The total number of sample was 76 women were recruited in this study: randomly allocated to study group (38) and control group (38). The study group had nursing guidelines and control group had the routine care based on the number of the women with urinary incontinence who admitted uro-gynecology unit at Ain Shams Maternity University Hospital.
Sample type:
A purposive sample was used to recruit all women suffering from marital problems from urinary incontinence who fulfilled study inclusion criteria.
Sample criteria:
The sample was selected in the study according to certain criteria which was women suffering from marital problems from urinary incontinence who would attend uro-gynecology unit for checkup and follow up according to the following criteria:
• Women age ranged from 20-45 years old.
• Married.
• Diagnosed with urinary incontinence.
• Free from chronic disease.
Data collection tools:
(1) Interviewing Arabic questionnaire sheet.
(2) The kings health questionnaire.
(3) Diary sheet.
(4) Observational checklist.
(5) Follow up card.
(6) Women opinionaire: women’s opinion regarding guidelines sessions.
I- Interviewing questionnaire sheet
It was designed by the researcher in simple Arabic language based on reviewing the related literatures (Linton, 2014, DeGroot & Munden, 2015: Washington & Leaver, 2015). It was divided into:
Part (1): It was used to assess women’s socio-demographic data e.g., age, occupation, level of education, it was consisted of 3 questions.
Part (2): Medical & obstetrical history:
- It was designed by the researcher and written in Arabic language after reviewing related literatures.
- It was used to assess of women data such as women’s history such as previous obstetrical and gynecological history, present and current medical history.
D) The previous obstetrical and gynecological history as (number of pregnancies, number, of labor. Types of births, etc). It included 8 questions.
E) History of obstetrics and gynecology; It was used to assess history as (menstrual cycle, operation related to urinary incontinence, complications during or after births, etc). It included 5 questions.
F) The current medical history: It was used to assess current medical history as (many times of urination, taking medications for urinary incontinence, time period of treatment, etc). It included 7 questions.
Part (3): Women’s knowledge related to urinary incontinence.
C. It was designed to assess level of knowledge regarding urinary incontinence as (concept, sign & symptoms, and complication, etc). It included 9 questions.
D. Risk factors and types of urinary incontinence. It included 27 questions.
Scoring system:
The score for correct answer for each statement was (2) and incorrect answer was (1) the total score of women knowledge was classified as follows:
• < 70% was considered unsatisfactory.
• ≥ 70% was considered satisfactory.
II- The kings health questionnaire (KHQ):
It was used to assess the impact of urinary incontinence on marital problems as physical limitations (13 items), social limitations (10 items), psychological limitations (10 items), sexual relationship (10 items), spiritual limitations (6 items) and economic effect (7 items). The responses in KHQ have four point rating system (No at all, Slightly Moderately and a lot) (Baum & Manni 2017; Bertold, Boccardo, Bombardieri, Laura & Valdagni, 2017). It was modified by the researcher and scored by Not at all = 4, Slightly = 3, Moderately = 2 and a lot = 1.
Scoring system:
Total score was classified as follows:
• < 70% was considered unsatisfactory.
• ≥ 70% was considered satisfactory.
III- Voiding diary:
It was a sheet designed by the researcher in Arabic language to record frequency of urine, timing and amount of voiding, it provided baseline information, help to monitor progress and effectiveness of therapy (Fantl et al., 2015).
IV- Observational checklist: For women with marital problems suffering from urinary incontinence.
It was developed by researcher based on literature review (Baum & Manni, 2017; Bertold, Boccard, Bombardieri, Laura & Valdagni, 2017). It was written in Arabic language & was used to assess women practices as hand washing, prineal care, kegel exercises and pelvic floor muscle exercises. The response of each procedure was divided into (done correctly and not done). The observational checklists were included hand washing 10 steps, care of prineal area 9 steps, kegel exercise 8 steps, pelvic floor muscle exercise 4 steps.
Scoring system:
The total score of women practice two marks was given to the step which was done correctly and one to the step which was not done and observational checklist was 31 marks.
Total score was classified as follows:
• < 70% was considered unsatisfactory level of care practices.
• ≥ 70% was considered satisfactory of care practices.
V- Follow up card:
It was designed by the researcher to identify women’s name, telephone number and time of visits.
VI: Women opinionaire: it included women’s opinion regarding guidelines sessions and consisted of ten statements and answer yes or no.
Supportive material (Nursing guidelines):
- Nursing guidelines was developed by the researcher and written in simple Arabic language using illustrated pictures based on related recent literatures (Baum, & Manni, 2017; Bertold, Boccardo, Bombardieri, Laura & Valdagni, and Small, 2017). It was included two parts as following:
Part (1): Theoretical part, it was included 10 hours (2 hours per week) at the session: It covered the following items.
- Definition of urinary incontinence.
- Types of urinary incontinence.
- Cause of urinary incontinence.
- Risk factors associated with urinary incontinence.
- Complications of urinary incontinence.
- Diagnostic studies.
- Marital problems that result from urinary incontinence.
- Medical management for urinary incontinence.
- Nursing management for reducing marital problems from urinary incontinence.
Part (2): Practical part: It was concerned with practical part as hand washing, preineal area care, kegel exercise and pelvic floor muscle exercise, it was done 2 hours per week.
Evaluation: it was done through pre test, post test and follow up.
Pilot study:
10% from total sample represented about (8 cases) was included and chosen randomly from the previously mentioned setting. It was carried out for a period of one week to evaluate the applicability of the tools to find the possible obstacles that might be faced during data collection.
There were no major modifications found after pilot study. The pilot also served to assess the applicability of the scale through examining its internal consistency.
Results
Results of the present study revealed that:
Women’s age was ranged from thirty five to forty. Moreover, 13.2% of them were in the age less than twenty years.
Regarding occupation, 44.7% of them were house wife. As for their level of education 34.2% were at preparatory and 5.3% of them have high education.
Concerning previous obstetrical and gynecological history most of women with normal delivery about (71.4%) and about more than one third (36.8%) had four or more times births, ago at the first birth range about 20-25 years about (77.1%), and most of them with problem during normal delivery and weight of baby during 4 kg or more about (85.7%).
Concerning present history of obstetrics and gynecology pelvic surgery about (68.4%), inflammation are the most complications during or after birth is about (60%), weight between 70- < 90kg is about (60.5%), length between 150- < 160cm is about (47.4%) and BMI is about (55.3%).
Concerning the current medical history about more than two third (68.4%) taking diuretic drinks, most of them not taking medications for UI about (86.8%) about (71.1%) not going to the clinic to treat this problem and about more than one third (47.4%) had severe amount of urination every day.
Concerning symptoms and types of urinary incontinence leaking urine during sex, suffering from gall stone in the ureter, waking up to urinate after you go to sleep and leakage of urine during cough, laugh and sneeze are the most common symptoms with statistically significant difference between two groups in post and follow up when p value < 0.05.
Statistically significant positive correlations between women’s total knowledge and practice in the study and control groups pre, post and follow up of guidelines implementation (P < 0.001).
Statistically significant negative correlations between women’s total knowledge and practice and king health in the study and control groups pre, post and follow up of guidelines implementation (P < 0.001).
Statistically significant deference between total king’s health pre and post with level of education when p- value < 0.05 and there was statistically significant deference in the control group between total king’s health pre with level of education when p value < 0.05.
Statistically significant deference between total knowledge pre with level of education when p value < 0.05 and there was statistically significant deference in the control group between total knowledge post and follow up with level of education when p value < 0.05.
Conclusion
Based on findings of the present study, it can be concluded that:
- The result of the study was supported the study hypothesis in which nursing guidelines reduced marital problems among women suffering from urinary incontinence.
- Also knowledge and practice of the study group improved significantly than control group.
- The study showed that there were statistically significant positive correlations with the increase of total knowledge, there is increase in practice, post test is highly significant than follow up.
- There were statistically significant negative correlations between women’ total knowledge practice and king health, with the increase of total knowledge & practice with the decrease in problems of king health especially sexual problems.
Recommendations
Based on the findings of the current study the following recommendations can be suggested:
1. Performing training programmes for improving women awareness about urinary incontinence and sexual life.
2. Designing posters, media at the clinics for women about the risk factors of urinary incontinence.
3. Replication of the study on a large sample for generalizing the findings.
For further research in the field:
- Study the factors that affect women utilization of urodynamic services.
- Conduct studies examining strategies to prevent the occurrence of urinary incontinence.
- Develop instruments to measure social and psychological variables associated with incontinence status, develop nun invasive technique to assess lower urinary tract function particularly for cognitively-impaired women.